When crises collide: COVID-19 and overdose in the Downtown Eastside

Last month, the B.C. government declared COVID-19 a public health emergency. But in the Downtown Eastside, the novel coronavirus has amplified an existing public health emergency: the overdose crisis, which has claimed more than 4,700 lives in B.C. in the last four years.

Front-line workers and community residents have warned that the virus could devastate a vulnerable population that is already struggling with homelessness, health issues, and substance use disorders, and that stay-at-home guidelines aimed at the general population aren’t an option for those without a home. Compounding the problem, many drop-in centres have shut their doors or severely reduced their services, cutting off access to meals, support services, and information.

We asked Lindsey Richardson, a UBC sociologist who specializes in the socio-economic determinants of health, how this outbreak is impacting people on the Downtown Eastside and what can be done to better support residents.

“The policy changes that are being implemented—such as safer supply and social assistance increases — should be long-term, not temporary. If that happens, we may actually see some good come from this public health emergency.”
Associate Professor, Sociology

Dr. Lindsey Richardson

How has COVID-19 impacted the Downtown Eastside?

There isn’t a community that hasn’t been adversely impacted by COVID-19, but as we’ve heard from residents and service providers, the Downtown Eastside bears a disproportionate burden. This is in part because there is a large population of people who use drugs who now face compounded risks from two public health emergencies.

Many residents are unable to access the social services they need while also following physical distancing measures implemented to prevent spread of the virus. Some service providers have adapted what they do, for example by providing food support or harm-reduction supplies at their door for people to take away. But many service providers have closed, making access to services that people in the Downtown Eastside rely on difficult or impossible.

What makes the Downtown Eastside particularly vulnerable to COVID-19?

Many people in the community have lower incomes or face longstanding barriers to accessing health care. Additionally, people who use drugs are more likely to have other health issues, including compromised immune systems or respiratory challenges, that make them more vulnerable to infection and more likely to experience poor, potentially deadly, outcomes related to COVID-19.

People’s ability to manage the significant changes we’re all coping with is strongly influenced by the resources they can deploy to protect themselves. How can you wash your hands frequently if you don’t have access to a sink in your room or don’t have shelter at all? How do you stay two metres away from people when you live in extremely close quarters? We know using drugs alone increases the risk of overdose. Do you forego social distancing in order to protect yourself against fatal overdose?

What measures have been taken to protect the DTES population since the outbreak? What more should be done?

A critically important development is that the federal government gave the green light on providing a medically prescribed “safer supply” of drugs. Championed by my colleagues at the BC Centre on Substance Use and a provincial working group of addiction medicine clinicians and people with lived experience, the province has announced new clinical guidelines to both stem the spread of COVID-19 and respond to the ongoing overdose emergency. These guidelines allow people to access alternatives to the toxic drug supply and even have them delivered, to reduce the likelihood of infection as well as risks associated with the toxic drug supply.

The Canadian Drug Policy Coalition has developed a resource hub to support people who use drugs and the service providers that work with them. There is also harm-reduction guidance from the BC Centre for Disease Control and drug user advocacy groups in the neighbourhood, such as suggesting ways to avoid contracting COVID-19 from drug use supplies, buddying up and making sure to have an overdose plan.

Many people on the Downtown Eastside will be eligible for federal COVID-19-specific benefits that are being offered to all Canadians. The provincial government has announced they will automatically increase income assistance payments by $300 for the next three months for those not receiving the federal benefit. However, these benefits require that people know about them and are able to access them. Drop-in spaces that provide people with access to computers to register for benefits are closed. So an important step to be taken will be developing ways to facilitate access to available supports.

Do you think COVID-19 will have long-term impacts on the neighbourhood?

I think COVID-19 will have long-term impacts in every neighbourhood. We will all likely be dealing with the loss of members of our communities. The impacts in the Downtown Eastside could be more extreme given the heightened vulnerability of residents. The policy changes that are being implemented—such as safer supply and social assistance increases — should be long-term, not temporary. If that happens, we may actually see some good come from this public health emergency.