COVID-19: Focus on Substance Use and Stigma

From: Public Health Agency of Canada

The CPHO Sunday Edition

This past week was Mental Health Week. This is a longstanding Canadian tradition in which communities, schools and workplaces come together to celebrate, protect and promote mental health. This week, through some of my daily statements and remarks, I have discussed some of the mental health impacts of COVID-19 and shared some useful and readily available resources.

This year’s Mental Health Week theme, #GetReal, is about expressing our emotions and getting the help and support we need. It is an important and fitting message to promote during this time when it is normal to be experiencing difficult emotions, like fear, loneliness, anger, and grief.

Some people however, may find it difficult to open up about the challenges they are facing because of stigmas and discrimination, which can also affect access to the supports they need. This can have serious negative impacts on our mental health and use of substances like alcohol and drugs.

The COVID-19 pandemic has contributed to significantly increased substance use and related harms. It has also intensified the existing overdose crisis in Canada, resulting in what some are referring to as a “dual crisis”. I remain deeply concerned by these trends. Mental Health Week and today’s Sunday Edition are opportunities to raise awareness about this serious public health issue.

COVID-19 Pandemic – Impact on People Who Use Substances

The COVID-19 pandemic has had serious negative consequences for people who use drugs and other substances. A report released just this week by the Canadian Institutes for Health Information highlights that more Canadians required hospital care for harm caused by substances such as alcohol, opioids, and stimulants between March and September 2020, compared with the same period in 2019.

For some Canadians, the stress, isolation, and uncertainty of the pandemic has led to increased substance use as a means to cope. For example, 15 percent of Canadians have reported increased alcohol use during the pandemic. Additionally, public health measures that have been put in place to contain the spread of COVID-19, such as physical distancing and limited trips outside the home, have had broader impacts including increased social isolation and reduced access to services, such as in-person support groups, substance use treatment programs, and harm reduction services. These measures can increase the risk of substance-related harms, including, for example, by increasing the likelihood that people will use substances alone.

These factors have resulted in particularly dire consequences in the context of the ongoing overdose crisis. Prior to the pandemic, there had been a 13 percent decrease in opioid overdose deaths in Canada between 2018 and 2019, suggesting that efforts to address the crisis were making gains, particularly in British Columbia and Alberta. The COVID-19 pandemic, unfortunately, has set back this progress. The latest national data indicates that in many areas of Canada, the COVID-19 pandemic is compounding the crisis, with the rates of overdoses, deaths, and other substance-related harms increasing over the past year. Between July and September 2020, 1,705 opioid overdose deaths were reported in Canada, representing the highest quarterly count since national surveillance began in 2016.

Putting an end to substance use stigma

There is an urgent need for increased action to support people who use substances. One way that we can do so is by reducing stigma. People who use substances experience considerable stigma and discrimination in their daily life. Stigma can make people feel ashamed of their drug use and make it hard for them and their loved ones to get help.

Stigma is prevalent in the health system and contributes to barriers to accessing and receiving appropriate care. A well-documented example of this is how stigma has created barriers to accessing effective treatment for opioid-use disorders. For many individuals, these barriers have only increased during the COVID-19 pandemic.

There are small ways that each of us can help. Change can start by being aware of the assumptions we make about people who use drugs and other substances. We need to keep in mind that substance use disorders are a medical condition, deserving of care and treatment just like any other, and remain open-minded and not let our judgements or assumptions colour the way we think of someone. Everyone has a story, and for people experiencing substance-related harms, we know that their’s often includes trauma. Kindness and respect are Canadian traits, and these traits are particularly important for those negatively impacted by trauma and substance use. The words we use matter. You can find a guide to non-stigmatizing language here.

Reducing stigma in the health system requires concrete actions by leaders and professionals. This lexicon and primer provide information on safe and compassionate communication for health professionals and evidence-based interventions to help reduce systemic stigma in health systems. My 2019 Annual Report also looks at the ways in which different stigmas intersect and provides examples of interventions and promising initiatives to address stigma across individual, interpersonal, institutional, and population levels.

While reducing stigma can help, our actions must not stop there. Substance use and mental health intersect in complex ways and it is important that whenever we are talking to, supporting or treating someone struggling with substance use and mental health challenges, that we consider the whole person and meet them where they are at in their journey. Evidence-based and innovative services that take this approach, like distribution of take-home naloxone kits, harm reduction services and safer supply programs are critical for saving lives. Improving access to and the availability of these services and addressing the unique needs of different populations must continue to be an urgent area focus.

Recent Progress and the Path Forward

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