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The Evolving Understanding of Substance Use During the Pandemic: An Interview with Dr. Tara Elton-Marshall


Earvin Tio

Dr. Tara Elton-Marshall is an independent scientist with the Institute for Mental Health Policy Research at the Centre of Addiction and Mental Health (CAMH), an assistant professor in the Clinical Public Health Division at the Dalla Lana School of Public Health at the University of Toronto, and an adjunct associate professor in the Department of Epidemiology and Biostatistics at Western University. Her journey began at the University of Waterloo, where she completed not only an undergraduate degree in psychology, but a doctorate as well, focusing on tobacco control policies. Following her graduate education, Dr. Elton-Marshall worked with the School of Public Health and Health Systems at the University of Waterloo focusing on youth surveys (see the Canadian student alcohol, tobacco, and drugs survey1) where she gained additional experience in survey design and administration, as well as policy evaluation.

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Policy is defined by the Centers for Disease Control and Prevention (CDC) as “a law, regulation, procedure, administrative action, incentive or voluntary practice of governments and other institutions.”2 Additionally, the CDC also states that “Policy evaluation uses a range of research methods to systematically investigate the effectiveness of policy interventions, implementation and processes, and to determine their merit, worth, or value in terms of improving the social and economic conditions of different stakeholders.”3 In essence, policy making and policy evaluation are people-focused. As Dr. Elton-Marshall puts it, the most rewarding part of her research is “getting out of the ivory tower” and working with people directly, especially those most impacted by her research outcomes.

In advance of joining CAMH, Dr. Elton-Marshall and Dr. Scott Leatherdale at the University of Waterloo received grant funding to examine the impact of the expansion of online gambling in Ontario. More recently, she is a nominated principal investigator (NPI) on a Canadian Institute of Health Research (CIHR) funded team grant investigating the impact of cannabis legalization in Ontario. In a broader view, Dr. Elton- Marshall’s research focuses on policies surrounding substance use and mental health. She is a co-principal investigator on the Ontario node of the Canadian Research Initiative in Substance Misuse (CRISM), otherwise known as the Ontario CRISM Node Team (OCRINT). Her work with OCRINT centers on engaging with key stakeholders such as community members with lived or living experience with drug use, healthcare and service providers that interface with the community, and other researchers who are working together to tackle issues in substance use seen in Ontario and Canada. One such issue that is a major focus for OCRINT priority projects is the opioid crisis seen in recent years4. Projects coordinated by the OCRINT team on this front involve investigating naloxone distribution, detoxification and withdrawal management, and opioid use in corrections populations. Dr. Elton Marshall also notes that she has observed an increase in overdoses during the COVID-19 pandemic. She speculates that this could be due to several reasons—people who use drugs may have a harder time accessing services and support, the drug supply chain may have been affected, and mandated self-isolation may contribute to higher chances of overdose due to increased isolation, for example.

With regards to the COVID-19 pandemic, Dr. Elton-Marshall and her colleagues at CRISM worked to formulate COVID-19 national rapid guidance documents based on data collected early on in the pandemic. Dr. Elton-Marshall worked specifically on the guidance document outlining harm reduction worker safety, specifically in supervised consumption services. She believes that it is important to keep these sites operational during the pandemic to combat the rise in overdoses. However, she also understands that the safety of harm reduction workers and community members who use these sites is paramount. In compiling the guidance document, her team engaged in extensive research around recommendations to ensure the safety of both clients and harm reduction workers are protected. The resulting guidance documents are now available on the CRISM website and have helped service providers manage the substance use crisis in light of the COVID-19 pandemic. Knowledge translation documents have also been developed to ensure that the information is widely accessible.

Dr. Elton-Marshall's team has also been conducting qualitative interviews with people who use drugs across Canada. She is hoping to understand the difficulties they may be experiencing, particularly around accessing services, increased isolation, and the potentially toxic drug supply. Preliminary data collected from these interviews have identified broader issues during the pandemic, such as food insecurity. For example, access to food banks has become increasingly difficult and as a result, people are facing extreme hunger which can potentially lead to drug use. She is also working with Toronto-based market research firm Delvinia on a project investigating mental health among Canadians over several time points to understand the effects of the pandemic on mental health over time. As a believer in open science, Dr. Elton-Marshall shares that the data collected with Delvinia is readily available through Delvinia’s website. Findings from this project are also presented on a regularly updated dashboard available on the CAMH website. One interesting result Dr. Elton-Marshall shares from this project is that women are now once again seemingly experiencing more anxiety than men, with an observed gender gap similar to the one seen earlier in the pandemic around the month of May. That is not to say that men do not experience mental health issues. However, Dr. Elton-Marshall states that there is no statistical significance in rates of depression between men and women. She also notes that the survey shows people with children are more likely to identify as depressed, anxious, and lonely than those who do not have children.

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Dr. Elton-Marshall is excited to share further outcomes from both her work with Delvinia, as well as her other ongoing projects, as the data becomes readily available. She also plans to continue her work with the Ontario Student Drug Use and Health Survey (OSDUHS) operating through CAMH as she believes youth and adolescents are an important population to study, especially during this pandemic. As for the future of research in this field, Dr. Elton- Marshall sees potential in machine learning and leveraging different data types helps to inform decision-making processes and draw better conclusions. She advises people interested in her field to get experience and to definitely look for opportunities—whether that be volunteering for a professor with interesting research topics, or simply exploring what a program offers.


 1. Canadian Student Tobacco, Alcohol and Drugs Survey. Government of Canada. en/health-canada/services/canadian- student-tobacco-alcohol-drugs survey. html. Accessed: 2020-11-16. 

 2. CDC, Office of the Associate Director for Policy. (2011). Definition of policy. PDF available upon request; please contact 

 3. Her Majesty’s Treasury. (2011). The magenta book: Guidance for evaluation. London, UK: Author. Retrieved from index.htm 

 4. Morin, K.A., et al. The opioid crisis: past, present and future policy climate in Ontario, Canada. Substance Abuse Treatment, Prevention, and Policy 12, 45 (2017).

Edited by Anglin Dent & Emily Mastragostino