Evaluation of An Emergency Safe Supply Drugs and Managed Alcohol Program in COVID-19 Isolation Hotel Shelters For People Experiencing Homelessness

Author: Thomas Brothers Malcolm Leaman Matthew Bonn Dan Lewer Jacqueline Atkinson John Fraser Amy Gillis Michael Gniewek Leisha Hawker Heather Hayman Peter Jorna David Martell Leisha Tiffany O'Donnell Helen Rivers-Bowerman Leah Genger

Theme: Clinical Research Year: 2022

During COVID-19 outbreaks in the congregate shelter system in Halifax, Canada, residents moved
into hotels for mandatory 14 days isolation. A health care team provided emergency “safe supply”
medications and beverage alcohol to facilitate isolation for residents who were dependent on these
substances. We aimed to evaluate (a) substances and dosages provided and (b) effectiveness and
safety of the program.

We retrospectively reviewed medical records of all COVID-19 isolation hotel shelter residents in May
2021. We extracted data on medication and alcohol dosages provided each day. The primary
outcome was prematurely leaving isolation against public health orders. Adverse events included (a)
overdose; (b) intoxication; and (c) diversion or sharing of medications or alcohol.

Over 25 days, 77 isolation hotel residents were assessed (mean age 42 ± 14 years; 24% women).
Sixty-two (81%) residents were provided medications, alcohol, or cigarettes. Seventeen residents
(22%) received opioid agonist treatment medications (methadone, buprenorphine, or slow-release
morphine) and 27 (35%) received hydromorphone tablets. Thirty-one (40%) received stimulant
tablets (methylphenidate, dextroamphetamine, or lisdexamfetamine). Six residents (8%) received
benzodiazepines. Forty-two (55%) residents received beverage alcohol. During residents’ 14 days of
isolation, mean daily dosages increased for hydromorphone (45 ± 32 to 57 ± 42mg),
methylphenidate (51 ± 28 to 77 ± 37mg), and alcohol (12.3 ± 7.6 to 13.0 ± 6.9 standard drinks). Six
residents (8%) left isolation prematurely, but four returned. Over 1,059 person-days in isolation,
there were zero overdoses. Documented concerns regarding intoxication occurred six times (0.005
events/person-day) and medication diversion or sharing three times (0.003 events/person-day).

An emergency safe supply medications and managed alcohol program in Halifax’s COVID-19 isolation
hotel shelters was associated with high rates of successful completion of the 14-day isolation period
and low rates of adverse events. This supports the relative safety and effectiveness of this approach.

Disclosure of Interest Statement:
MB reports personal fees from AbbVie, a pharmaceutical research and development company, and
grants and personal fees from Gilead Sciences, a research-based biopharmaceutical company,
outside of the submitted work. The other authors have no disclosures.

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