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. 2025 Nov 11;28(4):338–347. doi: 10.1007/s43678-025-01042-w

Staff perspectives on the impacts of the COVID-19 pandemic on the provision of emergency department care for patients who use opioids

Nicole D Gehring 1,#, Sarah A Weicker 2,3,#, Elaine Hyshka 1, Parabhdeep Lail 4, May Mrochuk 2, Katherine Rittenbach 5, Kelsey A Speed 1, Ginetta Salvalaggio 6, Gillian Harvey 7, Shanell Twan 8, Kathryn Dong 2,✉
PMCID: PMC13086662  PMID: 41217727

Abstract

Purpose

The COVID-19 pandemic and Canada’s drug poisoning crisis placed exceptional demands on emergency departments (ED). We aimed to explore the impact of these intersecting crises from the perspectives of ED staff to understand how EDs can improve care and protect the health and well-being of patients who use opioids, ED staff, and healthcare providers.

Methods

We conducted a focused ethnographic study involving 29 semi-structured interviews with ED staff who cared for patients who use opioids during the pandemic. Interviews explored ED staff perspectives on how the pandemic impacted care for patients who use opioids and how EDs can better serve this population. We conducted latent content analysis and main theme generation was informed by the socioecological model.

Results

Four main themes emerged. First, there was a change in patient behaviors, which impacted provider–patient relationships. Second, hospital pandemic policies and resource limitations created new barriers to care. Third, community service alterations, including the shift to virtual care and uncertain availability of services, further complicated patient care. Finally, participants highlighted opportunities to strengthen systems of care, including enhanced hospital addiction resources, improved addiction care training, expanded harm reduction services, and more robust community services.

Conclusions

The COVID-19 pandemic highlighted significant changes in ED care delivery for patients who use opioids. Efforts to enhance EDs should include anticipating the needs of people who use substances and the healthcare providers who care for them to mitigate unintended harm and ensure a more resilient healthcare system.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43678-025-01042-w.

Keywords: Acute care, People who use substances, Opioid crisis, Emergency department, Qualitative research, Drug poisoning crisis, COVID-19, Health services

Clinician’s capsule

What is known about the topic?
The intersecting COVID-19 pandemic and Canada’s drug poisoning crisis placed exceptional demands on EDs.
What did this study ask?
What were the impacts of COVID-19 and the drug poisoning crisis for ED staff caring for patients who use opioids?
What did this study find?
ED staff had to navigate evolving patient–provider dynamics while adapting to hospital policy, resource availability, and community care access challenges.
Why does this study matter to clinicians?
EDs should attend to addiction resources, staff training and well-being, and policy impacts on patients who use opioids.
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Introduction

Opioid toxicity killed more than 49,000 Canadians between January 2016 and June 2024 [1]. Emergency departments (EDs) are a major touchpoint between people who use opioids and the health system [2, 3]. EDs can play a critical role in preventing drug poisoning deaths by identifying patients at risk of drug poisoning, initiating evidenced-based treatments, connecting patients to community addiction care, and providing other critical interventions (e.g., safer use education and naloxone kits) [4, 5].

The unprecedented pressure of the COVID-19 pandemic had significant negative impacts on EDs [6]. Concurrently, the pandemic intersected with Canada’s opioid poisoning crisis with a corresponding increase in drug poisoning events and deaths [8, 9]. In 2019, there were a total of 18,302 opioid-related poisoning ED visits in Canada. This number rose to 22,732 in 2020, the year COVID-19 was declared a pandemic, and then dramatically rose again to 32,662 in 2021 [1]. Importantly, EDs are still facing increased patient volumes [1] and presentation complexity [7] related to substance use post-pandemic. Given the increased demands placed on EDs, understanding challenges seen within EDs during the COVID-19 pandemic and drug poisoning crises can help EDs better care for this patient population.

We explored the perspectives of ED staff who cared for patients who use opioids during the COVID-19 pandemic to determine: (1) how care for patients who use opioids was impacted during the pandemic; (2) the barriers and facilitators to providing effective opioid-related care during the pandemic; and (3) how ED care can be adapted for patients who use opioids.

Methods

Study setting

The study was conducted at two large, urban acute care hospitals located in Edmonton and Calgary. These two hospitals have the highest volumes of ED visits and hospitalizations related to substance use in the province [8]. Each hospital offers access to an Addiction Medicine Consult Team (referred to herein as ‘consult team’). These interdisciplinary teams provide in-hospital and in-ED consultation services to patients who use substances (see [9–11] for full details on services provided).

Study design

We adopted a focused ethnographic design. This applied qualitative method is used to study highly specialized areas of society, such as healthcare settings [12]. Focused ethnography commonly employs semi-structured interviews and often limits or omits participant observation [12]. Due to COVID-19 pandemic restrictions, it was not possible to include participant observation. As such, focused ethnography enabled us to rapidly generate new knowledge that could be used to improve health service delivery. We report this study using the consolidated criteria for reporting qualitative research (COREQ; Additional file 1) [13]. The study received ethics approval from the University of Alberta’s Health Research Ethics Board (Pro00104233).

Research team and reflexivity

Our research team consisted of eleven members. Primary affiliations of our team members were five clinicians (who have experience caring for people who use substances), five academics (who work in public health, including substance use), and one community liaison (who has lived experience of substance use). Ten members identify as cisgender women and one as non-binary. Ten team members have advanced experience in qualitative methods, substance use, and/or medicine. Our interdisciplinary team previously collaborated together and regularly engaged in self- and team-reflexivity throughout the study via field notes, electronic correspondence, and meetings to reduce potential bias. In addition, our team regularly engaged with patients throughout the study through ongoing consultation with an established Community Advisory Group comprised of people with lived experience of substance use and hospitalization.

Recruitment and data collection

Staff who work and/or provide consultative services in the ED and had experience caring for patients who use opioids were invited to participate via purposive sampling given the specialized topic. The consult team and ED operational leads at both hospitals helped identify potential participants through personal invitations, posters, and presentations. Interested participants contacted the research team directly via email or phone.

The interview guide (Additional file 2) explored staff perspectives on the impact of COVID-19 on caring for patients who use opioids within the ED, as well as how ED staff can best care for this patient population. The interview guide was piloted and revised base on the first three interviews. A member of the research team (NDG) conducted 29 one-time semi-structured interviews via Zoom between June 15 and November 31, 2021 [EH and EC (noted in the acknowledgements) sat in on some of the interviews]. No participants refused to participate or dropped out. Participants were offered a $50 e-gift card. The interviews were audio-recorded, transcribed verbatim, and de-identified. No transcripts were returned to participants for corrections and participants did not provide feedback on the findings; however, our Community Advisory Group provided feedback on the findings. The average length of the interviews was approximately 1 h and all participants provided verbal informed consent.

Data analysis

We used NVivo 12 software to manage the data [14] and we performed latent content analysis. NDG coded persistent concepts, considering their context, for each transcript via line-by-line coding to develop a preliminary codebook. KAS then co-coded 20% of the transcripts; coding was iteratively refined between NDG and KAS to reach consensus. Once no new ideas or codes were emerging from the data set, NDG grouped the codes into overarching themes. Overarching themes began to emerge reflecting components of the socioecological model, which considers health as an interplay between individual, interpersonal, organizational, community, and policy levels of influence [15]. SAW and NDG revisited the emerging themes in relation to the socioecological model post hoc to help inform final theme generation. Several strategies were used to ensure rigor [16]: (1) use of field notes and an audit trail; (2) generation of a codebook and co-coding, as well as several members of the team reviewing the codebook, transcripts, and categorization; and (3) recruiting comparable numbers of participants from each site.

Results

The majority of participants self-identified as white (76%) and as women (83%). Participant numbers were similar between Edmonton (55%) and Calgary (45%). Most were nurses (62%) and the majority were ED staff not affiliated with the consult team (66%) (Table 1). Four main themes emerged. We then mapped the major concepts from the four themes onto the socioecological model to demonstrate the interplay between individual, interpersonal, organizational, community, and policy levels that affected care delivery (Fig. 1).

Table 1.

Participant characteristics (n = 29)

Acute care location, n (%)
 Edmonton 16 (55.2)
 Calgary 13 (44.8)
Role, n (%)
 Nurse 18 (62.1)
 Physician 8 (27.6)
 Othera 3 (10.3)
Part of AMCT, n (%)
 No 19 (65.5)
 Yes 10 (34.5)
Gender, n (%)
 Woman 24 (82.8)
 Man 4 (13.8)
 Non-binary 1 (3.4)
Ethnicity/race, n (%)
 White 22 (75.9)
 Asian 1 (3.4)
 Southeast Asian 1 (3.4)
 Chinese 1 (3.4)
 Sri Lankan 1 (3.4)
 Indian 1 (3.4)
 Indigenous 1 (3.4)
 Mixed 1 (3.4)
Years working in ED, average ± SD 4.8 ± 5.4
Years of experience in total, average ± SD 8.5 ± 7.0
Specialization in substance use treatment in the ED
 No 20 (69.0)
 Yes 9 (31.0)
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All characteristics were self-reported

aOther included addiction counsellors or peer support workers

Fig. 1.

Fig. 1

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Four main themes in relation to the socioecological model

Changes in patient behaviors and patient–provider relationships

Participants observed changes in perceived patient unwillingness to access ED care as a result of fear and mistrust. Patients were noted to “be afraid of coming to the hospital because they were worried about getting COVID” (Participant 15, non-consult team staff), which in some cases led to delays in accessing care and contributed to increased complexity of presentations.

Participants also observed increased patient “mistrust in the system,” in part due to ED staff being overburdened by COVID-19 and substance use presentations:

“Currently, it feels very much like patients might not trust us as much because we’re so burnt out. And the department is so full. Our wait times at night are ten hours now normally. Especially for someone who is withdrawing, that’s a long time.” (Participant 11, non-consult team staff)

Participants also reported an apparent increase in aggressive and challenging patient behavior. Some respondents reported more erratic behavior following opioid poisoning reversal, attributing this to the “multiple, multiple, multiple doses” of naloxone required and the presence of unknown contaminants in the drug supply. Participants noted that due to the high acuity of ED presentations during the pandemic, they had less time available to verbally de-escalate patients, leading to a greater dependence on protective services. Often as a result of “frustration and exhaustion”, some respondents noted an erosion of the relationship between ED staff and patients.

The changing hospital landscape

Many participants highlighted that new hospital policies, designed to mitigate the spread of COVID-19, created barriers in the provision of ED care. For instance, donning and doffing personal protective equipment (PPE) resulted in less efficient care and less time to address the unique needs of patients who use substances. Participants also noted a decreased ability to build rapport with patients, in part due to PPE, and that pandemic policies made the hospital a less conducive environment for supporting patient well-being (e.g., exclusion of hospital visitors). As one emergency physician discussed:

“[I]n COVID, I think the biggest difference for managing that population was you used to be able to have a family member or friend come to the bedside for these overdose patients in crisis and we couldn’t have anybody there. And I think it was so, so isolating, not just for the patient who was quite sick [...] but for any family member or support person who’s usually there advocating for the patient.” (Participant 16, non-consult team staff)

Participants also described that there were no “in-and-out privileges” for patients, which was frustrating for individuals who wanted to leave the ED temporarily to use substances.

Participants noted that hospital-based addiction resources were adversely impacted during the pandemic. For example, participants from the Edmonton site discussed changes in supervised consumption service policies. Participants reported that prior to the pandemic, members of the community could also access the service to obtain supplies (e.g., naloxone kits and sterile drug consumption materials); however, this practice was not permitted during the pandemic. Moreover, several participants described how patients were required to have a staff-escort to attend the supervised consumption service, whereas prior to the pandemic they were free to visit the site independently. As one nurse described:

“[T]he nurse has to bring them or a member of the Supervised Consumption Site staff can bring them. But that’s a barrier right. These patients are not used to waiting. They’re used to having a certain amount of freedom and for someone to ask nursing staff, hospital staff, if they could call someone so they could use their substance. The stigma that they get […] is definitely a barrier.” (Participant 14, consult team member)

The pandemic contributed to increased levels of burnout experienced by hospital staff. Our participants noted that many staff appeared to be in “survival mode”, which limited their ability to provide compassionate care. One physician noted “growing frustration” and “fatigue” among ED providers in treating patients with substance use. In addition, participants noted that burnout resulted in some staff reducing their hours or seeking other employment opportunities. For example, one nurse remarked on the dramatic loss of senior addiction staff and peer support workers during the pandemic “because they’re so exhausted, and burnt out, and tired” (Participant 6, non-consult team member). Respondents also described that staffing shortages resulted in the closure of ED and acute care beds and limited supervised consumption service capacity.

Despite high levels of burnout, several participants described hospital staff going “above and beyond” and working “tirelessly” to find “creative ways” to bridge gaps in patient care. Participants noted that some staff took an active role in offering addiction services in the ED rather than outpatient services. For instance, some providers reported that they made greater efforts to initiate patients on opioid agonist treatment in the ED. One emergency physician shared the following:

“I would sort of push a little bit harder in terms of assessing [the patient’s] sort of readiness [for treatment], or encouraging them one way or the other to get opioid [agonist] therapy or some sort of mental health, or some sort of addictions follow up. I would try to square that away in the emerg rather than offload that to a clinic that may or may not be functioning at the time.” (Participant 3, non-consult team staff)

Several participants also acknowledged that the ED may have served as a patient’s only connection to the healthcare system during the pandemic; in some cases, staff advocated for patients at particularly high risk to stay in the ED longer or be admitted to facilitate needed care.

Alterations in community services

Participants described a high level of uncertainty regarding the availability of community services. One addiction counselor described how the unclear continuity of community care created new barriers for patients:

“[We are not] sure that services are even available because of COVID because so many things have gone virtual [...] what do we do [...] if the pharmacy isn’t open? What if the clinic isn’t open? Are we able to go down there because so many places are closed? And so, there’s that, I think, extra level of anxiety on the parts of the patient.” (Participant 1, consult team staff)

In particular, respondents highlighted concerns about changes in operating hours, closures resulting from outbreaks or staffing shortages, and reduced capacity to accommodate patients due to social distancing measures.

In response to the pandemic, participants noted that community addiction services adapted care delivery to include virtual options. Participants described how many services began allowing patients to connect with healthcare providers over the phone or computer. Participants described how virtual care provided more flexible opioid agonist treatment dosing for patients, with less stringent urine toxicology testing requirements to reduce patient exposure to COVID-19 and support self-isolation. However, numerous respondents noted challenges in accessing virtual services for structurally vulnerable individuals with limited technology literacy or access:

“[Virtual care is] a barrier, because not everyone has access to telehealth. I think that there’s an expectation that everyone has a phone or a smart phone, or access to reliable internet, or a phone number. Telehealth is great if I’m sitting at home in my house with a good wireless connection, but [not] if you’re in a shelter or […] on the street.” (Participant 25, non-consult team staff)

Participants also shared that some patients struggled without the structure and “human connection” provided by in-person care. In some cases, this “limited [individuals] wanting to seek help because they didn’t have those supports right in front of them” (Participant 8, non-consult team staff).

The pandemic complicated disposition planning for ED patients. Participants noted that in-person detox facilities and addiction services would screen incoming patients for COVID-19 symptoms. Withdrawal symptoms such as runny nose, fatigue, or gastrointestinal upset often overlapped with COVID-19 symptoms. One nurse shared:

“If you’re wanting to send someone from the Emergency Room, they would often ask you about those core symptoms. And if they did have any them, even if it was withdrawal related, it made it very challenging for that person to be transferred to that centre.” (Participant 14, consult team staff)

Some participants noted that these screening measures resulted in delays in care and reduced ED patient flow.

Isolation facilities were developed by community organizations with support from the provincial government for patients experiencing lack of housing who were required to isolate or quarantine under COVID-19 public health orders. Participants described how patients with symptoms of COVID-19, a positive test result, or who were a known close contact of a COVID-19 case were transferred to these centers from the ED upon discharge. Several respondents highlighted that these facilities were particularly beneficial for unhoused patients who use substances as they provided integrated patient care, including temporary housing, health services, and addiction care. One physician shared:

“I think [the isolation facilities were] a bit of silver lining because these people who maybe had been marginally housed before actually got to be in a place where there was 24-hour nurse supervision and like clean sheets and a bathroom. But […] now [they’re] legally required to be in a hotel for 14 days so […] it was a bit of a double-edged sword.” (Participant 18, non-consult team staff)

Participants described that some patients struggled to adhere to isolation requirements and left isolation facilities to use substances or see friends and family. In some cases, this resulted in patients being apprehended under public health legislation and brought back to the ED for involuntary hospital admission, inadvertently placing additional pressures on EDs.

Areas for improvement

Participants advocated for improvements in substance use care through the establishment of ED care pathways for common substance use concerns as well as increased access to addiction medicine expertise. One physician shared:

“I think honestly, we need [addiction consult teams] in all hospitals so that we have a constant addictions medicine presence, which leads to improved education around substance use disorders.” (Participant 7, consult team staff)

In addition, participants reported that ED care spaces staffed with personnel with dedicated substance use training could better address the unique needs of patients who use substances by offering a multidisciplinary approach, tailored care provision, and follow-up coordination.

Many respondents expressed concerns regarding inadequate substance use training. For example, one ED nurse shared the following:

“There needs to be a bit more training and education just around substance use in general. But specifically, opioids because we’re just seeing so many people right now who are asking to start [opioid agonist treatment] […] and there’s still a lot of people who don’t understand the process of it, how the medication really works […] what the follow-up is.” (Participant 26, consult team staff)

Participants described the need for further education on a variety of topics, including opioid agonist treatment initiation, withdrawal management, trauma informed care, motivational interviewing, and community addiction resources.

Participants also described the need for improved harm reduction services. Numerous respondents felt that EDs should take a more active role in providing patients with safer drug consumption supplies, such as “packages with [a] tourniquet, and sterile water, and a syringe, and alcohol wipes, and a cooker” (Participant 2, non-consult team staff). Hospital-based supervised consumption services were highlighted as an effective way to reduce harms and stigma associated with substance use; participants stressed the importance of expanding supervised consumption services to additional hospital sites to maximize their impact. Other harm reduction suggestions included introducing drug checking services as well as offering prescribed safer supply medications.

Finally, participants reported that the current system of addiction care often resulted in patients seeking ED care only after experiencing adverse substance use health outcomes, and noted that improved access to community addiction supports may reduce ED presentations. Specifically, respondents called for greater investment in low-barrier multidisciplinary services to manage withdrawal, harm reduction services, opioid agonist treatment, longitudinal care, and access to bed-based treatment. As one physician shared:

“We just are generally under resourced to treat these patients. We just don’t have great options to help these folks in general […] We don’t have enough detox centres to treat them. We’re losing our [community-based] safe injecting site. That’s devastating to try to protect these people from the harms that come with using, not just the substances themselves.” (Participant 15, non-consult team staff)

Furthermore, respondents underscored the importance of streamlining access to community follow-up services for ED patients and maintaining a blend of in-person and virtual care options.

Discussion

Interpretation of findings

The COVID-19 pandemic created new barriers in the provision of ED care for patients who use opioids. ED staff had to navigate evolving patient–provider dynamics while adapting to shifts in hospital policies, resource availability, and access to community care. Our findings underscore the need for EDs to proactively protect the health and well-being of patients who use opioids and the healthcare providers who care for them.

Comparison to previous studies

This study builds on existing literature describing how the dual public health crises further increased harm to patients who use opioids [7, 8, 17] while simultaneously restricting access to health and social services [18, 19]. As EDs remain a main point of care (during crises and normal circumstances), EDs must be counterbalanced with community services and resources in other parts of the healthcare continuum to ensure comprehensive care. While innovative adaptations during COVID-19, such as expanded virtual opioid care and isolation facilities, were implemented (albeit closed rapidly post-pandemic [20]) to respond to community gaps [21], they must be designed to allow equitable access. For instance, implementation of virtual care modalities should be accompanied by investments in training and infrastructure to ensure access for individuals with housing instability, financial barriers, and limited technology literacy [22].

Previous research has also shown that crises disproportionately impact populations experiencing health and social inequities [21, 23]. Governments responded rapidly and robustly to the COVID-19 pandemic; however, public health action specific to people who use substances (e.g., isolation facilities, allowing/enhancing encampments, and virtual opioid care) were not implemented until much later in the pandemic timeline [24, 25]. Supply chain disruptions of the illegal drug market during the pandemic led to an increasingly toxic drug supply [26], which was identified in this study as leading to more complex and higher acuity presentations. Innovative interventions such as access to safer supply [27, 28], expanded access to withdrawal management services, and expansion of supervised consumption services may reduce the immediate risk of death from supply chain disruptions. Moreover, stigma and discrimination in healthcare settings is widely reported by patients who use substances [29, 30] and this study highlighted that the pandemic inadvertently increased patient mistrust in healthcare systems.

Strengths and limitations

This study included a diverse mix of ED staff, offering a broad perspective on how multiple disciplines responded to the dual public health crises. However, we completed this study in 2021 at two urban acute care centers in Alberta with established addiction consult teams which may limit generalizability to EDs without integrated substance use resources. Regardless, Alberta’s opioid poisoning crisis remains a significant challenge for ED care (between 2022 and 2024 there were 17,075 opioid-related poisoning ED visits [31]). As such, we believe our findings and recommendations remain applicable for ED clinicians who care for people who use substances. In addition, our interview guide focused on patients who use opioids which limits our understanding of the complexity of the drug poisoning crisis, which has increasingly affected people who use substances other than opioids (e.g., stimulants) [1]. However, many participants discussed patients who use substances more broadly and the term ‘substance use’ was used throughout the manuscript to reflect this. Finally, patient perspectives were not included within this analysis, but are being examined within a separate study.

Clinical implications

This study underscores the importance of prioritizing ED staff well-being. Our findings noted that staff burnout and moral distress—attributed to increased workload, uncertainty and lack of addiction resources, and staffing shortages—contributed to reduced ability to provide compassionate substance-related care. EDs should include strategies to protect staff health and well-being in an effort to protect patient–provider relationships and maintain high-quality care for people who use substances. For example, effective human resource planning, such as reallocating staff, limiting overtime, and appropriate remuneration could potentially mitigate moral distress and burnout, and improve compassionate care for people who use substances [32]. Although we do acknowledge that this may not always be feasible under the constraints of Canada’s current healthcare system, they are critical considerations for substance use care. In addition, COVID-19 public health and hospital measures restricted ED staff ability to develop rapport with patients who use substances and de-escalate challenging situations. For any newly developed policies and procedures, ED policymakers and clinicians should consider their impacts and tailor policies specifically for patients who use substances [33]. At the minimum, EDs should incorporate the perspectives of patients with lived experience of substance use during policy development to better understand their needs during crises and beyond.

Research implications

It is essential to proactively strengthen EDs for patients who use opioids through the expansion and evaluation of education and training, institutional protocols, and engagement across sectors to improve clinician readiness to provide substance use interventions [34–36]. Future research could examine whether dedicated ED staff and care spaces could be used to better support the unique needs of patients who use substances; for example, the implementation of ED substance use navigators (trained staff who provide motivational interviewing, strengths-based counseling, harm reduction, resource coordination, etc.) has been associated with higher patient engagement in addiction treatment post-discharge [37].

Conclusion

The pandemic resulted in an escalation of substance-related harms while placing a strain on ED resources and disrupting access to community services. EDs should anticipate the needs of patients who use substances and the healthcare staff who care for them—both in times of crisis and routine care. This includes enhancing addiction resources and staff training within EDs, prioritizing ED staff well-being, carefully considering and mitigating the impacts of new policies on patients who use substances, and maintaining flexible and innovative approaches to addiction service delivery.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 23 KB) (22.6KB, docx)
Supplementary file2 (DOCX 21 KB) (20.8KB, docx)

Acknowledgements

We respectfully acknowledge that this work took place on Treaty 6 Territory, a traditional gathering place for diverse Indigenous Peoples, including the First Nations, Métis, and Inuit. The authors are thankful to the participants who shared their time and expertise, Brynn Kosteniuk who helped in the early stages of the study, and Ethan Candler who participated in some of the interviews.

Glossary

COREQ

COnsolidated criteria for REporting Qualitative research

ED

Emergency Department

PPE

Personal protective equipment

Author contributions

Gehring: data curation, formal analysis, project administration, and writing—original draft. Weicker: formal analysis and writing—original draft. Hyshka: conceptualization, data curation, funding acquisition, investigation, methodology, resources, supervision, and writing—review and editing. Lail: conceptualization, funding acquisition, investigation, methodology, resources, and writing—review and editing. Mrochuk: conceptualization, funding acquisition, investigation, methodology, resources, and writing—review and editing. Rittenbach: conceptualization, funding acquisition, investigation, methodology, resources, and writing—review and editing. Speed: project administration, validation, and writing—review and editing. Salvalaggio: conceptualization, funding acquisition, investigation, methodology, resources, and writing—review and editing. Harvey: conceptualization, funding acquisition, methodology, resources, and writing—review and editing. Twan: conceptualization, funding acquisition, methodology, resources, and writing—review and editing. Dong: conceptualization, funding acquisition, investigation, methodology, resources, supervision, and writing—review and editing.

Funding

This study was funded by the Canadian Institutes of Health Research (CIHR—448953). The views expressed are those of the authors and do not necessarily represent the views of the funders. Dong received a medical leadership salary from Alberta Health Services as the medical lead for the Edmonton Addiction Medicine Consult Team during the time data collection was taking place.

Data availability

The data set analyzed for this study are not publicly available to protect participant anonymity. Additional information may be provided upon reasonable request to the corresponding author.

Declarations

Conflict of interest

The other authors declared no conflicts of interest.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Nicole D. Gehring and Sarah A. Weicker contributed equally to this work.

References

  • 1.Government of Canada. Opioid- and stimulant-related harms in Canada. 2024. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/#a4.
  • 2.Caudarella A, Dong H, Milloy MJ, Kerr T, Wood E, Hayashi K. Non-fatal overdose as a risk factor for subsequent fatal overdose among people who inject drugs. Drug Alcohol Depend. 2016;162:51–5. 10.1016/j.drugalcdep.2016.02.024. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Moe J, Camargo CA, Davis RB, Jelinski S, Rowe BH. Frequent emergency department use and mortality in patients with substance and opioid use in Alberta: a population-based retrospective cohort study. CJEM. 2019. 10.1017/cem.2019.15. [DOI] [PubMed] [Google Scholar]
  • 4.Hawk K, D’Onofrio G. Emergency department screening and interventions for substance use disorders. Addctn Sci Clin Pract. 2018;13:18. 10.1186/s13722-018-0117-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Koh JJ, Klaiman M, Miles I, Cook J, Kumar T, Sheikh H, Dong K, Orkin A, Shouldice E. Draft CAEP position statement: emergency department management of people with opioid use disorder, Canadian Association of Emergency Physicians (CAEP) Opioid Task Force. 2020. https://caep.ca/wp-content/uploads/2020/02/2020-01-29-FINAL-DRAFT-CAEP-Position-Statement-on-Management-of-People-with-Opioid-Use-Disorder-AddAuth-1.pdf. Accessed 27 May 2020. [DOI] [PubMed]
  • 6.Dixon E, Murphy M, Wynne R. A multidisciplinary, cross-sectional survey of burnout and wellbeing in emergency department staff during COVID-19. Australas Emerg Care. 2022;25:247–52. 10.1016/j.auec.2021.12.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Canadian Institute for Health Information. Unintended consequences of COVID-19: impact on harms caused by substance use. 2021. https://www.cihi.ca/sites/default/files/document/unintended-consequences-covid-19-substance-use-report-en.pdf.
  • 8.Alberta Health. Alberta COVID-19 opioid response surveillance report Q2 2020, Edmonton, AB. 2020. https://open.alberta.ca/publications/alberta-opioid-response-surveillance-report.
  • 9.Dong K, Brouwer J, Johnston C, Hyshka E. Supervised consumption services for acute care hospital patients. CMAJ. 2020;92:E476–9. 10.1503/cmaj.191365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Hyshka E, Morris H, Anderson-Baron J, Nixon L, Dong K, Salvalaggio G. Patient perspectives on a harm reduction-oriented addiction medicine consultation team implemented in a large acute care hospital. Drug Alcohol Depend. 2019;1:107523. 10.1016/j.drugalcdep.2016.06.025. [DOI] [PubMed] [Google Scholar]
  • 11.Salvalaggio G, Dong KA, Hyshka E, Nixon L, Lavergne KJ, Nichols J, et al. Enhanced multidisciplinary care for inner city patients with high acute care use: study protocol. Can J Addctn. 2016;7:34–41. [Google Scholar]
  • 12.Cruz EV, Higginbottom G. The use of focused ethnography in nursing research. Nurse Res. 2013;20:36–43. 10.7748/nr2013.03.20.4.36.e305. [DOI] [PubMed] [Google Scholar]
  • 13.Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57. 10.1093/intqhc/mzm042. [DOI] [PubMed] [Google Scholar]
  • 14.NVivo (Version 12). 2020. www.lumivero.com.
  • 15.McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15:351–77. 10.1177/109019818801500401. [DOI] [PubMed] [Google Scholar]
  • 16.Morse JM. Critical analysis of strategies for determining rigor in qualitative inquiry. Qual Health Res. 2015;25:1212–22. 10.1177/1049732315588501. [DOI] [PubMed] [Google Scholar]
  • 17.Public Health Agency of Canada. Modelling opioid-related deaths during the overdose crisis. 2020. https://www.canada.ca/en/health-canada/services/opioids/data-surveillance-research/modelling.html.
  • 18.Jacka BP, Janssen T, Garner BR, Yermash J, Yap KR, Ball EL, et al. Impacts of the COVID-19 pandemic on healthcare access among patients receiving medication for opioid use disorder. Drug Alcohol Depend. 2021;221:108617. 10.1016/j.drugalcdep.2021.108617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.King C, Vega T, Button D, Nicolaidis C, Gregg J, Englander H. Understanding the impact of the SARS-COV-2 pandemic on hospitalized patients with substance use disorder. PLoS ONE. 2021;16:e0247951. 10.1371/journal.pone.0247951. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Gallant K, Speed KA, Betsos A, Abele B, Bonn M, Crichlow F, et al. “The people who depended on us became expendable”: experiences of frontline workers with lived and living expertise of drug use during the COVID-19 pandemic. Harm Reduct J. 2025;22(1):80. 10.1186/s12954-025-01221-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Salvalaggio G, Hyshka E, Brown C, Pinto AD, Halas G, Green L, et al. A comparison of the COVID-19 response for urban underserved patients experiencing healthcare transitions in three Canadian cities. Can J Public Health. 2022. 10.17269/s41997-022-00651-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Drake C, Yu J, Lurie N, Kraemer K, Polsky D, Chaiyachati KH. Policies to improve substance use disorder treatment with telehealth during the COVID-19 pandemic and beyond. J Addctn Med. 2020;14:e139–41. 10.1097/ADM.0000000000000727. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Green H, Fernandez R, MacPhail C. The social determinants of health and health outcomes among adults during the COVID-19 pandemic: a systematic review. Public Health Nurs. 2021. 10.1111/phn.1295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Bahji A, Danilewitz M, Crockford D. Supporting persons who use drugs during the COVID-19 pandemic: a rapid review of international guidelines. Can J Addctn. 2021;12:6. 10.1097/CXA.0000000000000110. [Google Scholar]
  • 25.Conway B, Truong D, Wuerth K. COVID-19 in homeless populations: unique challenges and opportunities. Future Virol. 2020. 10.2217/fvl-2020-0156. [Google Scholar]
  • 26.Ledlie S, Juurlink DN, Tadrous M, Mamdani M, Paterson JM, Gomes T. Opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories. CMAJ. 2024;196:E469–76. 10.1503/cmaj.231339. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Bonn M, Touesnard N, Cheng B, Pugliese M, Comeau E, Bodkin C, Brothers TD, Genge C, Herder M, Lepage C, Scheim A, Werb D, Wildeman D. Securing safe supply during COVID-19 and beyond: scoping review and knowledge mobilization. 2021. https://digitalcommons.schulichlaw.dal.ca/cgi/viewcontent.cgi?article=2323&context=scholarly_works.
  • 28.Ledlie S, Garg R, Cheng C, Kolla G, Antoniou T, Bouck Z, et al. Prescribed safer opioid supply: a scoping review of the evidence. Int J Drug Policy. 2024;125:104339. 10.1016/j.drugpo.2024.104339. [DOI] [PubMed] [Google Scholar]
  • 29.Galarneau LR, Scheuermeyer FX, Hilburt J, O’Neill ZR, Barbic B, Moe J, et al. Qualitative exploration of emergency department care experiences among people with opioid use disorder. Ann Emerg Med. 2023;82:1–10. 10.1016/j.annemergmed.2023.02.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Hawk K, McCormack R, Edelman EJ, Coupet E, Toledo N, Gauthier P, et al. Perspectives about emergency department care encounters among adults with opioid use disorder. JAMA Netw Open. 2022;5:e2144955. 10.1001/jamanetworkopen.2021.44955. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Government of Canada. Key findings: opioid- and stimulant-related harms in Canada. 2025. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/.
  • 32.Wong A, Olusanya O, Parulekar P, Highfield J. Staff wellbeing in times of COVID-19. J Intensive Care Soc. 2021;22:328–34. 10.1177/1751143720968066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Dong K, Meador K, Hyshka E, Salokangas E, Burton-MacLeod S, Bablitz C, Lail P, Colizza K, Etches N, Cardinal C, Twan S, Gilani F, Brooks HL, Wild CT. Supporting people who use substances in acute care settings during the COVID-19 pandemic: version 2 CRISM—interim guidance document. 2021. https://crism.ca/wp-content/uploads/2021/02/Supporting-people-who-use-substances-in-acute-care-settings-during-the-COVID-19-pandemic-V2-18-Feb-2021.pdf.
  • 34.Dong KA, Lavergne KJ, Salvalaggio G, Weber SM, Xue CJ, Kestler A, et al. Emergency physician perspectives on initiating buprenorphine/naloxone in the emergency department: a qualitative study. JACEP Open. 2021;2:e12409. 10.1002/emp2.12409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Gehring ND, Speed KA, Dong K, Pauly B, Salvalaggio G, Hyshka E. Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study. BMC Health Serv Res. 2022;22:138. 10.1186/s12913-022-08498-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Hawk KF, D’Onofrio G, Chawarski MC, O’Connor PG, Cowan E, Lyons MS, et al. Barriers and facilitators to clinician readiness to provide emergency department-initiated buprenorphine. JAMA Netw Open. 2020;3:e204561. 10.1001/jamanetworkopen.2020.4561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Hailozian C, Herring AA. Effectiveness of substance use navigation for emergency department patients with substance use disorders: an implementation study. Ann Emerg Med. 2023;81:297–308. 10.1016/j.annemergmed.2022.09.025. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary file1 (DOCX 23 KB) (22.6KB, docx)
Supplementary file2 (DOCX 21 KB) (20.8KB, docx)

Data Availability Statement

The data set analyzed for this study are not publicly available to protect participant anonymity. Additional information may be provided upon reasonable request to the corresponding author.

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