Rapidly assessing the impact of the COVID-19 pandemic on people who inject drugs in Toronto



Substance Use and Harm Reduction

This study is part of the MAP/St. Michael’s Hospital Foundation COVID-19 Catalyst Fund, launched to advance our most urgent priority projects. Learn more

A population at risk

In the midst of the COVID-19 pandemic, there has been a spike in opioid-related overdoses and deaths in Toronto. This disturbing trend — bucking a year-long decrease in overdoses — is linked to significant reductions in front-line addiction treatment, harm reduction, and safe consumption service access. That’s because physical distancing requirements have severely limited these services’ capacity to deliver care to their clients.

People who inject drugs represent one of Toronto’s most marginalized and vulnerable groups, many of whom inject drugs frequently, have precarious or no housing, and are often living with multiple, chronic health conditions. The pandemic has placed them at great risk of a syndemic (multiple, intersecting epidemics) of fatal overdose, drug addiction, and COVID-19.

Directly responding to the impact of the COVID-19 pandemic among people who inject drugs in Toronto

In partnership with service and health-care providers, we are undertaking a rapid epidemiological investigation of the health and toxicological impacts of the COVID-19 pandemic among people who inject drugs in Toronto. Study questions include:

  • How common is COVID-19 among people who inject drugs, and what are this group’s risk factors for infection and complications?
  • Are COVID-19 restrictions making it harder for people who inject drugs to access services that protect them from overdose?
  • Are street drugs becoming more toxic as pandemic-related international travel restrictions impact the illegal drug trade?

This project builds on an ongoing cohort study of approximately 700 people who inject drugs in Toronto. Unique in Canada, this study can track participants’ health-care use and outcomes through linkages to their clinical health data. This means that we can understand and follow not only individual experiences, but also individual trajectories over time through clinical diagnoses, care, and related outcomes.

The Outcome

Initial findings will be available by June 2020. Because the project team involves clinicians and front-line service providers, our findings can and will be used to rapidly inform how clinical and front-line services are deployed across Toronto to better serve this marginalized population.


Substance Use and Harm Reduction

Dr. Dan Werb

A sought-after source of expertise on addictions and drug policy, Dr. Werb has devoted his career to the development of effective solutions to protect health and human rights among communities affected by drug use.


  • Jason Altenberg (South Riverdale Community Health Centre)
  • Lorraine Barnaby (Parkdale Queen West Community Health Centre)
  • Dr. Dan Beriault (St. Michael’s Hospital)
  • Zachary Bouck (St. Michael’s Hospital)
  • Dr. Alexander Caudarella (St. Michael’s Hospital)
  • Shaun Hopkins (Toronto Public Health)
  • Dr. Ayden Scheim (Drexel University)
  • Dr. Cristiana Stefan (Centre for Addiction and Mental Health)
  • Dr. Lianping Ti (University of British Columbia)


  • Jen Ko (South Riverdale Community Health Centre)

Contact Info

Ruby Sniderman

Research Coordinator