People who use drugs have felt the impacts of the COVID 19 pandemic with on their access to addictions medicine at time when access is crucial. The opioid overdose crisis has resulted in an estimated 21,174 deaths in Canada between 01/2016 and 12/ 2020.1 Fentanyl has overtaken the unregulated street supply of drugs making it hard to avoid, has led to more frequent injection and increased the risk of overdose due to the variable potency. Fentanyl use is also leading to ever-increasing drug tolerance creating challenges for people who use fentanyl (PWUF) and their treatment providers. With this changing context has come an evidence gap addictions clinicians must navigate as they change(d) their practices to improve care and access during the pandemic. Some changes are perceived by stakeholders to be long overdue while others as time-limited to the pandemic.

Our proposed exploratory qualitative research project aims to examine how fentanyl has changed addictions medicine in general and in the context of the COVID‑19 pandemic, and how clinical (e.g., physicians and nurse practitioners) and PWUF stakeholders (i.e., people receiving opioid agonist treatment; safer supply; not in treatment; on a waitlist for treatment) understand the impact and sustainability of these changes. We will interview 90 people including physicians who prescribe methadone/suboxone and safer supply as well as people enrolled methadone/suboxone/safe supply and people who are not in treatment to understand the impact of fentanyl tolerance on addictions medicine. We will used thematic analyses to understand our data, consult with our advisory group, clinicians and people who use drugs to interpret our data. Our multi-disciplinary team includes clinicians, people who use drugs, junior and senior academics, and experts in knowledge translation. Our findings will be used to add to the evidence base about if and how to revise treatment regimens and for advocacy purposes.