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Evaluation of risk mitigation measures for people with substance use disorders to address the dual public health crises of COVID-19 and overdose in British Columbia: a mixed-method study protocol
  1. Bohdan Nosyk1,2,
  2. Amanda Slaunwhite3,
  3. Karen Urbanoski4,5,
  4. Natt Hongdilokkul6,
  5. Heather Palis3,
  6. Kurt Lock3,
  7. Jeong E Min2,
  8. Bin Zhao3,
  9. Kiffer G Card4,5,
  10. Brittany Barker7,8,
  11. Louise Meilleur7,
  12. Charlene Burmeister9,
  13. Erica Thomson10,
  14. Phoenix Beck-McGreevy10,
  15. Bernie Pauly4,11
  1. 1Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  2. 2Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
  3. 3BC Centre for Disease Control, Vancouver, British Columbia, Canada
  4. 4Canadian Institute for Substance Use Research, Victoria, British Columbia, Canada
  5. 5School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
  6. 6British Columbia Office of the Human Rights Commissioner, Vancouver, British Columbia, Canada
  7. 7First Nations Health Authority, West Vancouver, British Columbia, Canada
  8. 8Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  9. 9Professionals for Ethical Engagement of Peers, Vancouver, British Columbia, Canada
  10. 10BC/Yukon Association of Drug War Survivors, New Westminster, British Columbia, Canada
  11. 11School of Nursing, University of Victoria, Victoria, British Columbia, Canada
  1. Correspondence to Dr Bohdan Nosyk; bnosyk{at}


Introduction The COVID-19 pandemic was preceded by an ongoing overdose crisis and linked to escalating drug overdose deaths in British Columbia (BC). At the outset of these dual public health emergencies, the BC government announced interim Risk Mitigation Guidance (RMG) that permitted prescribing medication alternatives to substances, including opioids, alcohol, stimulants and benzodiazepines, an intervention sometimes referred to as ‘safe supply’. This protocol outlines the approach for a study of the implementation of RMG and its impacts on COVID-19 infection, drug-related and systemic harms, continuity of care for people with substance use disorder (SUD), as well as their behavioural, psychosocial and well-being outcomes.

Methods and analysis We conducted a parallel mixed-method study that involved both analysis of population-level administrative health data and primary data collection, including a 10-week longitudinal observational study (target n=200), a cross-sectional survey (target n=200) and qualitative interviews (target n=60). We implemented a participatory approach to this evaluation, partnering with people with lived or living expertise of drug use, and researchers and public health decision-makers across the province. Linked population-level administrative databases will analyse data from a cohort of BC residents with an indication of SUD between 1996 and 2020. We will execute high-dimensional propensity score matching and marginal structural modelling to construct a control group and to assess the impact of RMG dispensation receipt on a collaboratively determined set of primary and secondary outcomes.

Ethics and dissemination Study activities were developed to adhere to the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, recommended COVID-19 research practices, and guided by the Truth and Reconciliation Commission’s Calls to Action for public health, data governance and research ethics related to Indigenous people. Results will be disseminated incrementally, on an ongoing basis, through the consortium established for this study, then published in peer-reviewed journals.

  • epidemiology
  • public health
  • health policy
  • substance misuse

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  • Contributors BN, AS and NH conceptualised the study, designed the administrative health data analysis plan and cowrote the first draft of the manuscript. KU and BP conceptualised the study, designed the plan for primary data collection and cowrote the first draft of the manuscript. HP and JEM designed the administrative health data analysis plan and revised the manuscript. KL, BB, LM, CB, ET and PB-M revised the manuscript. BZ designed the administrative health data analysis plan. KGC designed the plan for primary data collection and revised the manuscript.

  • Funding This work was supported by Canadian Institutes for Health Research (CIHR, grant number 172 671) and Michael Smith Foundation for Health Research (MSFHR, grant number 18 951). KU is supported by a Canada Research Chair through CIHR. BP is supported through the Island Health Scholar in Residence funded by Island Health. BN is supported by an MSFHR Scholar award. BB is supported by a CIHR Health System Impact Fellowship. KGC is supported by an MSFHR Trainee Award and a CIHR Health Systems Impact Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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