Key messages for community physicians: supporting people who use drugs during extreme weather events

Key messages:

• The combination of extreme weather and reduced services during the holidays, in the context of a toxic unregulated drug supply, poses extraordinary risk to people who use drugs.
• This risk is in addition to the risk associated with the ongoing public health emergency.
• Extreme weather can impact people who use drugs due to direct health effects (hypothermia/frostbite), disruption of services, and/or changes in the drug supply.
• This advisory supports physicians to reduce the risk of overdose and other death among people who use drugs in the context of extreme weather events.

Recommendations:

• Carries of medication can be granted at physician discretion in response to extraordinary circumstances, even when select patients may normally receive medications as daily witnessed dosing. This includes Opioid Agonist Therapy medications such as methadone and slow-release oral morphine (BCCSU OUD Guidelines, BCCSU OUD Practice Update).
• Physicians may consider assessing patients for prescribed safer supply in the context of extreme weather events. Provincial guidance is available to support physician prescribing of safer supply (Risk Mitigation in the Context of Dual Public Health Emergencies, Prescribed Safer Supply Policy Direction, BCCSU OUD Practice Update). Physicians are encouraged to consult the 24/7 Addiction Medicine Clinician Support Line or the RACEapp for support as needed.
• Virtual overdose prevention services are available through the Lifeguard app. The app can be downloaded from the App Store and Google Play. Physicians can recommend this service to patients where barriers exist to the use of in-person overdose prevention services. Note that the Lifeguard app relies on BC Emergency Health Services response (i.e. it is not suitable for areas with complete road closures).
• Safer use strategies to discuss with patients are available on the BCCDC website and Toward the Heart.
• In select circumstances, physicians may feel that patient safety is best achieved by witnessing a patient’s use of drugs outside a formal overdose prevention service setting. An example of this would be an emergency department where alternative overdose prevention services are not available. Provincial guidance exists to support physicians to witness drug consumption on an episodic basis (Provincial Episodic Overdose Prevention Service Protocol). Physicians should consult with their medical leadership about considerations for offering this service in their facilities.
• Physicians are encouraged to review their organizational policies to identify if additional supports or extended hours can be offered to patients during this and subsequent extreme weather events.