Factors Associated With Changes in Illicit Opioid Use During the COVID-19 Pandemic Among Incarcerated People Who Use Drugs in Quebec, Canada

Author: Hyejin Park Blake Linthwaite Camille Dussault Alexandros Halavrezos Sylvie Chalifoux Jessica Sherman Lina Del Balso Jane Buxton Joe Cox Nadine Kronfli Joe

Theme: Epidemiology & Public Health Research Year: 2022

Background: People who use drugs (PWUD) have been disproportionately affected by the COVID-19
pandemic, yet the pandemic’s effect on opioid consumption patterns among incarcerated PWUD is
unknown. We examined reported changes in illicit opioid use and related factors among
incarcerated PWUD in Quebec, Canada, during the COVID-19 pandemic.
Methods: We conducted an observational, cross-sectional study in three Quebec provincial prisons.
Participants completed self-administered questionnaires on sociodemographic and clinical
characteristics. The primary outcome, “changes in illicit opioid consumption”, was measured based
on participants’ responses to the question “Has your consumption of opioid drugs that were not
prescribed to you by a medical professional changed since March 2020?”. The association of
independent variables (age, ethnicity, income, household density, and overdose history) and recent
changes (past six months) in opioid consumption were examined using mixed-effects Poisson
regression models with robust standard errors. Crude and adjusted risk ratios with 95% confidence
intervals (95% CIs) were calculated.
Results: A total of 123 participants (median age 37, 76% White) were included between January 19
and September 15, 2021. The majority (72; 59%) reported a decrease in illicit opioid consumption
since March 2020. Individuals over 40 were 11% less likely (95% CI 14-8% vs. 18-39) to report a
decrease, while those living with others and with a history of opioid overdose since March 2020
were 30% (95% CI 9-55% vs. living alone) and 9% (95% CI 0-18% vs. not) more likely to report a
decrease in illicit opioid consumption since the start of the COVID-19 pandemic, respectively.
Conclusion: We identified possible factors associated with changes in illicit opioid consumption
among incarcerated PWUD in Quebec provincial prisons. Irrespective of opioid consumption
patterns, increased access to drug treatment programs, harm reduction services, and discharge
planning for incarcerated PWUD are recommended to mitigate the harms from opioids or other
Disclosure of Interest Statement: JC has received research funding from ViiV Healthcare for an
investigator-initiated study and from Gilead Sciences for clinical trials, and reports remuneration for
advisory work (ViiV Healthcare, Gilead Sciences, and Merck Canada) outside of the submitted work.
NK reports research funding from Gilead Sciences, McGill Interdisciplinary Initiative in Infection and
Immunity, Canadian Institutes of Health Research, and Canadian Network on Hepatitis C; reports
advisory fees from Gilead Sciences, ViiV Healthcare, Merck, and AbbVie; and reports speaker fees
from Gilead Sciences, AbbVie, and Merck, all outside of the submitted work. No pharmaceutical
grants were received in the development of this study.

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