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Mitra S, Bouck Z, Larney S, Zolopa C, Høj S, Minoyan N, Upham K, Rammohan I, Mok WY, Hayashi K, Milloy MJ, DeBeck K, Scheim A, Werb D. The impact of the COVID-19 pandemic on people who use drugs in three Canadian cities: a cross-sectional analysis. Harm Reduct J 2024; 21:94. [PMID: 38750575 PMCID: PMC11097551 DOI: 10.1186/s12954-024-00996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic had a disproportionate impact on the health and wellbeing of people who use drugs (PWUD) in Canada. However less is known about jurisdictional commonalities and differences in COVID-19 exposure and impacts of pandemic-related restrictions on competing health and social risks among PWUD living in large urban centres. METHODS Between May 2020 and March 2021, leveraging infrastructure from ongoing cohorts of PWUD, we surveyed 1,025 participants from Vancouver (n = 640), Toronto (n = 158), and Montreal (n = 227), Canada to describe the impacts of pandemic-related restrictions on basic, health, and harm reduction needs. RESULTS Among participants, awareness of COVID-19 protective measures was high; however, between 10 and 24% of participants in each city-specific sample reported being unable to self-isolate. Overall, 3-19% of participants reported experiencing homelessness after the onset of the pandemic, while 20-41% reported that they went hungry more often than usual. Furthermore, 8-33% of participants reported experiencing an overdose during the pandemic, though most indicated no change in overdose frequency compared the pre-pandemic period. Most participants receiving opioid agonist therapy in the past six months reported treatment continuity during the pandemic (87-93%), however, 32% and 22% of participants in Toronto and Montreal reported missing doses due to service disruptions. There were some reports of difficulty accessing supervised consumption sites in all three sites, and drug checking services in Vancouver. CONCLUSION Findings suggest PWUD in Canada experienced difficulties meeting essential needs and accessing some harm reduction services during the COVID-19 pandemic. These findings can inform preparedness planning for future public health emergencies.
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Affiliation(s)
- Sanjana Mitra
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Department of Medicine, University of California, San Diego, USA
| | - Zachary Bouck
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Sarah Larney
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Département de Médecine Famille et de Médicine d'Urgence, Université de Montréal, Montréal, Canada
| | - Camille Zolopa
- Department of Educational and Counselling Psychology, McGill University, Montréal, Canada
| | - Stine Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Social and Preventive Medicine, École de Santé Publique, Université de Montréal, Montréal, Canada
| | - Katie Upham
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Indhu Rammohan
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Wing Yin Mok
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
- School of Public Policy, Simon Fraser University, Burnaby, Canada
| | - Ayden Scheim
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, United States.
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van den Berk-Clark C, Fedorova M, Duncan E, Ju T, Pickard J. Funding and Implementation of Recovery Oriented Treatment Programs in the US from 2006-2020. JOURNAL OF DRUG EDUCATION 2024; 53:3-18. [PMID: 38056006 DOI: 10.1177/00472379231217830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Background: Not much is known about funding for and implementation of Person-centered, long-term services - referred to as "recovery services." Methods: SAMSHA funding archives from 2004-2020 were analyzed using Latent Class Analysis (LCA). Results: All 50 states (plus DC and Guam) received about 482 recovery-based grants from 2004-2020 (total from 2004-2020 = $425 million vs. 63.3 ± 29.1 million in total SAMSHA funding per year on average). LCA showed 4 trends: peer focused (Pr(Class) = .09, 95%CI = 0.08, 0.10), treatment focused (Pr(Class) = 0.14, 95%CI = 0.12, 0.18), system focused (Pr(Class) = 0.57, 95% CI = 0.54, 0.59) and consumer focused (Pr(Class) = 0.19 (0.17, 0.21). Conclusions: Funding for recovery makes up a relatively low percentage of overall funding for substance prevention and treatment. Implications are discussed.
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Affiliation(s)
| | | | - Emily Duncan
- Department of Family and Community Medicine, Saint Louis University, St. Louis, MO, USA
| | - Tiffany Ju
- UC Davis Department of Pediatrics, Sacramento, CA, USA
| | - Joseph Pickard
- School of Social Work, University of Missouri St. Louis, St. Louis, MO, USA
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Holland A, Brothers TD, Lewer D, Maynard OM, Southwell M. "Safer supply" alternatives to toxic unregulated drug markets. BMJ 2024; 384:q6. [PMID: 38199644 DOI: 10.1136/bmj.q6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Affiliation(s)
- Adam Holland
- University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, UK
| | - Thomas D Brothers
- These authors contributed equally and are listed in alphabetical order
- Division of General Internal Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Dan Lewer
- These authors contributed equally and are listed in alphabetical order
- Bradford Institute for Health Research, Bradford Institute for Health Research Temple Bank House, Bradford Royal Infirmary, Bradford, UK
| | - Olivia M Maynard
- These authors contributed equally and are listed in alphabetical order
- University of Bristol, School of Psychological Science, Clifton, Bristol, UK
| | - Mat Southwell
- These authors contributed equally and are listed in alphabetical order
- European Network of People who Use Drugs
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Jaffe K, Richardson L. "I thought it was for guys that did needles": Medication perceptions and lay expertise among medical research participants. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209134. [PMID: 37572960 DOI: 10.1016/j.josat.2023.209134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/22/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Although randomized controlled trials (RCTs) examine "objective" indicators of safety and efficacy of investigational drugs, participants may not perceive study medications as neutral entities. Some medications are imbued with social and cultural meaning, such as stigmatized medications for opioid use disorders. Such perceptions surrounding substance use treatments can extend to the research context and shape RCT participants' experiences with and adherence to study medications. METHODS Considering these complexities in substance use research, we conducted a nested qualitative study within a multi-site, pragmatic RCT in Canada testing two treatments (methadone versus buprenorphine/naloxone) for opioid use disorder. Between 2017 and 2020, we conducted 115 interviews with 75 RCT participants across five trial sites in British Columbia, Alberta, Ontario, and Quebec. RESULTS Using an abductive coding approach, we characterized participants by their previous experience with medication for opioid use disorder and by their exposure to drug culture and drug scenes. Across these experience types, we identified systematic differences around participants' perceptions of the study medications, sources of information and expertise, and medication stigma. CONCLUSION Our findings illustrate the critical importance of social context in shaping medication beliefs and study experiences among people who use drugs, with implications for the conduct of future RCTs in substance use.
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Affiliation(s)
- Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA; British Columbia Centre on Substance Use, Vancouver, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Sociology, University of British Columbia, Vancouver, Canada.
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Mitra S, Choi J, van Draanen J, Kerr T, Gilbert M, Hayashi K, Milloy MJ, Johnson C, Richardson L. Socioeconomic marginalization and risk of overdose in a community-recruited cohort of people who use drugs: A longitudinal analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104117. [PMID: 37453374 PMCID: PMC10842635 DOI: 10.1016/j.drugpo.2023.104117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Poverty and socioeconomic disadvantage are important contributors to drug-related harm, but their precise role in overdose risk remains poorly understood. We sought to examine linkages between socioeconomic marginalization and non-fatal overdose risk in a community deeply affected by the ongoing drug poisoning crisis. METHODS This observational study used data derived from two community-recruited prospective cohorts of people who use drugs (PWUD) in Vancouver, British Columbia, Canada. Generalized linear mixed-effects models were used to assess longitudinal associations between multiple dimensions of socioeconomic disadvantage and self-reported non-fatal overdose. RESULTS Between 2014 and 2020, 1,493 participants (38.2% women; 59.6% white; 35.7% Indigenous) provided 9,968 interviews. Non-fatal overdose was reported by 32.5% of participants over the study period. In multivariable analyses, non-fatal overdose was independently associated with incarceration (adjusted odds ratios [AOR]: 1.42, 95% confidence interval [CI]: 1.08-1.88, p=0.012), homelessness (AOR: 1.57, 95%CI: 1.27-1.93, p<0.001), increased monthly income (AOR: 1.01, 95%CI: 1.00-1.01, p=0.029), and lower material security (AOR: 0.76, 95%CI: 0.67-0.88, p<0.001). We also observed differing strengths of association between illegal income generation and overdose in men (AOR: 1.84, 95%CI: 1.46-2.32, p<0.001) compared to women (AOR: 1.37, 95%CI: 1.06-1.78, p=0.016). CONCLUSION Non-fatal overdose was positively associated with incarceration, homelessness, higher monthly income, material insecurity, and engagement illegal income generating activities, underscoring the importance of addressing the socioeconomic production of overdose risk. These initiatives may include supportive housing interventions, alternative economic supports, and broader drug policy reform.
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Affiliation(s)
- Sanjana Mitra
- Interdisciplinary Graduate Studies Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - JinCheol Choi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Jenna van Draanen
- School of Nursing, Department of Child, Family, and Population Health Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7263, USA
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada; British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, 8888 University Drive, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - M J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Cheyenne Johnson
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC V6T 1Z1, Canada.
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Guise A, Harris M, McCusker M, McNeil R, Werb D. Stigma is stopping an evidence based response to drug overdose deaths in the UK. BMJ 2023; 382:e074934. [PMID: 37558236 DOI: 10.1136/bmj-2023-074934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
| | | | | | - Ryan McNeil
- University of Yale, New Haven, Connecticut, USA
| | - Dan Werb
- University of Toronto. Toronto, Canada
- University of California San Diego, San Diego, USA
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Duthie K, Mathison E, Eyford H, Ghosh SM. Prescribing safe supply: ethical considerations for clinicians. JOURNAL OF MEDICAL ETHICS 2023; 49:377-382. [PMID: 35985806 DOI: 10.1136/jme-2021-108087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/11/2022] [Indexed: 05/24/2023]
Abstract
The COVID-19 pandemic has exacerbated the drug poisoning epidemic in a number of ways: individuals use alone more often, there is decreased access to harm reduction services and there has been an increase in the toxicity of the unregulated drug supply. In response to the crisis, clinicians, policy makers and people who use drugs have been seeking ways to prevent the worst harms of unregulated opioid use. One prominent idea is safe supply. One form of safe supply enlists clinicians to prescribe opioids so that people have access to drugs of known composition and strength. In this paper, we assess the ethical case for clinicians providing this service. As we describe, there is much that is unknown about safe supply. However, given the seriousness of the overdose death epidemic and the current limited evidence for safe supply's efficacy, we argue that it is ethically permissible for clinicians to begin prescribing opioids for some select patients.
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Affiliation(s)
- Katherine Duthie
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Mathison
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada
- Department of Philosophy, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Helgi Eyford
- Clinical Ethics Service, Alberta Health Services, Edmonton, Alberta, Canada
| | - S Monty Ghosh
- Addictions Services, Alberta Health Services, Calgary, Alberta, Canada
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Kennedy MC, Hayashi K, Milloy MJ, Compton M, Kerr T. Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis. Addiction 2022; 117:986-997. [PMID: 34854162 PMCID: PMC8904318 DOI: 10.1111/add.15717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS In response to a dramatic rise in overdose deaths due to injection drug use, there was a rapid scale-up of low-threshold supervised injection services (SIS), termed 'overdose prevention sites' (OPS), in Vancouver, Canada in December 2016. We measured the potential impact of this intervention on SIS use and related health outcomes among people who inject drugs (PWID). DESIGN Segmented regression analyses of interrupted time series data from two community-recruited prospective cohorts of PWID from January 2015 to November 2018 were used to measure the impact of the OPS scale-up on changes in SIS use, public injection, syringe sharing and addiction treatment participation, controlling for pre-existing secular trends. SETTING Vancouver, Canada. PARTICIPANTS Of 745 PWID, 292 (39.7%) were women, 441 (59.6%) self-reported white ancestry and the median age was 47 years (interquartile range = 38, 53) at baseline. MEASUREMENTS Immediate (i.e. step level) and gradual (i.e. slope) changes in the monthly proportion of participants who self-reported past 6-month SIS use, public injection, syringe sharing and participation in any form of addiction treatment. FINDINGS Post OPS expansion, the monthly prevalence of SIS use immediately increased by an estimated 6.4% [95% confidence interval (CI) = 1.7, 11.2] and subsequently further increased by an estimated 0.7% (95% CI = 0.3, 1.1) per month. The monthly prevalence of addiction treatment participation immediately increased by an estimated 4.5% (95% CI = 0.5, 8.5) following the OPS expansion, while public injection and syringe sharing were estimated to immediately decrease by 5.5% (95% CI = 0.9, 10.0) and 2.5% (95% CI = 0.5, 4.6), respectively. Findings were inconclusive as to whether or not an association was present between the intervention and subsequent gradual changes in public injection, syringe sharing and addiction treatment participation. CONCLUSIONS Scaling-up overdose prevention sites in Vancouver, Canada in December 2016 was associated with immediate and continued gradual increases in supervised injection service engagement and immediate increases in related health benefits.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | | | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
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Gehring ND, Speed KA, Launier K, O'Brien D, Campbell S, Hyshka E. The state of science on including inhalation within supervised consumption services: A scoping review of academic and grey literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103589. [DOI: 10.1016/j.drugpo.2022.103589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 01/09/2023]
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