Factors associated with changes in illicit opioid use during the COVID-19 pandemic among incarcerated people who use drugs in Quebec, Canada

Purpose: People who use drugs (PWUD) have been disproportionately affected by the COVID-19 pandemic. This study aims to examine changes in illicit opioid use and related factors among incarcerated PWUD in Quebec, Canada, during the pandemic.

Design/methodology/approach: The authors conducted an observational, cross-sectional study in three Quebec provincial prisons. Participants completed self-administered questionnaires. The primary outcome, "changes in illicit opioid consumption," was measured using 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 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.

Findings: A total of 123 participants (median age 37, 76% White) were included from January 19 to September 15, 2021. The majority (72; 59%) reported decreased 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 were 30% (95% CI 9-55 vs living alone) and 9% (95% CI 0-18 vs not) more likely to report decreased illicit opioid consumption since March 2020, respectively.

Originality/value: The authors identified possible factors associated with changes in illicit opioid consumption among incarcerated PWUD in Quebec. Irrespective of opioid consumption patterns, increased access to opioid agonist therapy and enhanced discharge planning for incarcerated PWUD are recommended to mitigate the harms from opioids and other drugs.