While many aspects of society in Newfoundland and Labrador ground to a halt at the start of the pandemic in March, the doors for the Safe Works Access Program (SWAP) in St. John's remained open, and staff have been busy throughout, dealing with clients and a shift in how they operate.
"We've definitely seen our service pick up, probably just as busy or busier than it ever has been," said harm reduction coordinator Alexe Morgan.
"A lot of mental health concerns, still a lot of addiction concerns, folks possibly relapsing because of those things as well."
The need for harm reduction services for drug addictions didn't disappear with the arrival of COVID-19., although programs like SWAP had to change how they work to meet the needs of their clients.
SWAP, which is run by the AIDS Committee of Newfoundland and Labrador, is a free, confidential needle distribution service. In an average year it gives out about one million needles, according to Morgan. It also provides safe supplies such as bowl pipes, cotton swabs, and naloxone kits.
Morgan said SWAP staff had to change how they provided those supplies — physical distancing was brought in for visits, and delivery service times altered to make sure people could get what they needed.
While SWAP has been busy, the pandemic has caused changes in drug consumption in the province.
According to the RCMP, travel restrictions caused a drop in the smuggling of illegal drugs, which has driven up prices, with the price of cocaine doubling in recent months.
Morgan said anecdotally she's heard the higher prices are driving people to try less expensive drugs such as meth, which brings with it a high overdose risk.
Last week the Royal Newfoundland Constabulary sent out a public warning about the presence of fentanyl in the community and the risk of cross contamination with other illegal drugs.
Experts in harm reduction say that underscores the need for a wide distribution of naloxone kits. Naloxone can temporarily reverse an opioid overdose, giving time to call 911 and emergency responders to arrive.
"We really have to make sure that people are aware of how to use naloxone and how to have access to naloxone because whenever someone is trying a new substance, again with different tolerance level, you're not sure what's actually in it," said Jane Henderson, the province's harm reduction consultant with Eastern Health.
Since 2016, more than 3,700 naloxone kits have been distributed across the province.
Henderson said the pandemic forced a change to how those were handed out.
Before COVID-19, Henderson said people who wanted a naloxone kit had to meet with someone face-to-face for training on how to administer it.
"In light of COVID, we've created a bunch of literature and a bunch of training that we can give without actually meeting with someone," she said.
The kits are free and if anyone wants one all they have to do is call 811. There are more than 110 sites across the province that distribute the kits.
Pandemic or not, Henderson said part of the challenge with getting people the treatment they need is the fight against stigma.
"This is a public health crisis that we are facing," she said.
"We have to continue with the messaging that we 100 per cent believe that addiction is a disease of the brain. And we look at addiction through a medical model, not a punitive one."
Henderson said people shouldn't feel afraid to get the help they need.
"People deserve treatment without stigma and discrimination," she said.