Factors associated with perceived decline in the quality of drugs during the COVID-19 pandemic: Evidence from community-recruited cohorts of people who use drugs in Vancouver, Canada

Driven by an increasingly toxic drug supply, drug toxicity deaths in the United States and Canada have risen to unprecedented levels during the COVID-19 pandemic. This study aimed to characterize the prevalence of and the factors associated with a perceived decline in the quality of drugs during the COVID-19 pandemic among community-recruited cohorts of PWUD in Vancouver, Canada. Data collection took place between July and November 2020. In adherence with COVID-19 safety protocols, questionnaires were administered by interviewers through remote means (e.g., phone or videoconference). Using multivariable logistic regression, we characterized the prevalence of and factors associated with a perceived decline in drug quality during the start of the COVID-19 pandemic in Vancouver, Canada. Of the 738 individuals included in this analysis, 272 (36.9%) reported that the quality of drugs declined during the COVID-19 pandemic. In multivariable analysis, perceived decline in the quality of drugs was significantly associated with: recent non-fatal overdose (adjusted odds ratio [AOR]=2.01, 95% Confidence Interval [CI]: 1.29–3.15), at least weekly injection drug use (AOR=1.94, 95% CI: 1.40–2.71), at least weekly crack use (AOR=1.61, 95%CI: 1.10–2.36), and at least weekly crystal methamphetamine use (AOR=1.46, 95%CI: 1.03–2.08). Over a third of PWUD perceived that the quality of drugs declined during the COVID-19 pandemic and these individuals were significantly more likely to report experiencing a recent non-fatal overdose, engaging in frequent injection drug and stimulant use. Study findings indicate the need for interventions to address the toxic drug supply, including providing a regulated supply. •Data from established cohorts of people who use drugs in Vancouver, Canada.•36.9% of study participants reported a perceived decline in drug quality.•Outcome was associated with weekly injection, crack cocaine, and crystal meth use.•Perceived decline in drug quality was also associated with non-fatal overdose.•Findings suggest addressing the toxic drug supply, including through “safer” supply.