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Di Ciaccio M, Boulahdour N, Tadjeddine A, Brouk N, Ouchallal R, Hami N, Bourhaba O, Adami E, Lorente N, Delabre RM, Karkouri M, Rojas Castro D. Psychosocial experience of the Covid-19 crisis among people who use or inject drugs in Algeria: A community-based qualitative study. J Health Psychol 2024:13591053241259251. [PMID: 39045700 DOI: 10.1177/13591053241259251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
The COVID-19 crisis had a global impact and many marginalised groups, such as people who use or inject drugs, are more vulnerable to the SARS-CoV-2 virus and its consequences due to their pre-existing health inequalities. Moreover, people who use/inject drugs are also criminalised in some countries such as Algeria. This analysis aimed to explore the psychosocial experience of the COVID-19 crisis among people who use/inject drugs in Algeria. Twenty-nine qualitative interviews were conducted in 2021 with a community-based approach. Results of the thematic content analysis showed the intersectional effects of the COVID-19 crisis among people who use or inject drugs through the experience of a double crisis: one related to COVID-19 and the second to their specific difficulties related to drug use. Addressing social inequalities in health of people who use or inject drugs, through better recognition of their rights and needs, is crucial to improving their health.
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Affiliation(s)
| | | | | | - Nafaa Brouk
- Association de Protection Contre le Sida (APCS), Oran, Algeria
- Unité de dépistage du cancer du sein, EPSP, Alger, Algeria
| | - Rachida Ouchallal
- Association de Protection Contre le Sida (APCS), Oran, Algeria
- EHS Frantz-Fanon, Blida, Algeria
| | - Noria Hami
- Association de Protection Contre le Sida (APCS), Oran, Algeria
- Etablissement Hospitalier Pédiatrique, Oran, Algeria
| | - Othmane Bourhaba
- Association de Lutte Contre le Sida (ALCS), Casablanca, Morocco
- Community-based research laboratory, Coalition PLUS, Dakar, Senegal
| | - Elisa Adami
- Community-based research laboratory, Pantin, France
| | - Nicolas Lorente
- Community-based research laboratory, Pantin, France
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, España
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | | | - Mehdi Karkouri
- Association de Lutte Contre le Sida (ALCS), Casablanca, Morocco
- Community-based research laboratory, Coalition PLUS, Dakar, Senegal
- Centre Hospitalier Universitaire, Casablanca, Morocco
| | - Daniela Rojas Castro
- Community-based research laboratory, Pantin, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Gliddon HD, Ward Z, Heinsbroek E, Croxford S, Edmundson C, Hope VD, Simmons R, Mitchell H, Hickman M, Vickerman P, Stone J. Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104324. [PMID: 38218700 DOI: 10.1016/j.drugpo.2024.104324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND In England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced. METHODS We analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011-2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs' (2011-2014), 'Prioritised DAAs' (2015-2016) and 'Unrestricted DAAs' (2017-2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period. RESULTS The proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95-2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45-0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12-0.60), never (vs current, aOR:0.31, 95 %CI:0.13-0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08-0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06-1.54). CONCLUSION COC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.
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Affiliation(s)
- H D Gliddon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Public Health Specialty Training Programme, South West, United Kingdom
| | - Z Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - E Heinsbroek
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Croxford
- National Public Health Speciality Training Programme, West Midlands, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - R Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - H Mitchell
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - P Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - J Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom.
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3
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Delabre RM, Di Ciaccio M, Lorente N, Villes V, Castro Avila J, Yattassaye A, Bonifaz C, Ben Moussa A, Sikitu IZ, Khodabocus N, Freitas R, Spire B, Veras MA, Sagaon-Teyssier L, Girard G, Roux P, Velter A, Delpech V, Ghosn J, Riegel L, Rojas Castro D. Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program). JMIR Res Protoc 2023; 12:e45204. [PMID: 38096016 PMCID: PMC10755648 DOI: 10.2196/45204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/18/2023] [Accepted: 08/10/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. OBJECTIVE This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enquêtes Pour évaluer l'Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. METHODS A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. RESULTS From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). CONCLUSIONS The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45204.
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Affiliation(s)
| | | | - Nicolas Lorente
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Agència de Salut Pública de Catalunya, Badalona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Virginie Villes
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | | | - Adam Yattassaye
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association pour la Résilience des Communautés pour l'Accès au Développement et à la Santé PLUS, Bamako, Mali
| | - César Bonifaz
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Corporación Kimirina, Quito, Ecuador
| | - Amal Ben Moussa
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association de Lutte Contre le Sida, Casablanca, Morocco
| | - Ingrid-Zaïre Sikitu
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association Nationale de Soutien aux Séropositifs et Malades du Sida, Bujumbura, Burundi
| | - Niloufer Khodabocus
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Prévention Information Lutte contre le SIDA, Port Louis, Mauritius
| | - Rosa Freitas
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Bruno Spire
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Association pour la Résilience des Communautés pour l'Accès au Développement et à la Santé PLUS, Bamako, Mali
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Gabriel Girard
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Perrine Roux
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Annie Velter
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
- Santé Publique France, Saint-Maurice, France
| | - Valérie Delpech
- Director of Population and Public Health Directorate, North Coast North South Wales, Australia
| | - Jade Ghosn
- Assistance Publique - Hôpitaux de Paris Nord, Service des Maladies Infectieuses, Center Hospitalier Universitaire Bichât - Claude Bernard, Paris, France
- Infection, Antimicrobials, Modelling, Evolution, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Université Paris Cité, Paris, France
| | - Lucas Riegel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
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Vashisht S, Jha S, Kant S, Thakur N, Rai S. Challenges Faced and Coping Strategies Adopted by Injecting Drug Users during COVID-19 Lockdown-A Qualitative Study. Indian J Community Med 2023; 48:846-851. [PMID: 38249706 PMCID: PMC10795882 DOI: 10.4103/ijcm.ijcm_649_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/30/2023] [Indexed: 01/23/2024] Open
Abstract
Background The lockdown due to COVID-19 pandemic has adversely affected the lives of vulnerable population, including the injecting drug users (IDUs). The objective of the study was to document the coping mechanism adopted by IDUs and suggest measures to mitigate the adverse effects, if similar situation were to arise in future. Materials and Methods A qualitative study was conducted at the Targeted Intervention Non-Government Organizations catering to IDUs in Delhi and Ghaziabad district of Uttar Pradesh. Four focus group discussions among 41 IDUs and 7 key informant interviews of the NGO staff were conducted in the study. The Hindi recordings were coded and the data analysis was performed manually using grounded theory approach. Results We found that the lockdown affected the lives of most of the IDUs and they found it difficult to access the harm reduction services. To cope with this, many IDUs started following alternate methods to support the drug habits. There was an increase in reuse of needles and syringes. Conclusion The lockdown during COVID-19 and the resulting challenges negatively impacted the physical and mental health of the IDUs. We recommend that in any similar future scenario, travel pass may be issued to the IDUs and the TI-NGO personnel.
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Affiliation(s)
- Shruti Vashisht
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shreya Jha
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishakar Thakur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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5
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Roxburgh A, Livingston M, Dietze P, Nielsen S, Cogger S, Bartlett M, Day C, Latimer J, Jauncey M, Clark N. The impact of COVID-19 public health measures on attendance and overdose at supervised injecting facilities in Australia. Public Health 2023; 224:90-97. [PMID: 37742585 DOI: 10.1016/j.puhe.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic disrupted service provision of harm reduction and drug treatment services for people who inject drugs in many countries. The two supervised injecting facilities (SIFs) in Sydney and Melbourne were differentially impacted by the pandemic, requiring local procedural changes in each service. We aimed to examine the impact of pandemic responses (including restrictions on movement, known as 'lockdowns') on service use and key parameters such as client reports of drug injected and recorded overdose rates. STUDY DESIGN Time series analysis of weekly client visits and monthly overdoses occurring at each service. METHODS Administrative client data from the two SIFs (Sydney data from 1 January 2018 to 30 April 2022; Melbourne data from 1 July 2018 to 30 April 2022) were examined using interrupted time series analyses with lockdown dates in each state entered as interruption terms. We analysed weekly SIF visits overall and by drug type, and monthly rates of opioid overdose at each service. RESULTS Lockdowns resulted in decreased visits to both services. The number of weekly client visits decreased during the first national lockdown for both the Sydney (trend change = -57.9; 95% CI [-109.4, -6.4]) and Melbourne SIF (near sig trend change = -54.8 [-110.8, 1.05]). Trends in visit numbers increased after lockdowns were lifted in each city; however, visits in Sydney have not returned to the numbers recorded prior to the pandemic. Visits to the Melbourne SIF related to heroin use declined at each lockdown (trend 1 = -42.7 [-81.5, -3.9]; trend 2 = -56.1 [-94.6, -17.7]; trend 3 = -33.8 [-67.4, -0.2]); heroin visits to the Sydney SIF declined during the first lockdown and remained low (trend = -55.6 [-82.8, -28.3]). Methamphetamine visits to the Sydney SIF fluctuated, surpassing heroin visits at several timepoints. Rates of monthly opioid overdoses at both services declined immediately following the start of the first lockdown (Sydney = -16.6 [-26.1, -6.8]; Melbourne = -6.4 [-8.7, -4.1]), with increasing trends recorded at the end of the final lockdown in each jurisdiction (Sydney = 2.8 [0.6, 5.0]; Melbourne = 1.3 [0.72, 3.2]). CONCLUSIONS Public health restrictions related to the COVID-19 pandemic were associated with reduced client visits to, and overdoses in, Australian SIFs. Variations were noted in the drugs injected, likely reflecting changes in local drug markets. Shifts to other drugs during these periods were evident: methamphetamine in Sydney; co-injection of heroin and diphenhydramine in Melbourne.
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Affiliation(s)
- A Roxburgh
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia.
| | - M Livingston
- National Drug Research Institute, Curtin University, Perth, Australia
| | - P Dietze
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - S Nielsen
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - S Cogger
- North Richmond Community Health Medically Supervised Injecting Room, Melbourne Australia
| | - M Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - C Day
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - J Latimer
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - M Jauncey
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - N Clark
- North Richmond Community Health Medically Supervised Injecting Room, Melbourne Australia; Addiction Medicine, Royal Melbourne Hospital, Melbourne, Australia
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Moreheart S, Shannon K, Krüsi A, McDermid J, Ettinger E, Braschel M, Goldenberg SM. Negative changes in illicit drug supply during COVID-19: Associations with use of overdose prevention and health services among women sex workers who use drugs (2020-2021). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104212. [PMID: 37797570 PMCID: PMC10798550 DOI: 10.1016/j.drugpo.2023.104212] [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: 11/30/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Women sex workers are a highly criminalized population who are over-represented amongst people who use drugs (PWUD) and face gaps in overdose prevention and harm reduction services. British Columbia, Canada continues to face a pronounced drug poisoning crisis of the illicit drug supply, which has intensified during the COVID-19 pandemic. Our objective was to examine the prevalence and structural correlates of experiencing negative changes in illicit drug supply (e.g., availability, quality, cost, or access to drugs) amongst women sex workers who use drugs during the first year of the COVID-19 pandemic. METHODS Cross-sectional questionnaire data were drawn from a prospective, community-based cohort of women sex workers in Vancouver (AESHA) from April 2020 to 2021. Bivariate and multivariable logistic regression was used to investigate structural correlates of negative changes in drug supply during COVID-19 among sex workers who use drugs. RESULTS Among 179 sex workers who use drugs, 68.2% reported experiencing negative changes to drug supply during COVID-19, 54.2% recently accessed overdose prevention sites, and 44.7% reported experiencing recent healthcare barriers. In multivariable analysis adjusted for injection drug use, women who reported negative changes in illicit drug supply had higher odds of experiencing recent healthcare barriers (AOR 2.28, 95%CI 1.12-4.62); those recently accessing overdose prevention sites (AOR 1.75, 95%CI 0.86-3.54) faced marginally higher odds also. CONCLUSIONS Over two-thirds of participants experienced negative changes to illicit drug supply during the first year of the COVID-19 pandemic. The association between experiencing negative changes in the illicit drug supply and accessing overdose prevention services highlights the agency of women in taking measures to address overdose-related risks. Highly criminalized women who experience structural barriers to direct services are also vulnerable to fluctuations in the illicit drug supply. Attenuating health consequences requires interventions tailored to sex workers' needs.
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Affiliation(s)
- Sarah Moreheart
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Emma Ettinger
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Miriam Goldenberg
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, United States.
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7
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Richards-Jones L, Patel P, Jagpal PK, Lowrie R, Saunders K, Burwood S, Shrestha S, Paudyal V. Provision of drug and alcohol services amidst COVID-19 pandemic: a qualitative evaluation on the experiences of service providers. Int J Clin Pharm 2023; 45:1098-1106. [PMID: 36971897 PMCID: PMC10042098 DOI: 10.1007/s11096-023-01557-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The impact of COVID-19 pandemic on the provision of drug and alcohol (D&A) services and associated outcomes have been under-researched. AIM This study aimed to understand the experiences of service providers in relation to how drug and alcohol (D&A) services were affected during COVID-19 pandemic, including the adaptations made and lessons learnt for the future. METHOD Focus groups and semi-structured interviews were conducted with participants from various D&A service organisations across the UK. Data were audio recorded, followed by transcription and thematic analysis. RESULTS A total of 46 participants representing various service providers were recruited between October and January 2022. The thematic analysis identified ten themes. COVID-19 required significant changes to how the treatment was provided and prioritised. Expansion of telehealth and digital services were described, which reduced service wait times and increased opportunities for peer network. However, they described missed opportunities for disease screening, and some users risked facing digital exclusion. Participants who provided opiate substitution therapy service spoke of improving service provider/user trust following the shift from daily supervised treatment consumption to weekly dispensing. At the same time, they feared fatal overdoses and non-adherence to treatment. CONCLUSION This study demonstrates the multifaceted impact of the COVID-19 pandemic on UK-based D&A service provisions. The long-term impact of reduced supervision on Substance Use Disorder treatment and outcomes and any effect of virtual communications on service efficiency, patient-provider relationships and treatment retention and successes are unknown, suggesting the need for further study to assess their utility.
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Affiliation(s)
- Levi Richards-Jones
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Priya Patel
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Parbir Kaur Jagpal
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard Lowrie
- Pharmacy and Prescribing Support Unit, NHS Glasgow and Clyde, Glasgow, G76 7AT, UK
| | | | | | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Allen ST, Schneider KE, Morris M, Saloner B, Sherman SG. Factors Associated with HIV Testing Among People Who Inject Drugs: Findings from a Multistate Study at the Start of the COVID-19 Pandemic. AIDS Behav 2023; 27:1674-1681. [PMID: 36327014 PMCID: PMC9632597 DOI: 10.1007/s10461-022-03899-9] [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] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Few studies have examined HIV testing among people who inject drugs (PWID) during the COVID-19 pandemic. This study examines factors associated with PWID who have been recently (past six months) tested for HIV during the COVID-19 pandemic. PWID were recruited between August 2020 and January 2021 from 22 drug treatment and harm reduction programs in nine states and the District of Columbia. We used logistic regression to identify correlates of recent HIV testing among PWID (n = 289). Most (52.9%) PWID reported having been recently tested for HIV. Factors associated with recent HIV testing included: having attended college [adjusted odds ratio (aOR) 2.32, 95% confidence interval (95% CI) 1.32-4.10], weekly hunger (aOR 2.08, 95% CI 1.20-3.60), crystal methamphetamine injection (aOR 2.04, 95% CI 1.05-3.97), and non-metropolitan residence (aOR 0.33, 95% CI 0.13, 0.88). Findings suggest HIV testing initiatives should be expanded during times of crisis, such as global pandemics.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA.
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., 21205, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
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Foreman-Mackey A, Xavier J, Corser J, Fleury M, Lock K, Mehta A, Lamb J, McDougall J, Newman C, Buxton JA. "It's just a perfect storm": Exploring the consequences of the COVID-19 pandemic on overdose risk in British Columbia from the perspectives of people who use substances. BMC Public Health 2023; 23:640. [PMID: 37013524 PMCID: PMC10069735 DOI: 10.1186/s12889-023-15474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Despite the implementation and expansion of public health and harm reduction strategies aimed at preventing and reversing overdoses, rates of overdose-related events and fatalities continue to rise in British Columbia. The COVID-19 pandemic created a second, concurrent public health emergency that further exacerbated the illicit drug toxicity crisis, reinforced existing social inequities and vulnerabilities, and highlighted the precariousness of systems in place that are meant to protect the health of communities. By exploring the perspectives of people with recent experience of illicit substance use, this study sought to characterize how the COVID-19 pandemic and associated public health measures influenced risk and protective factors related to unintentional overdose by altering the environment in which people live and use substances, influencing the ability of people who use substances to be safe and well. METHODS One-on-one semi-structured interviews were conducted by phone or in-person with people who use illicit substances (n = 62) across the province. Thematic analysis was performed to identify factors shaping the overdose risk environment. RESULTS Participants pointed to factors that increased risk of overdose, including: [1] physical distancing measures that created social and physical isolation and led to more substance use alone without bystanders nearby able to respond in the event of an emergency; [2] early drug price spikes and supply chain issues that created inconsistencies in drug availability; [3] increasing toxicity and impurities in unregulated substances; [4] restriction of harm reduction services and supply distribution sites; and [5] additional burden placed on peer workers on the frontlines of the illicit drug toxicity crisis. Despite these challenges, participants highlighted factors that protected against overdose and substance-related harm, including the emergence of new programs, the resiliency of communities of people who use substances who expanded their outreach efforts, the existence of established social relationships, and the ways that individuals consistently prioritized overdose response over concerns about COVID-19 transmission to care for one another. CONCLUSIONS The findings from this study illustrate the complex contextual factors that shape overdose risk and highlight the importance of ensuring that the needs of people who use substances are addressed in future public health emergency responses.
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Affiliation(s)
- Annie Foreman-Mackey
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Jessica Xavier
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Jenny Corser
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Mathew Fleury
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Faculty of Health Sciences, SFU, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- First Nations Health Authority, 540-757 West Hastings St, Vancouver, BC, V6C 1A1, Canada
| | - Kurt Lock
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Amiti Mehta
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- First Nations Health Authority, 540-757 West Hastings St, Vancouver, BC, V6C 1A1, Canada
| | - Jessica Lamb
- Professionals for Ethical Engagement of Peers, Peer Engagement and Evaluation Project, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Jenny McDougall
- Professionals for Ethical Engagement of Peers, Peer Engagement and Evaluation Project, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Cheri Newman
- Professionals for Ethical Engagement of Peers, Peer Engagement and Evaluation Project, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Jane A Buxton
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Wiessing L, Sypsa V, Abagiu AO, Arble A, Berndt N, Bosch A, Buskin S, Chemtob D, Combs B, Conyngham C, Feelemyer J, Fitzgerald M, Goldberg D, Hatzakis A, Patrascu RE, Keenan E, Khan I, Konrad S, Leahy J, McAuley A, Menza T, Merrick S, Metcalfe R, Rademaker T, Revivo S, Rosca P, Seguin-Devaux C, Skinner S, Smith C, Tinsley J, Wilberg M, Des Jarlais D. Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel. AIDS Behav 2023; 27:1140-1153. [PMID: 36367613 PMCID: PMC9651099 DOI: 10.1007/s10461-022-03851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.
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Affiliation(s)
- Lucas Wiessing
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289, Lisbon, Portugal.
| | - V Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A O Abagiu
- National Institute for Infectious Diseases, Bucharest, Romania
| | - A Arble
- Hamilton County Public Health, Cincinnati, OH, USA
| | - N Berndt
- Luxembourg National Focal Point of the European Monitoring Centre for Drugs and Drug Addiction, Department of Epidemiology and Statistics, Directorate of Health, Luxembourg-Hamm, Luxembourg
| | - A Bosch
- STD, HIV, and TB Section - Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, St. Paul, MN, USA
| | - S Buskin
- University of Washington, Seattle, WA, USA
- Public Health - Seattle & King County, Seattle, WA, USA
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - B Combs
- Scott County Health Department, Scottsburg, IN, USA
| | - C Conyngham
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - J Feelemyer
- School of Global Public Health, New York University, New York, NY, USA
| | - M Fitzgerald
- National Social Inclusion Office, Health Services Executive, Dublin, Ireland
| | - D Goldberg
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - R E Patrascu
- National Institute for Infectious Diseases, Bucharest, Romania
| | - E Keenan
- National Social Inclusion Office, Health Services Executive, Dublin, Ireland
| | - I Khan
- First Nations and Inuit Health Branch, Indigenous Services Canada, Regina, Canada
| | - S Konrad
- First Nations and Inuit Health Branch, Indigenous Services Canada, Regina, Canada
| | - J Leahy
- Oregon Health Authority, Portland, OR, USA
| | - A McAuley
- Public Health Scotland, Glasgow, Scotland, United Kingdom
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - T Menza
- Oregon Health Authority, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | - S Merrick
- Hamilton County Public Health, Cincinnati, OH, USA
| | - R Metcalfe
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
- Sandyford Sexual Health Service, Glasgow, Scotland, United Kingdom
| | - T Rademaker
- Hamilton County Public Health, Cincinnati, OH, USA
| | - S Revivo
- Izhar Needle and Syringe Programme, Public Health Association, Jerusalem, Israel
| | - P Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health, Jerusalem, Israel
| | - C Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Skinner
- University of Saskatchewan, Saskatoon, Canada
| | - C Smith
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - J Tinsley
- Public Health - Seattle & King County, Seattle, WA, USA
| | - M Wilberg
- Minnesota Department of Human Services, St. Paul, Minnesota, USA
| | - D Des Jarlais
- School of Global Public Health, New York University, New York, NY, USA
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11
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Allen ST, Schneider KE, Morris M, Rouhani S, Harris SJ, Saloner B, Sherman SG. Factors associated with receptive injection equipment sharing among people who inject drugs: findings from a multistate study at the start of the COVID-19 pandemic. Harm Reduct J 2023; 20:18. [PMID: 36793041 PMCID: PMC9930060 DOI: 10.1186/s12954-023-00746-5] [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: 10/05/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Receptive injection equipment sharing (i.e., injecting with syringes, cookers, rinse water previously used by another person) plays a central role in the transmission of infectious diseases (e.g., HIV, viral hepatitis) among people who inject drugs. Better understanding these behaviors in the context of COVID-19 may afford insights about potential intervention opportunities in future health crises. OBJECTIVE This study examines factors associated with receptive injection equipment sharing among people who inject drugs in the context of COVID-19. METHODS From August 2020 to January 2021, people who inject drugs were recruited from 22 substance use disorder treatment programs and harm reduction service providers in nine states and the District of Columbia to complete a survey that ascertained how the COVID-19 pandemic affected substance use behaviors. We used logistic regression to identify factors associated with people who inject drugs having recently engaged in receptive injection equipment sharing. RESULTS One in four people who inject drugs in our sample reported having engaged in receptive injection equipment sharing in the past month. Factors associated with greater odds of receptive injection equipment sharing included: having a high school education or equivalent (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [95% CI] 1.24, 3.69), experiencing hunger at least weekly (aOR = 1.89, 95% CI 1.01, 3.56), and number of drugs injected (aOR = 1.15, 95% CI 1.02, 1.30). Older age (aOR = 0.97, 95% CI 0.94, 1.00) and living in a non-metropolitan area (aOR = 0.43, 95% CI 0.18, 1.02) were marginally associated with decreased odds of receptive injection equipment sharing. CONCLUSIONS Receptive injection equipment sharing was relatively common among our sample during the early months of the COVID-19 pandemic. Our findings contribute to existing literature that examines receptive injection equipment sharing by demonstrating that this behavior was associated with factors identified in similar research that occurred before COVID. Eliminating high-risk injection practices among people who inject drugs requires investments in low-threshold and evidence-based services that ensure persons have access to sterile injection equipment.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD, 21205, USA.
| | - Kristin E Schneider
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD, 21205, USA
| | - Miles Morris
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD, 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD, 21205, USA
| | - Samantha J Harris
- Department of Health Policy and Management; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Brendan Saloner
- Department of Health Policy and Management; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD, 21205, USA
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12
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Torres-Leguizamon M, Favaro J, Coello D, Reynaud EG, Néfau T, Duplessy C. Remote harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA. Harm Reduct J 2023; 20:1. [PMID: 36611167 PMCID: PMC9823260 DOI: 10.1186/s12954-023-00732-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Harm Reduction (HR) policies for People Who Use Drugs (PWUD) have a significant positive impact on their health. Such approaches limit the spread of infections and reduce opioid overdose mortality. These policies have led to the opening of specialized structures located mainly in big cities and urbanized zones. The COVID-19 pandemic reduced access to HR structures in locations undergoing lockdown. Before the pandemic, HR services in France and in the USA were complemented by the development of remote HR programs: HaRePo (Harm Reduction by Post) for France, implemented in 2011, and NEXT Distro for the USA founded in 2017. These programs are free and specifically designed for people who have difficulties accessing HR tools and counseling in-person. PWUD can access HaRePo program by phone and/or email. NEXT Distro users can access the program through its dedicated website. The aim of the study is to test if and possibly how COVID-19 pandemic and the associated lockdowns have impacted the HR services in both countries. METHODS By using t-test comparing the year 2019 with the year 2020, we analyzed how lockdowns impacted the number of new users entering the programs, as well as the numbers of parcels sent and naloxone distributed, by using records of both structures. RESULTS We showed that the activity of both programs was significantly impacted by the pandemic. Both show an increase in the number of new users joining the programs (+ 77.6% for HaRePo and + 247.7% for NEXT Distro) as well as for the number of parcels sent per month (+ 42.7% for HaRePo and + 211.3% for NEXT Distro). It shows that remote HR was able to partially compensate for the reduced HR activities due to COVID-19. We also observed that the distribution of naloxone per parcel tends to increase for both structures. CONCLUSION With the ability to reach PWUD remotely, HaRePo and NEXT Distro were particularly effective at maintaining service continuity and scaling up services to meet the needs of PWUD during the COVID-19 pandemic. By studying two independent structures in France and in the USA sharing similar objectives (remote HR), we showed that this approach can be a key solution to crises that impact classical HR structures despite various differences in operating procedures between countries.
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Affiliation(s)
| | | | | | - Emmanuel G. Reynaud
- grid.7886.10000 0001 0768 2743School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Thomas Néfau
- SAFE, 11 Avenue de la Porte de la Plaine, 75015 Paris, France
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13
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Lessons from the COVID-19 pandemic for substance misuse services: findings from a peer-led study. Harm Reduct J 2022; 19:140. [PMID: 36503439 PMCID: PMC9742020 DOI: 10.1186/s12954-022-00713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The measures implemented to contain the spread of the COVID-19 virus disrupted the provision of substance misuse treatment and support. However, little is known about the impact of this disruption on individuals seeking treatment for drug- and/or alcohol-related problems (henceforth service users). This study aimed to help substance misuse services learn lessons and identify ways of optimising delivery and minimising harm in the event of any future lockdowns or global crises. METHODS The study was co-produced by a team of peer researchers, practitioners, policymakers and academics. Telephone interviews were conducted with 202 substance misuse service users over a 6-month period commencing June 2020. The interviews were conducted by a small group of seven peer researchers each with lived experience of substance use problems. The interview data were recorded by the peers in an anonymous online questionnaire survey and analysed using standard quantitative and qualitative methods. RESULTS Service users responded to the COVID-19 pandemic in a variety of ways. Diverse responses were noted in relation to their substance use patterns, their personal lives and their substance misuse treatment experiences. For some, the pandemic acted as a new risk environment factor that increased their vulnerability to substance-related harm. For others, it facilitated aspects of the enabling environment, thereby reducing the risk of harm. CONCLUSIONS Service users are not a homogenous group, and an individualised approach to treatment that recognises the potential for varied responses to the same stimuli is needed. The findings suggest that service users would benefit from having a choice in how they access treatment and from greater access to outreach programmes that take treatments and harm reduction tools such as naloxone into the community. The research also supports the involvement of people with lived experience in substance use research, policy and practice.
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Zolopa C, Brothers TD, Leclerc P, Mary JF, Morissette C, Bruneau J, Hyshka E, Martin NK, Larney S. Changes in supervised consumption site use and emergency interventions in Montréal, Canada in the first twelve months of the COVID-19 pandemic: An interrupted time series study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103894. [PMID: 36308892 PMCID: PMC9574459 DOI: 10.1016/j.drugpo.2022.103894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has impacted supervised consumption site (SCS) operations in Montréal, Canada, potentially including changes in SCS visits, on-site emergency interventions, injection of specific drugs, and distribution of harm reduction materials. METHOD We used administrative data from all four Montréal SCS from 1 March 2018 - 28 February 2021 to conduct an interrupted time series study with 13 March 2020 as the intervention point. We employed segmented regression using generalised least squares fit by maximum likelihood. We analysed monthly SCS visits and materials distributed as counts, and emergency interventions and drugs injected as proportions of visits. RESULTS SCS visits (level change = -1,286; 95% CI [-1,642, -931]) and the proportion of visits requiring emergency intervention (level = -0.27% [-0.47%, -0.06%]) decreased immediately in March 2020, followed by an increasing trend in emergency interventions (slope change = 0.12% [0.10%, 0.14%]) over the ensuing 12 months. Over the same period, the proportion of injections involving opioids increased (slope = 0.05% [0.03%, 0.07%]), driven by increasing pharmaceutical opioid and novel synthetic opioid injections. Novel synthetic opioids were the drugs most often injected prior to overdose. The proportion of injections involving unregulated amphetamines increased immediately (level = 7.83% [2.93%, 12.73%]), then decreased over the next 12 months (slope = -1.86% [-2.51%, -1.21%]). There was an immediate increase in needle/syringe distribution (level = 16,552.81 [2,373, 30,732]), followed by a decreasing trend (slope = -2,398 [-4,218, -578]). There were no changes in pre-existing increasing trends in naloxone or fentanyl test strip distribution. CONCLUSION Reduced SCS use and increasing emergency interventions at SCS are cause for serious concern. Findings suggest increased availability of novel synthetic opioids in Montréal, heightening overdose risk.
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Affiliation(s)
- Camille Zolopa
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec H2X 0A9, Canada
| | - Thomas D Brothers
- Department of Medicine, Dalhousie University, 6299 South St., Halifax, Nova Scotia B3H 4R2, Canada; UCL Collaborative Centre for Inclusion Health, University College London, 1-19 Torrington Pl., London, WC1E 7HB, United Kingdom
| | - Pascale Leclerc
- Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (CIUSSS), 1560 rue Sherbrooke E, Montréal, Québec H2L 4M1, Canada
| | | | - Carole Morissette
- Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (CIUSSS), 1560 rue Sherbrooke E, Montréal, Québec H2L 4M1, Canada; Direction régionale de santé publique, 1560 rue Sherbrooke Est, Pavillon JA de Sève, Montréal, Québec, H2L 4M1, Canada
| | - Julie Bruneau
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec H2X 0A9, Canada; Department of Emergency and Family Medicine, Université de Montréal, 2900 blvd Edouard Montpetit, Montréal, Québec H3T 1J4, Canada
| | - Elaine Hyshka
- School of Public Health, College of Health Sciences, University of Alberta, 11405 87th ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Sarah Larney
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec H2X 0A9, Canada; Department of Emergency and Family Medicine, Université de Montréal, 2900 blvd Edouard Montpetit, Montréal, Québec H3T 1J4, Canada; National Drug and Alcohol Research Centre, UNSW Sydney, Anzac Parade, Kensington NSW 2052, Australia.
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15
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Behavioural Risk for HIV, Hepatitis B, and Hepatitis C Infections among a Population of Drug Users and Injectors across Four Regions in Ghana. Interdiscip Perspect Infect Dis 2022; 2022:2544481. [PMID: 36092389 PMCID: PMC9458387 DOI: 10.1155/2022/2544481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Blood borne infections such as HIV, Hepatitis B (HBV), and Hepatitis C (HCV) are of great importance to governments and their implementing partners, especially among people who use drugs (PWUD) and people who inject drugs (PWID). Prevalence and determinants of HIV, HBV, and HCV among PWUD and PWID in Ghana are not well established, the significance of this study. Method This assessment was a cross-sectional study implemented via the respondent driven sampling approach. A team of community advisory boards that comprised former users, current users, and civil society organizations were constituted to help in the implementation of the study. The study was conducted in four regions in Ghana. The assessment was based on a representation of populations of PWID and PWUD from the four regions. Efforts were made by the team to ensure adequate representation of women where feasible. A quantitative questionnaire was developed and used to obtain information on the respondents' sociodemographics, sexual behavior, substance use, and biological characteristics. The prevalence of HIV, HBV, and HCV among PWID and PWUD was determined using blood samples. First response and oral quick test for confirmation of HIV positivity were carried out, while SD bioline was used to test for the presence of HBV and HBC. Data were analyzed using the Bayesian generalized linear model via the binomial family of distributions under the logit link function with weak Cauchy and Normal distribution as prior. Results A total of 323 PWUD and PWID participants were interviewed across four regions of Ghana. The overall median age of the respondents was 36 (28, 43) years. The prevalence of HIV, HBV, and HCV infection in the study was 2.5%, 4.6%, and 5.9%, respectively. The prevalence of HIV, HBV, and HCV among drug users was 2.5% (95% CI: 0.7%–4.2%), 4.1% (95% CI: 1.8%–6.2%), and 6.7% (95% CI: 3.9%–9.4%), respectively. Most drug injectors and users started using and injecting drugs at ages less than 20 years and between 20 and 29 years, respectively. Drug users who identified themselves as part of the general population were 66% less likely to be tested HIV positive (POR = 0.34, CrI: 0.12–0.81) compared to sex workers. Part time employment respondents had fivefold odds (POR = 5.50, CrI: 1.20–16.16) of being HBV positive as against full-time employment. Conclusion Most of the injectors and users started drugs at an early age. Drug users and injectors are at higher risk of these infections because of associated risky sexual behaviors and risky injection practices. Harm reduction programs to help addicts who are willing to quit the practice are recommended.
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Chieh K, Patel I, Walter L, Li L. Disparities in naloxone prescriptions in a University Hospital during the COVID-19 pandemic. Harm Reduct J 2022; 19:84. [PMID: 35883136 PMCID: PMC9321310 DOI: 10.1186/s12954-022-00667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Per the CDC, it is estimated that 69,710 opioid overdose deaths occurred in the United States from September 2019 to September 2020. However, it is unclear whether naloxone prescribing also increased or otherwise fluctuated in this time. The objective of this study was to characterize the naloxone prescribing rate in patients with opioid use disorder (OUD) at the University of Alabama at Birmingham Hospital in 2019 and 2020. METHODS A cross-sectional, retrospective medical record review was performed on patients with OUD from January 2019 through December 2020. Naloxone prescribing, defined as either a written prescription or a provided take-home kit, was assessed for all patients with OUD. RESULTS In 2019, 11,959 visits were made by 2962 unique patients with OUD, compared to 11,661 visits from 2,641 unique patients in 2020; 609 naloxone prescriptions were provided in 2019 (5.1%) and 619 in 2020 (5.3%). In both years, most OUD-related visits and naloxone prescriptions were from and to male, white, individuals. Compared with 2019, more naloxone prescriptions were given to uninsured patients in 2020 (33.2% vs 44.3%, p < 0.05), and more OUD patients were admitted to inpatient settings (26.0% vs 31.2%, p < 0.05) and received more naloxone prescriptions in the inpatient setting (46.3% vs 62.0%, p < 0.05) in 2020. The proportion of frequent users (i.e., visits ≥ 4 times/year) increased in 2020 for the emergency department (21.5% vs 26.4%, p < 0.001) and inpatient setting (24.9% vs 28.6%, p = 0.03). CONCLUSIONS Our findings indicate the need for improving naloxone awareness in providers and prescribing for patients with OUD, particularly in emergency department and outpatient settings. Our results also demonstrated a disparity in naloxone prescribing; a disproportionate number of opioid-related emergency department visits and overdose deaths were noted in Black people and frequent users.
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Affiliation(s)
- Kimberly Chieh
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 University Blvd., Birmingham, AL, 35294, USA
| | - Ishika Patel
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 University Blvd., Birmingham, AL, 35294, USA
| | - Lauren Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 University Blvd., Birmingham, AL, 35294, USA.
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17
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Urtaran-Laresgoiti M, González-Rábago Y, Martín U, Rivadeneyra-Sicilia A, Morteruel M. Health and health inequalities impact assessment for non-clinical measures to control COVID-19 in the Basque Country and Navarre (Spain). J Public Health Res 2022; 11:22799036221110020. [PMID: 35911433 PMCID: PMC9335482 DOI: 10.1177/22799036221110020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022] Open
Abstract
This article describes the results of a health and health inequalities impact assessment of the COVID-19 pandemic control measures in the regions of the Basque Country and Navarre in Spain. A literature review was conducted on Pubmed and Web of Science (WoS) databases, in addition to individual semi-structured interviews and focus groups with experts, key informants and different profiles of citizens. A wide variety of social determinants of health have been affected by the measures, which included individual health-related behaviors, service disruption in formal care, educational settings, and health care provision. These changes have particularly affected certain population groups including children and adolescents, older people, those with health conditions and disabilities together with caregivers, women, as well as people with low levels of education, income, and resources. In future scenarios it will be necessary to pay attention to the potential impacts of policy responses on health inequalities to avoid an increase in existing health gaps.
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Affiliation(s)
- M Urtaran-Laresgoiti
- Department of Sociology and Social Work, University of Basque Country (UPV/EHU), Leioa, Spain.,Research Group Social Determinants of Health and Demographic Change-OPIK, Leioa, Spain
| | - Y González-Rábago
- Department of Sociology and Social Work, University of Basque Country (UPV/EHU), Leioa, Spain.,Research Group Social Determinants of Health and Demographic Change-OPIK, Leioa, Spain
| | - U Martín
- Department of Sociology and Social Work, University of Basque Country (UPV/EHU), Leioa, Spain.,Research Group Social Determinants of Health and Demographic Change-OPIK, Leioa, Spain
| | - A Rivadeneyra-Sicilia
- ISPED, University of Bordeaux, Bordeaux Population Health Research Centre U1219-, Bordeaux, France
| | - M Morteruel
- Research Group Social Determinants of Health and Demographic Change-OPIK, Leioa, Spain.,Department of Nursing I, University of the Basque Country (UPV/EHU), Leioa, Spain
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18
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Muller A, Akiyama MJ, Riback L, Nyakowa M, Musyoki H, Cherutich P, Kurth A. Impact of COVID-19 on substance use disorder treatment services in Kenya: Qualitative findings from healthcare providers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103710. [PMID: 35580533 PMCID: PMC9106529 DOI: 10.1016/j.drugpo.2022.103710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND People who inject drugs are at an increased risk for contracting SARS-CoV-2 and have experienced barriers to accessing harm reduction services during the COVID-19 pandemic. Understanding how to best provide these services is essential for COVID-19 mitigation. The goal of this study was to ascertain challenges and successes for caring for people who inject drugs in Kenya during the COVID-19 pandemic. METHODS We conducted focus group discussions and one-on-one key informant interviews with healthcare providers who work with people who inject drugs in Kenya. Interviews explored how COVID-19 and social distancing measures impacted service provision, as well as what strategies were used to overcome these barriers. We used thematic analysis to analyze transcribed interviews. RESULTS Participants included 29 service providers from 11 healthcare professions at three medication assisted treatment (MAT) and four drop-in center (DIC) sites (N=15 males and N=14 females, with an average age of 35 years). Four overarching themes emerged in our thematic analysis in which providers described both barriers to providing care and solutions to overcome them: (1) COVID-19-related misconceptions; (2) Limited COVID-19 testing and screening; (3) Structural changes related to service provision; and (4) Access to material resources such as meals, needle and syringe program kits, and personal protective equipment. CONCLUSIONS Our findings demonstrate the COVID-19 pandemic-imposed challenges for substance use disorder treatment providers and patients, however with ingenuity many of these challenges were able to be overcome.
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Affiliation(s)
- Abbe Muller
- Boston University School of Medicine, Boston, Massachusetts, USA.
| | - Matthew J Akiyama
- Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, USA
| | - Lindsey Riback
- Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, USA
| | - Mercy Nyakowa
- Kenya Ministry of Health, National AIDS & STI Control Program (NASCOP), Nairobi, Kenya
| | - Helgar Musyoki
- Kenya Ministry of Health, National AIDS & STI Control Program (NASCOP), Nairobi, Kenya
| | - Peter Cherutich
- Kenya Ministry of Health, National AIDS & STI Control Program (NASCOP), Nairobi, Kenya
| | - Ann Kurth
- Yale University School of Nursing, Orange CT
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19
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Glick JL, Grieb SM, Harris SJ, Weir BW, Smith KC, Puryear T, Hamilton White R, Allen ST. Exploring the impact of the COVID-19 pandemic on syringe services programs in rural Kentucky. Harm Reduct J 2022; 19:47. [PMID: 35590373 PMCID: PMC9117854 DOI: 10.1186/s12954-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The coronavirus pandemic (COVID-19) exacerbated risks for adverse health consequences among people who inject drugs by reducing access to sterile injection equipment, HIV testing, and syringe services programs (SSPs). Several decades of research demonstrate the public health benefits of SSP implementation; however, existing evidence primarily reflects studies conducted in metropolitan areas and before the COVID-19 pandemic. OBJECTIVES We aim to explore how the COVID-19 pandemic affected SSP operations in rural Kentucky counties. METHODS In late 2020, we conducted eighteen in-depth, semi-structured interviews with persons (10 women, 8 men) involved in SSP implementation in rural Kentucky counties. The interview guide broadly explored the barriers and facilitators to SSP implementation in rural communities; participants were also asked to describe how COVID-19 affected SSP operations. RESULTS Participants emphasized the need to continue providing SSP-related services throughout the pandemic. COVID-19 mitigation strategies (e.g., masking, social distancing, pre-packing sterile injection equipment) limited relationship building between staff and clients and, more broadly, the pandemic adversely affected overall program expansion, momentum building, and coalition building. However, participants offered multiple examples of innovative solutions to the myriad of obstacles the pandemic presented. CONCLUSION The COVID-19 pandemic impacted SSP operations throughout rural Kentucky. Despite challenges, participants reported that providing SSP services remained paramount. Diverse adaptative strategies were employed to ensure continuation of essential SSP services, demonstrating the commitment and ingenuity of program staff. Given that SSPs are essential for preventing adverse injection drug use-associated health consequences, further resources should be invested in SSP operations to ensure service delivery is not negatively affected by co-occurring crises.
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Affiliation(s)
- Jennifer L. Glick
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Suzanne M. Grieb
- grid.21107.350000 0001 2171 9311Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21224 USA
| | - Samantha J. Harris
- grid.21107.350000 0001 2171 9311Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Brian W. Weir
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Katherine C. Smith
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Tyler Puryear
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Rebecca Hamilton White
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Sean T. Allen
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
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20
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Otiashvili D, Kirtadze I, Mgebrishvili T, Beselia A, Tabatadze M, Vardanashvili I, Ober AJ. Implementation and evaluation of a syringe vending machine trial in Tbilisi, Georgia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103649. [PMID: 35299004 DOI: 10.1016/j.drugpo.2022.103649] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Syringe vending machines (SVM) have proven to be an effective vehicle for providing an uninterrupted supply of sterile equipment to PWID, but they have not been implemented or disseminated broadly. The aim of this study was to implement and evaluate outcomes of introducing SVM in Tbilisi, Georgia. METHODS We installed SVM at five HIV prevention sites in 10 locations in Tbilisi, Georgia and studied implementation over 20 months. We used the RE-AIM framework to assess outcomes across four RE-AIM domains: reach, effectiveness at providing syringe access, adoption and implementation. RESULTS Reach. SVM reached 8% of the target population. Effectiveness at Providing Syringe Access. SVM dispensed 14% of all syringes distributed by HIV prevention services. Using SVM was associated with PWID receiving more sterile syringes from HIV prevention outlets. Adoption. All HIV prevention sites (N=5) invited to implement SVM agreed to participate. Sixty one percent of PWID who received SVM access cards used SVM at least once. Women and young PWID were more likely to use SVM compared to other PWID. IMPLEMENTATION At some sites adherence of the outreach staff to the operational protocol was suboptimal. CONCLUSIONS SVM are an acceptable, feasible and effective intervention for improving access to sterile injection equipment for PWID. Future research will need to elaborate approaches to build the sense of ownership and improve motivation of the field staff to engage with the new intervention, and to examine strategies for attracting groups of PWID who are not in contact with prevention and treatment services.
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Affiliation(s)
- David Otiashvili
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia; School of Natural Sciences and Medicine, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., Tbilisi 0162, Georgia.
| | - Irma Kirtadze
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia; School of Arts and Sciences, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., Tbilisi 0162, Georgia
| | - Tamar Mgebrishvili
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia
| | - Ada Beselia
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia
| | - Mzia Tabatadze
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia
| | - Irina Vardanashvili
- School of Business, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., Tbilisi 0162, Georgia
| | - Allison J Ober
- RAND Corporation, 1776 Main Street PO Box 2138 Santa Monica, CA 90407-2138, United States
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21
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Efunnuga H, Higgs P, Walker S, O'Keefe D. Health service utilisation and access for people who inject drugs during COVID-19. Drug Alcohol Rev 2022; 41:1304-1310. [PMID: 35266229 PMCID: PMC9111766 DOI: 10.1111/dar.13456] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The wide-spread implementation of interventions to limit transmission and public health consequences of COVID-19 in the Australian state of Victoria had flow-on consequences for people who use and inject drugs. Consequences included the interruption of illicit drug supply and drug procurement, and the disruption to the delivery of health services. To inform strategies that can minimise the adverse outcomes of similar future disruptive events, this study explored how COVID-19 restrictions impacted access to harm reduction and drug treatment services for people who inject drugs in Melbourne, Victoria. METHODS Qualitative semi-structured interviews were conducted via an online calling app, with 11 participants of a broader cohort study (the SuperMIX study) in April 2020. Interviews were focused on participants experiences of accessing and using harm reduction and drug treatment services. Data were thematically analysed using a process of blended coding. RESULTS Findings revealed how disruptions in the delivery of harm reduction and drug treatment services-in response to COVID-19 restrictions-created barriers accessing sterile injecting equipment, increased risk of arrest by police and exacerbated social isolation. Participants reported difficulties adapting to changes in services access, with some increases in injecting risk behaviours. However, improvements in opioid agonist therapy prescriptions were noted as a beneficial outcome. DISCUSSION By examining the impacts of COVID-19 and the resultant restrictions on people who inject drugs' access to health services in Melbourne, Victoria, findings provide guidance for future responses to the unanticipated large-scale effects of the COVID-19 pandemic, and similar disruptive events.
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Affiliation(s)
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia.,Behaviours and Health Risks, Burnet Institute, Melbourne, Australia
| | - Shelley Walker
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia.,National Drug Research Institute, Curtin University, Perth, Australia
| | - Daniel O'Keefe
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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22
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Trayner KM, McAuley A, Palmateer NE, Yeung A, Goldberg DJ, Glancy M, Hunter C, Ritchie T, Craik J, Raeburn F, McTaggart S, Barnsdale L, Campbell J, Shepherd SJ, Bradley-Stewart A, Gunson RN, Templeton K, Hutchinson SJ. Examining the impact of the first wave of COVID-19 and associated control measures on interventions to prevent blood-borne viruses among people who inject drugs in Scotland: an interrupted time series study. Drug Alcohol Depend 2022; 232:109263. [PMID: 35120807 PMCID: PMC8802039 DOI: 10.1016/j.drugalcdep.2021.109263] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND COVID-19 has likely affected the delivery of interventions to prevent blood-borne viruses (BBVs) among people who inject drugs (PWID). We examined the impact of the first wave of COVID-19 in Scotland on: 1) needle and syringe provision (NSP), 2) opioid agonist therapy (OAT) and 3) BBV testing. METHODS An interrupted time series study design; 23rd March 2020 (date of the first 'lockdown') was chosen as the key date. RESULTS The number of HIV tests and HCV tests in drug services/prisons, and the number of needles/syringes (N/S) distributed decreased by 94% (RR=0.062, 95% CI 0.041-0.094, p < 0.001), 95% (RR=0.049, 95% CI 0.034-0.069, p < 0.001) and 18% (RR = 0.816, 95% CI 0.750-0.887, p < 0.001), respectively, immediately after lockdown. Post-lockdown, an increasing trend was observed relating to the number of N/S distributed (0.6%; RR = 1.006, 95% CI 1.001-1.012, p = 0.015), HIV tests (12.1%; RR = 1.121, 95% CI 1.092-1.152, p < 0.001) and HCV tests (13.2%; RR = 1.132, 95 CI 1.106-1.158, p < 0.001). Trends relating to the total amount of methadone prescribed remained stable, but a decreasing trend in the number of prescriptions (2.4%; RR = 0.976, 95% CI 0.959-0.993, p = 0.006) and an increasing trend in the quantity prescribed per prescription (2.8%; RR = 1.028, 95% CI 1.013-1.042, p < 0.001) was observed post-lockdown. CONCLUSIONS COVID-19 impacted the delivery of BBV prevention services for PWID in Scotland. While there is evidence of service recovery; further effort is likely required to return some intervention coverage to pre-pandemic levels in the context of subsequent waves of COVID-19.
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Affiliation(s)
- Kirsten M.A. Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK,Corresponding author at: School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Norah E. Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - David J. Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Megan Glancy
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Carole Hunter
- NHS Greater Glasgow and Clyde Addiction Services, 150 Brand Street, Glasgow, G51 1DH, UK
| | - Trina Ritchie
- NHS Greater Glasgow and Clyde Addiction Services, 150 Brand Street, Glasgow, G51 1DH, UK
| | - Julie Craik
- Public Health Protection Unit, Gartnaval Royal Hospital, NHS Greater Glasgow and Clyde, Glasgow, G12 0XH, UK
| | - Fiona Raeburn
- NHS Grampian Drug and Alcohol Services, Fulton Clinic, Royal Cornhill Hospital, Aberdeen, AB25 2ZH, UK
| | - Stuart McTaggart
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Lee Barnsdale
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - John Campbell
- NHS Greater Glasgow and Clyde Addiction Services, 150 Brand Street, Glasgow, G51 1DH, UK
| | - Samantha J. Shepherd
- West of Scotland Specialist Virology Centre, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | | | - Rory N. Gunson
- West of Scotland Specialist Virology Centre, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Kate Templeton
- East of Scotland Specialist Virology Centre, Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - Sharon J. Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
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23
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del Palacio-Gonzalez A, Thylstrup B, Houborg E. The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users’ needs and recommendations for the future. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:175-189. [PMID: 35757093 PMCID: PMC9189563 DOI: 10.1177/14550725211069229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study was to document employees’ experiences of changes in service provision for substance use disorders (SUDs) during the first COVID-19 lockdown in Denmark (spring 2020), as well as to examine their relation to challenges in meeting the service users’ needs. Methods: Employees (N = 373) working in SUD treatment and harm reduction services completed an online survey soon after the first national lockdown. The survey included questions about changes in service provision during the lockdown, perceived concerns of the service users, and challenges in meeting the users’ emerging needs. Results: Employees reported some positive changes in service provisions, such as increased flexibility in appointments, administering medication-assisted treatment (MAT), and use of telehealth. Negative changes were related to reduced contact with practitioners and harm reduction facilities. Approximately one third of employees reported significant challenges in meeting the users’ emerging needs. This was particularly so when users’ concerns were about physical and mental well-being, and substance use. In regression models, negative changes in the access to practitioners and MAT administration (but not other changes) predicted difficulties meeting the users’ needs. Conclusion: Employees in SUD treatment and harm reduction services in Denmark experienced both positive and negative changes as a result of the first lockdown. However, not all the provision changes were linked to challenges in meeting the users’ needs. We discuss practical and research implications of our findings with a focus on the users’ physical and mental health, use of telehealth, MAT, and overall service reorganisation.
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24
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Brewster B, Robinson G, Silverman BW, Walsh D. Covid-19 and child criminal exploitation in the UK: implications of the pandemic for county lines. TRENDS IN ORGANIZED CRIME 2021; 26:156-179. [PMID: 34898976 PMCID: PMC8648145 DOI: 10.1007/s12117-021-09442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 05/17/2023]
Abstract
In March 2020, the UK was placed in lockdown following the spread of the Covid-19 virus. Just as legitimate workplaces made changes to enable their employees to work from home, the illicit drugs trade also made alternative arrangements, adapting its supply models to ensure continuity of operations. Based upon qualitative interviews with 46 practitioners, this paper assesses how front-line professionals have experienced and perceived the impact of Covid-19 on child criminal exploitation and County Lines drug supply in the UK. Throughout the paper, we highlight perceived adaptations to the County Lines supply model, the impact of lockdown restrictions on detection and law enforcement activities aimed at County Lines, and on efforts to safeguard children and young people from criminal exploitation. Our participants generally believed that the pandemic had induced shifts to County Lines that reflected an ongoing evolution of the drug supply model and changes in understanding or attention because of Covid-19 restrictions, rather than a complete reconstitution of the model itself. Practitioners perceived that Covid-19 has had, and continues to have, a significant impact on some young people's vulnerability to exploitation, on the way in which police and frontline practitioners respond to County Lines and child criminal exploitation, and on the way illegal drugs are being moved and sold.
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Affiliation(s)
- Ben Brewster
- Rights Lab, University of Nottingham, Highfield House, University Park, Nottingham, NG7 2RD UK
| | - Grace Robinson
- Rights Lab, University of Nottingham, Highfield House, University Park, Nottingham, NG7 2RD UK
| | - Bernard W. Silverman
- Rights Lab, University of Nottingham, Highfield House, University Park, Nottingham, NG7 2RD UK
| | - Dave Walsh
- De Montfort University School of Law, Vaughan Wy, Leicester, LE1 5XZ UK
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25
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Kesten JM, Holland A, Linton MJ, Family H, Scott J, Horwood J, Hickman M, Telfer M, Ayres R, Hussey D, Wilkinson J, Hines LA. Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103391. [PMID: 34343945 PMCID: PMC8289673 DOI: 10.1016/j.drugpo.2021.103391] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND People who inject drugs (PWID) are a high-risk group for COVID-19 transmission and serious health consequences. Restrictions imposed in the UK in response to the pandemic led to rapid health and housing service alterations. We aimed to examine PWID experiences of: 1) challenges relating to the COVID-19 public health measures; 2) changes to opioid substitution therapy (OST) and harm reduction services; and 3) perceived effects of COVID-19 on drug use patterns and risk behaviour. METHODS Telephone semi-structured interviews were conducted with 28 PWID in Bristol, Southwest of England. Analysis followed a reflexive thematic analysis. RESULTS Concern about COVID-19 and adherence to public health guidance varied. Efforts made by services to continue providing support during the pandemic were appreciated and some changes were preferred, such as less frequent OST collection, relaxation of supervised consumption and needle and syringe programmes (NSP) home delivery. However, remote forms of contact were highlighted as less beneficial and more difficult to engage with than in-person contact. Public health guidance advising people to 'stay home' led to increased isolation, boredom, and time to ruminate which impacted negatively on mental health. Lockdown restrictions directly impacted on sources of income and routine. Changes in drug use were explained as a consequence of isolation and fewer interactions with peers, problems accessing drugs, reduced drug purity and reduced financial resources. CONCLUSION This study captures the significant impacts and challenges of the COVID-19 pandemic on the lives of PWID. While rapid adaptations to service delivery to help mitigate the risks of COVID-19 were appreciated and some changes such as relaxation of supervised daily OST consumption were viewed positively, barriers to access need further attention. Going forwards there may be opportunities to harness the positive aspects of some changes to services.
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Affiliation(s)
- Joanna M Kesten
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, United Kingdom; NIHR Applied Research Collaboration (ARC) West, 9th Floor, Whitefriars, Lewins Mead, Bristol BS1 2NT, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, United Kingdom
| | - Adam Holland
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, United Kingdom
| | - Myles-Jay Linton
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, United Kingdom; School of Education, 35 Berkeley Square, Bristol BS8 1JA, United Kingdom
| | - Hannah Family
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom; Dept Pharmacy & Pharmacology. University of Bath, Claverton Down, Bath BA2 7AY, United Kingdom
| | - Jenny Scott
- Dept Pharmacy & Pharmacology. University of Bath, Claverton Down, Bath BA2 7AY, United Kingdom
| | - Jeremy Horwood
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, United Kingdom; NIHR Applied Research Collaboration (ARC) West, 9th Floor, Whitefriars, Lewins Mead, Bristol BS1 2NT, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, United Kingdom
| | - Matthew Hickman
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, United Kingdom; NIHR Applied Research Collaboration (ARC) West, 9th Floor, Whitefriars, Lewins Mead, Bristol BS1 2NT, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, United Kingdom
| | - Maggie Telfer
- Bristol Drugs Project, 11 Brunswick Square, Bristol BS2 8PE, United Kingdom
| | - Rachel Ayres
- Bristol Drugs Project, 11 Brunswick Square, Bristol BS2 8PE, United Kingdom
| | - Deborah Hussey
- Bristol Drugs Project, 11 Brunswick Square, Bristol BS2 8PE, United Kingdom
| | - Jack Wilkinson
- Bristol Drugs Project, 11 Brunswick Square, Bristol BS2 8PE, United Kingdom
| | - Lindsey A Hines
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom; Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom.
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Bates G, Shepherd S, McVeigh J. Harm reduction strategies for androgen users: providing appropriate support and improving engagement with healthcare. Curr Opin Endocrinol Diabetes Obes 2021; 28:630-635. [PMID: 34534148 DOI: 10.1097/med.0000000000000676] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW As evidence continues to emerge of the harms associated with nonmedical androgen use, this review explores the implications from recent studies for designing strategies to reduce harm and support good health amongst androgen users. RECENT FINDINGS Studies have predominantly come from researchers in the UK and Australia. Major themes include questioning the scope and content of harm reduction strategies and identifying approaches to improve engagement between the androgen using community and healthcare providers. Findings suggest that a broader range of interventions and forms of advice are needed than are commonly provided. This must be supported by efforts to increase opportunities to deliver harm reduction through new engagement approaches, better relationships with health professionals and more guidance on identifying and managing associated adverse health impacts. SUMMARY A fully developed harm reduction-based response to nonmedical androgen use will be one that not only seeks to reduce risk of bloodborne virus transmission and injecting-related harms, but that considers the range of needs amongst the diverse community of androgen users and respects their decisions and rights. Co-producing interventions with members of this community will help develop effective and engaging approaches. Rigorous studies are needed to evaluate new harm reduction interventions as well as those already delivered.
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Affiliation(s)
- Geoff Bates
- Institute for Policy Research, University of Bath, Bath
| | | | - Jim McVeigh
- Department of Sociology, Manchester Metropolitan University, Manchester, UK
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27
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Aponte-Melendez Y, Mateu-Gelabert P, Fong C, Eckhardt B, Kapadia S, Marks K. The impact of COVID-19 on people who inject drugs in New York City: increased risk and decreased access to services. Harm Reduct J 2021; 18:118. [PMID: 34819070 PMCID: PMC8611635 DOI: 10.1186/s12954-021-00568-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background While people who inject drugs (PWID) are vulnerable to the adverse outcomes of events like COVID-19, little is known regarding the impact of the current pandemic on PWID. We examine how COVID-19 has affected PWID in New York City across four domains: substance use, risk behaviors, mental health, and service utilization. Methods As part of a randomized trial to improve access to HCV treatment for PWID, we recruited 165 participants. Eligibility criteria included detectable HCV RNA and recent drug injection. The present cross-sectional analysis is based on a subsample of 106 participants. We compared responses between two separate samples: 60 participants interviewed prior to the pandemic (pre-COVID-19 sample) and 46 participants interviewed during the pandemic (COVID-19 sample). We also assessed differences by study group [accessible care (AC) and usual care (UC)]. Results Compared to the pre-COVID-19 sample, those interviewed during COVID-19 reported higher levels of mental health issues, syringe reuse, and alcohol consumption and greater reductions in syringe-service programs and buprenorphine utilization. In the analysis conducted by study group, the UC group reported significantly higher injection risk behaviors and lower access to buprenorphine treatment during COVID-19, while during the same period, the AC group reported lower levels of substance use and injection risk behaviors. Conclusion The current study provides insight on how COVID-19 has negatively affected PWID. Placing dispensing machines of harm-reduction supplies in communities where PWID live and increasing secondary exchange, mobile services, and mail delivery of supplies may help maintain access to lifesaving supplies during big events, such as COVID-19. Trial registration ClinicalTrials.gov NCT03214679. Registered July 11 2017. https://clinicaltrials.gov/ct2/show/NCT03214679.
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Affiliation(s)
- Yesenia Aponte-Melendez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA. .,NYU Rory Meyers College of Nursing, 380 Second Avenue, New York, NY, 10010, USA.
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA
| | | | - Shashi Kapadia
- Weill Cornell Medicine, 1305 York Ave 4th Floor, New York, NY, 10021, USA
| | - Kristen Marks
- Weill Cornell Medicine, 1305 York Ave 4th Floor, New York, NY, 10021, USA
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28
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Schmidt RA, Genois R, Jin J, Vigo D, Rehm J, Rush B. The early impact of COVID-19 on the incidence, prevalence, and severity of alcohol use and other drugs: A systematic review. Drug Alcohol Depend 2021; 228:109065. [PMID: 34600257 PMCID: PMC8455354 DOI: 10.1016/j.drugalcdep.2021.109065] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this paper was to examine the early impact of COVID-19 on substance use to assess implications for planning substance use treatment and support systems. METHOD A systematic review of literature published up to March 2021 was conducted to summarize changes in prevalence, incidence, and severity of substance use associated with COVID-19 and the accompanying public health measures, including lockdown, stay-at-home orders, and social distancing. RESULTS We identified 53 papers describing changes to substance use at the population level. The majority of papers described changes related to alcohol use and most relied on self-reported measures of consumption during the COVID-19 pandemic, compared with pre-pandemic use. There was less evidence to support changes in non-alcohol substance use. In general, risky pre-pandemic alcohol use, caregiving responsibilities, stress, depression, anxiety, and current treatment for a mental disorder were found to be associated with increased substance use. CONCLUSION This review provides preliminary data on changes in substance use, indicating that certain segments of the population increased their alcohol use early on in the COVID-19 pandemic and may be at greater risk of harm and in need of additional services. There is a need for additional population-level information on substance use to inform evidence-based rapid responses from a treatment system perspective.
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Affiliation(s)
- Rose A. Schmidt
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada,Correspondence to: 33 Ursula Franklin Street, Toronto, ON, Canada
| | - Rosalie Genois
- Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC J1K 2R1, Canada.
| | - Jonathan Jin
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada.
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada.
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada; Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992 Moscow, Russian Federation; Agència de Salut Pública de Catalunya, 81-95 Roc Boronat St., 08005 Barcelona, Spain; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany.
| | - Brian Rush
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada.
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29
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Bardsley M, Heinsbroek E, Harris R, Croxford S, Edmundson C, Hope V, Hassan N, Ijaz S, Mandal S, Shute J, Hutchinson SJ, Hickman M, Sinka K, Phipps E. The impact of direct-acting antivirals on hepatitis C viraemia among people who inject drugs in England; real-world data 2011-2018. J Viral Hepat 2021; 28:1452-1463. [PMID: 34270172 PMCID: PMC9290701 DOI: 10.1111/jvh.13575] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/03/2021] [Accepted: 06/26/2021] [Indexed: 12/13/2022]
Abstract
Direct-acting antiviral (DAA) therapy for anybody with viraemic HCV infection has been scaled-up in England since 2017. To assess early impacts, we investigated trends in, and factors associated with, HCV viraemia among people who inject drugs (PWID). We also examined trends in self-reported treatment access. Bio-behavioural data from an annual, national surveillance survey of PWID (2011-2018) estimated trends in viraemic prevalence among HCV antibody-positive PWID. Multivariable logistic regression identified characteristics independently associated with viraemia. Trends in treatment access were examined for PWID with known infection. Between 2011 and 2016, viraemic prevalence among antibody-positive PWID remained stable (2011, 57.7%; 2016, 55.8%) but decreased in 2017 (49.4%) and 2018 (50.4%) (both p < 0.001). After adjustment for demographic and behavioural characteristics, there remained significant reduction in viraemia in 2017 (adjusted odds ratio [aOR] 0.79, 95% CI 0.65-0.94) and 2018 (aOR 0.79, 95% CI 0.66-0.93) compared to 2016. Other factors associated with viraemia were male gender (aOR 1.68, 95% CI 1.53-1.86), geographical region, injecting in past year (aOR 1.26, 95% CI 1.13-1.41), imprisonment (aOR 1.14, 95% CI 1.04-1.31) and homelessness (aOR 1.17, 95% CI 1.04-1.31). Among non-viraemic PWID with known infection, the proportion reporting ever receiving treatment increased in 2017 (28.7%, p < 0.001) and 2018 (38.9%, p < 0.001) compared to 2016 (14.5%). In conclusion, there has been a small reduction in HCV viraemia among antibody-positive PWID in England since 2016, alongside DAA scale-up, and some indication that treatment access has improved in the same period. Population-level monitoring and focus on harm reduction is critical for achieving and evaluating elimination.
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Affiliation(s)
- Megan Bardsley
- National Infection Service, Public Health England, London, UK
| | | | - Ross Harris
- National Infection Service, Public Health England, London, UK
| | - Sara Croxford
- National Infection Service, Public Health England, London, UK
| | | | - Vivian Hope
- National Infection Service, Public Health England, London, UK.,Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Nasra Hassan
- National Infection Service, Public Health England, London, UK
| | - Samreen Ijaz
- National Infection Service, Public Health England, London, UK
| | - Sema Mandal
- National Infection Service, Public Health England, London, UK
| | - Justin Shute
- National Infection Service, Public Health England, London, UK
| | - Sharon J Hutchinson
- Glasgow Caledonian University, Glasgow, UK.,Public Health Scotland, Glasgow, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katy Sinka
- National Infection Service, Public Health England, London, UK
| | - Emily Phipps
- National Infection Service, Public Health England, London, UK
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30
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Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168470. [PMID: 34444219 PMCID: PMC8394531 DOI: 10.3390/ijerph18168470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 12/28/2022]
Abstract
People who use drugs (PWUD) experience many social and health harms and are considered at greater risk of acquiring COVID-19. Little research has examined the impact of coronaviruses either on PWUD, or on services targeted to PWUD. We report the findings of a systematic review of empirical evidence from studies which have examined the impact of coronaviruses (Severe Acute Respiratory Syndrome (SARS-CoV-1) and Middle Eastern Respiratory Syndrome (MERS-CoV) and COVID-19) on PWUD or on service responses to them. Five databases were searched (MEDLINE, PsycINFO, CINAHL, ASSIA and EMBASE) as well as COVID-19 specific databases. Inclusion criteria were studies reporting any impact of SARS, MERS or COVID-19 or any service responses to those, published between January 2000 and October 2020. Weight of Evidence judgements and quality assessment were undertaken. In total, 27 primary studies were included and grouped by seven main themes: treatment/recovery services; emergency medical settings; low-threshold services; prison setting, PWUD/substance use disorder (SUD) diagnosis; people with SUD and HIV; ‘Sexual minority’ men. Overall, research in the area was scant, and of average/poor quality. More robust research is required to inform on-going and future responses to coronavirus epidemics for PWUD.
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31
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Wenger LD, Kral AH, Bluthenthal RN, Morris T, Ongais L, Lambdin BH. Ingenuity and resiliency of syringe service programs on the front lines of the opioid overdose and COVID-19 crises. Transl Res 2021; 234:159-173. [PMID: 33746108 PMCID: PMC8217165 DOI: 10.1016/j.trsl.2021.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/25/2021] [Accepted: 03/15/2021] [Indexed: 12/09/2022]
Abstract
As COVID-19 accelerated throughout 2020, syringe service programs (SSPs) faced challenges necessitating programmatic adaptations to prevent overdose deaths while simultaneously keeping workers and participants safe from COVID-19. We used qualitative methods to gain an understanding of the social context within which SSPs are operating during the COVID-19 pandemic. We conducted 36 in-depth interviews with program representatives from 18 programs and used the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation framework to guide data analysis. We focused on 3 of the 4 EPIS constructs: Outer context, inner context, and innovation factors. Our data indicate that responding to the pandemic led to innovations in service delivery such as secondary and mail-based distribution, adoption of telemedicine for enrolling participants in medications for opioid use disorder (MOUD) and use of virtual training platforms for overdose prevention. We found high levels of staff and volunteer commitment, which was a cornerstone to the success of these innovations. We observed that many SSPs were short-staffed because of their commitment to safety, and some lost current funding as well as opportunities for future funding. Despite minimal staffing and diminished funding, SSPs innovated at an accelerated pace. To ensure the sustainability of these new approaches, a supportive external context (federal, state, and local policies and funding) is needed to support the development of SSPs' inner contexts (organizational characteristics, characteristics of individuals) and sustainment of the innovations achieved regarding delivery of naloxone and MOUD.
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Affiliation(s)
| | | | - Ricky N Bluthenthal
- University of Southern California, Keck School of Medicine, Los Angeles, California
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32
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Galarneau LR, Hilburt J, O’Neill ZR, Buxton JA, Scheuermeyer FX, Dong K, Kaczorowski J, Orkin AM, Barbic SP, Bath M, Moe J, Miles I, Tobin D, Grier S, Garrod E, Kestler A. Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study. PLoS One 2021; 16:e0255396. [PMID: 34324589 PMCID: PMC8320992 DOI: 10.1371/journal.pone.0255396] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022] Open
Abstract
AIM To capture pandemic experiences of people with opioid use disorder (OUD) to better inform the programs that serve them. DESIGN We designed, conducted, and analyzed semi-structured qualitative interviews using grounded theory. We conducted interviews until theme saturation was reached and we iteratively developed a codebook of emerging themes. Individuals with lived experience of substance use provided feedback at all steps of the study. SETTING We conducted phone or in-person interviews in compliance with physical distancing and public health regulations in outdoor Vancouver parks or well-ventilated indoor spaces between June to September 2020. PARTICIPANTS Using purposive sampling, we recruited participants (n = 19) who were individuals with OUD enrolled in an intensive community outreach program, had visited one of two emergency departments, were over 18, lived within catchment, and were not already receiving opioid agonist therapy. MEASUREMENTS We audio-recorded interviews, which were later transcribed verbatim and checked for accuracy while removing all identifiers. Interviews explored participants' knowledge of COVID-19 and related safety measures, changes to drug use and healthcare services, and community impacts of COVID-19. RESULTS One third of participants were women, approximately two thirds had stable housing, and ages ranged between 23 and 59 years old. Participants were knowledgeable on COVID-19 public health measures. Some participants noted that fear decreased social connection and reluctance to help reverse overdoses; others expressed pride in community cohesion during crisis. Several participants mentioned decreased access to housing, harm reduction, and medical care services. Several participants reported using drugs alone more frequently, consuming different or fewer drugs because of supply shortages, or using more drugs to replace lost activities. CONCLUSION COVID-19 had profound effects on the social lives, access to services, and risk-taking behaviour of people with opioid use disorder. Pandemic public health measures must include risk mitigation strategies to maintain access to critical opioid-related services.
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Affiliation(s)
- Lexis R. Galarneau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail: (LG); (AK)
| | - Jesse Hilburt
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Zoe R. O’Neill
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Jane A. Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Frank X. Scheuermeyer
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montréal, and Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Aaron M. Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Skye Pamela Barbic
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Misty Bath
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Jessica Moe
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columba, Canada
| | - Isabelle Miles
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Dianne Tobin
- Vancouver Area Network of Drug Users, Vancouver, British Columbia, Canada
| | - Sherry Grier
- Portland Hotel Society Community Services Society, Vancouver, British Columbia, Canada
| | - Emma Garrod
- Providence Health Care, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- * E-mail: (LG); (AK)
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Abstract
PURPOSE OF REVIEW The COVID-19 pandemic and associated restrictions have uniquely and disproportionately affected vulnerable populations. This review summarizes recent evidence on the relationship between psychiatric disorders, substance use disorders and COVID-19, highlighting acute and long-term risks, pharmacotherapy interactions and implications regarding appropriate and timely evidence-based treatment. RECENT FINDINGS Evidence points to a complex relationship between psychiatric and substance use disorders and COVID-19. A range of risk factors associated with psychiatric and substance use disorders increases the risk of exposure to, and complications arising from, the COVID-19 virus. COVID-19 infection has been indicated as having acute and potential long-term impacts on both psychiatric and substance use disorders. Social disruption associated with restrictions imposed to curb transmission has also been identified as a risk factor for new onset of disorders and recurrence and exacerbation of existing conditions. SUMMARY Early recognition and intervention are key to preventing chronic disability associated with psychiatric disorders, substance use disorders, and their co-occurrence. It is critical that those most in need of services do not fall through the cracks of our healthcare systems. The pandemic has fast tracked the opportunity for widespread implementation of digital health interventions but ensuring these are accessible and available to all, including our most vulnerable, will be a critical task for our future health and social ecosystems.
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Affiliation(s)
- Christina Marel
- University of Sydney, Matilda Centre for Research in Mental Health and Substance Use, Sydney, New South Wales, Australia
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34
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Li R, Zhao M. Maintaining treatment and prevention programs for opioid use disorders during the coronavirus disease 2019 pandemic. Curr Opin Psychiatry 2021; 34:369-375. [PMID: 33859127 PMCID: PMC8183244 DOI: 10.1097/yco.0000000000000708] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current article reviews the impact of the biggest health crisis for many decades, coronavirus disease 2019 (COVID-19), on opioid treatment programs and the strategies adopted for maintaining opioid treatment programs during the pandemic. RECENT FINDINGS The difficulty of access to opioid treatment services and the mental health problems accompanying opioid use disorders are the two main challenges to maintaining accessible and effective opioid treatment. Many countries and institutions issued guidance and recommendations to address these challenges. General coping strategies, loosening of policies, telemedicine, and depot buprenorphine are four main strategies to cope with the challenges posed by the pandemic. SUMMARY There were considerable obstacles to maintaining opioid intervention programs during the COVID-19 pandemic. Strategies addressing the obstacles are identified. Research in this area needs to be strengthened.
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Affiliation(s)
- Ruihua Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
- Shanghai Key Laboratory of Psychotic Disorders
- CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China
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35
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Parkes T, Carver H, Masterton W, Falzon D, Dumbrell J, Grant S, Wilson I. "You know, we can change the services to suit the circumstances of what is happening in the world": a rapid case study of the COVID-19 response across city centre homelessness and health services in Edinburgh, Scotland. Harm Reduct J 2021; 18:64. [PMID: 34118942 PMCID: PMC8197599 DOI: 10.1186/s12954-021-00508-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/01/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated unprecedented changes in the way that health, social, and housing services are delivered to individuals experiencing homelessness and problem substance use. Protecting those at high risk of infection/transmission, whilst addressing the multiple health and social needs of this group, is of utmost importance. This study aimed to document the impact of the COVID-19 pandemic on individuals who were experiencing homelessness in one city centre in Scotland, and how services adapted in response. METHODS Semi-structured interviews were conducted with individuals with lived/living experience of homelessness (n = 10), staff within onethird sector service (n = 5), and external professionals (n = 5), during April-August 2020, using a rapid case study design. These were audio-recorded, fully transcribed, and analysed using Framework. Analysis was informed by inclusion health and equity-orientated approaches to meeting the needs of people with multiple and complex needs, and emerging literature on providing harm reduction in the context of COVID-19. RESULTS Those with lived/living experience of homelessness and problem substance use faced a range of additional challenges during the pandemic. Mental health and use of substances were affected, influenced by social isolation and access to services. A range of supports were provided which flexed over the lockdown period, including housing, health and social care, substance use treatment, and harm reduction. As well as documenting the additional risks encountered, findings describe COVID-19 as a 'path-breaking' event that created opportunities to get evidence into action, increase partnership working and communication, to proactively address risks. CONCLUSIONS This rapid case study has described the significant impact of the COVID-19 pandemic on a group of people experiencing homelessness and problem substance use within one city centre in Scotland and provides a unique lens on service/professional responses. It concludes with lessons that can inform the international and ongoing response to this pandemic. It is vital to recognise the vision and leadership that has adapted organisational responses in order to reduce harms. We must learn from such successes that were motivated both by compassion and care for those vulnerable to harms and the desire to provide high-quality, evidence-based, harm reduction services.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK.
| | - Hannah Carver
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Wendy Masterton
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Danilo Falzon
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Joshua Dumbrell
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK.,The Salvation Army, Homelessness Services Unit, Edinburgh, Scotland, UK
| | - Susan Grant
- The Salvation Army, Homelessness Services Unit, Edinburgh, Scotland, UK
| | - Iain Wilson
- The Salvation Army, Homelessness Services Unit, Edinburgh, Scotland, UK
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Lindqvist K, Wallmofeldt C, Holmén E, Hammarberg A, Kåberg M. Health literacy and changes in pattern of drug use among participants at the Stockholm Needle Exchange Program during the COVID-19 pandemic. Harm Reduct J 2021; 18:52. [PMID: 33971892 PMCID: PMC8107802 DOI: 10.1186/s12954-021-00499-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
Background and aims People who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden’s initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown. In this study, we investigate changes in drug use patterns, utilization of NEP associated health services, COVID-19 health literacy and the prevalence of SARS-CoV-2 antibodies among NEP clients in Stockholm during the COVID-19 pandemic.
Methods NEP visits and services provided (needles/syringes, HIV and hepatitis C tests and treatment, naloxone distributed) and overall mortality among NEP clients between January 1 and October 31, 2020, were used for trend analyses in comparison with corresponding 2019 data. Between July 27 and October 2, 2020, NEP clients (n = 232) responded to a 27 item COVID-19 Health Literacy Questionnaire. SARS CoV-2 IgG antibody tests (n = 779) were performed between June 15 and October 31, 2020. Results During the COVID-19 pandemic number of clients, client visits, naloxone distribution and HCV tests remained stable compared to 2019, while distribution of needles/syringes increased (p < 0.0001); number of HIV tests and HCV treatments decreased (p < 0.05); and mortality decreased (< 0.01). Overall, the level of health literacy concerning transmission routes and protective measures was high. SARS-CoV-2 antibody prevalence was 5.4% (95% CI 4.0–7.2). Conclusions The Stockholm NEP managed to maintain a high level of clients and services during the pandemic. In general, COVID-19 health literacy was adequate and the overall SARS-CoV-2 antibody prevalence was low compared to the general population, which highlights a need for prioritized and targeted COVID-19 vaccination among PWID.
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Affiliation(s)
- K Lindqvist
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - C Wallmofeldt
- Norra Stockholms Psykiatri (Psychiatry of Northern Stockholm), S:t Görans Hospital, Stockholm, Sweden
| | - E Holmén
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - M Kåberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden. .,Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Sprututbytet, S:t Görans sjukhus, Akutvägen 29, 112 81, Stockholm, Sweden.
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A rapid review of the impacts of "Big Events " on risks, harms, and service delivery among people who use drugs: Implications for responding to COVID-19. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103127. [PMID: 33549464 PMCID: PMC7816610 DOI: 10.1016/j.drugpo.2021.103127] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND "Big Events" are major disruptions to physical, political, and economic environments that can influence vulnerability to drug-related harms. We reviewed the impacts of Big Events with relevance to the COVID-19 pandemic on drug-related risk and harms and access to drug treatment and harm reduction services. METHODS We conducted a rapid review of quantitative, qualitative, and mixed methods literature relating to the following Big Events: respiratory infection pandemics, natural disasters, financial crises, and heroin shortages. Included studies reported data on changes to risks, harms, and/or service provisioning for people who use illicit drugs (other than cannabis) in the context of these Big Events. Searches were conducted in PubMed in May 2020, and two reviewers screened studies for inclusion. Peer-reviewed studies published in English or French were included. We used a narrative synthesis approach and mapped risk pathways identified in the literature. RESULTS No studies reporting on respiratory infection pandemics were identified. Twelve studies reporting on natural disaster outcomes noted marked disruption to drug markets, increased violence and risk of drug-related harm, and significant barriers to service provision caused by infrastructure damage. Five studies of the 2008 global financial crisis indicated increases in the frequency of drug use and associated harms as incomes and service funding declined. Finally, 17 studies of heroin shortages noted increases in heroin price and adulteration, potentiating drug substitutions and risk behaviors, as well as growing demand for drug treatment. CONCLUSION Current evidence reveals numerous risk pathways and service impacts emanating from Big Events. Risk pathway maps derived from this literature provide groundwork for future research and policy analyses, including in the context of the COVID-19 pandemic. In light of the findings, we recommend responding to the pandemic with legislative and financial support for the flexible delivery of harm reduction services, opioid agonist treatment, and mental health care.
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Lanièce Delaunay C, Greenwald ZR, Minoyan N, Artenie AA, Jeong D, Marathe G, Saeed YA, Kolla G, Kunden RD, Okwor CIA, Wallace HL, Mendlowitz A, Liu CH, Mazouz S, D’souza S, Perciani CT, Rheault M, Palmer MA, Palayew A, Abdelnabi MN, Cunningham EB. Striving toward hepatitis C elimination in the era of COVID-19. CANADIAN LIVER JOURNAL 2021; 4:4-7. [DOI: 10.3138/canlivj-2020-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Charlotte Lanièce Delaunay
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Zoë R Greenwald
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | | | - Dahn Jeong
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gayatri Marathe
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yasmin A Saeed
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Kolla
- Canadian Centre for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Rasika D Kunden
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Hannah L Wallace
- Division of Biomedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Andrew Mendlowitz
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Ching-Hsuan Liu
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sabrina Mazouz
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Simmone D’souza
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Catia Taniela Perciani
- Soham and Shaila Ajmera Family Transplant Centre, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Marylin Rheault
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Michael A Palmer
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adam Palayew
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Mohamed N Abdelnabi
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Evan B Cunningham
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
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Croxford S, Emanuel E, Ibitoye A, Njoroge J, Edmundson C, Bardsley M, Heinsbroek E, Hope V, Phipps E. Preliminary indications of the burden of COVID-19 among people who inject drugs in England and Northern Ireland and the impact on access to health and harm reduction services. Public Health 2021; 192:8-11. [PMID: 33601307 PMCID: PMC7836733 DOI: 10.1016/j.puhe.2021.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/02/2021] [Indexed: 12/12/2022]
Abstract
Objective The aim of the study was to describe the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on people who inject drugs (PWID) in England, Wales and Northern Ireland. Study design This is a cross-sectional Unlinked Anonymous Monitoring (UAM) Survey of PWID. Methods People who had ever injected psychoactive drugs were recruited to the UAM Survey by specialist drug/alcohol services in England, Wales and Northern Ireland. From June 2020, in addition to providing a dried blood spot sample and completing the UAM behavioural questionnaire, participants were asked to complete an enhanced coronavirus disease 2019 (COVID-19) questionnaire. Preliminary data are presented to the end of October and were compared with data from the 2019 UAM Survey, where possible. Results Between June and October, 288 PWID were recruited from England and Northern Ireland. One in nine (11%; 29/260) PWID reported testing positive for SARS-CoV-2 or experiencing COVID-19 symptoms. Fifteen percent (26/169) reported injecting more frequently in 2020 than in 2019; cocaine injection in the preceding four weeks increased from 17% (242/1456) to 25% (33/130). One in five PWID (19%; 35/188) reported difficulties in accessing HIV and hepatitis testing, and one in four (26%; 47/179) reported difficulties in accessing equipment for safer injecting. Conclusions Our preliminary findings suggest that PWID have experienced negative impacts on health, behaviours and access to essential harm reduction, testing and treatment services owing to the COVID-19 pandemic. Continued monitoring through surveillance and research is needed to understand the subsequent impact of COVID-19 on blood-borne virus transmission in this population and on health inequalities.
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Affiliation(s)
- S Croxford
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom.
| | - E Emanuel
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - A Ibitoye
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - J Njoroge
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - C Edmundson
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - M Bardsley
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - E Heinsbroek
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom; Joint Biosecurity Centre, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, United Kingdom
| | - V Hope
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom; Public Health Institute, Liverpool John Moores University, 3rd Floor, Exchange Station, Tithebarn Street, Liverpool, L2 2QP, United Kingdom
| | - E Phipps
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
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COVID-19 and people who use drugs; seizing opportunity in times of chaos. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103097. [PMID: 33485187 PMCID: PMC7832925 DOI: 10.1016/j.drugpo.2020.103097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 01/28/2023]
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Olding M, Barker A, McNeil R, Boyd J. Essential work, precarious labour: The need for safer and equitable harm reduction work in the era of COVID-19. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103076. [PMID: 33321286 DOI: 10.1016/j.drugpo.2020.103076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 01/23/2023]
Abstract
This commentary highlights labour concerns and inequities within the harm reduction sector that hinder programs' ability to respond to converging public health emergencies (the overdose crisis and COVID-19), and potentially contribute to spread of the novel coronavirus. Many harm reduction programs continue to support people who use illicit drugs (PWUD) during the pandemic, yet PWUD working in harm reduction programs (sometimes termed 'peers') experience precarious labour conditions characterized by low wages, minimal employee benefits (such as paid sick leave) and high employment insecurity. Along with precarious labour conditions, PWUD face heightened vulnerabilities to COVID-19 and yet have been largely overlooked in global response to the pandemic. Operating under conditions of economic and legal precarity, harm reduction programs' reliance on precarious labour (e.g. on-call, temporary and unpaid work) renders some services vulnerable to staffing shortages and service disruptions during the pandemic, while also heightening the risk of virus transmission among workers, service users and their communities. We call for immediate policy and programmatic actions to strengthen working conditions within these settings with a priority on enhancing protections and supports for workers in peer roles.
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Affiliation(s)
- Michelle Olding
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, Canada, V6Z 1Y6; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Allison Barker
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, Canada, V6Z 1Y6; Yale School of Medicine, New Haven, CT, United States; Yale School of Public Health, New Haven, CT, United States; Department of Anthropology, Yale University, New Haven, CT, United States
| | - Jade Boyd
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, Canada, V6Z 1Y6; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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42
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Mariottini C, Ojanperä I, Kriikku P. Increase in drugs-of-abuse findings in post-mortem toxicology due to COVID-19 restrictions-First observations in Finland. Drug Test Anal 2020; 13:867-870. [PMID: 33217177 DOI: 10.1002/dta.2982] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 01/03/2023]
Abstract
A lot has been published on the anticipated effects of the current COVID-19 pandemic on users of illegal drugs. In this study, we present evidence-based data on such effects, namely, the increased number of drug findings in post-mortem investigations. All post-mortem toxicology cases positive for at least one of the following: buprenorphine, amphetamine or cannabis, were investigated in the first 8 months of the year 2020, and the monthly numbers were compared to those in the previous 5 years from 2015 to 2019. These substances served as indicator analytes that could reveal changes in the drug using population. Right after the government restrictions came into force in March 2020, the numbers of buprenorphine, amphetamine and cannabis findings increased. The increase was most noticeable for amphetamine and was evident in all age groups. Our findings indicate that the assumptions on the increased risk of drug-related harm (including death) have become reality. Reduced access to harm-reduction services seems to have increased the mortality among individuals that use buprenorphine, amphetamine or cannabis. Significant and prompt actions need to be taken in order to find new ways in helping this vulnerable group of people.
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Affiliation(s)
- Claudia Mariottini
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Ilkka Ojanperä
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.,Forensic Toxicology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pirkko Kriikku
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.,Forensic Toxicology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Wilkinson R, Hines L, Holland A, Mandal S, Phipps E. Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID-19 response. Harm Reduct J 2020; 17:95. [PMID: 33261636 PMCID: PMC7705852 DOI: 10.1186/s12954-020-00445-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND People who inject drugs are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. METHODS A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic-type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. RESULTS In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly; for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. CONCLUSIONS This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.
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Affiliation(s)
- Rebecca Wilkinson
- Rebecca Wilkinson, Public Health Registrar, School of Primary Care, Population Sciences and Medical Education, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - Lindsey Hines
- Lindsey Hines, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Holland
- Adam Holland Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sema Mandal
- Sema Mandal Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
| | - Emily Phipps
- Emily Phipps Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
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Grebely J, Cerdá M, Rhodes T. COVID-19 and the health of people who use drugs: What is and what could be? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102958. [PMID: 33183679 PMCID: PMC7837052 DOI: 10.1016/j.drugpo.2020.102958] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
SARS-CoV-2, the virus that causes COVID-19, has changed the world as we know it, and continues to do so. How COVID-19 affects people who use drugs, the environments in which they live, and capacities of response, warrants immediate attention. This special issue begins to map how COVID-19 is altering the health of people who use drugs, including in relation to patterns of drug use, service responses, harms that may relate to drug use, interventions to reduce risk of harms, COVID-19 health, and drug policies. We emphasise the need to envisage COVID-19 and its effects as a matter of intersecting ‘complex adaptive systems’: that is, the impacts of COVID-19 extend beyond the virus and related illness conditions to encompass multiple social, cultural, economic, policy and political effects; and these affect the health of people who use drugs directly as well as indirectly by altering the risk and enabling environments in which they live. We synthesize emergent evidence on the impact of COVID-19 on the health of people who use drugs. A key concern we identify is how to sustain policy and service delivery improvements prompted by COVID-19. We need to maintain an ethos of emergent adaptation and experimentation towards the creation of safer environments in relation to the health of people who use drugs.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, United States
| | - Tim Rhodes
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; London School of Hygiene and Tropical Medicine, London, UK
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45
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Nelson EUE, Dumbili EW, Odeigah OW. Drug use treatment during COVID-19 pandemic: community-based services in Nigeria. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1838640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Ediomo-Ubong Ekpo Nelson
- Centre for Research and Information on Substance Abuse, Uyo, Nigeria
- International Blue Cross, Nigeria
| | - Emeka W. Dumbili
- Institute for Therapy and Health Research, Kiel, Germany
- Department of Sociology and Anthropology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ogochukwu Winifred Odeigah
- Department of Psychology, University of Ibadan, Ibadan, Nigeria
- Department of Psychology, College of Arts, Management and Social Sciences, Chrisland University, Abeokuta Nigeria
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Walters SM, Seal DW, Stopka TJ, Murphy ME, Jenkins WD. COVID-19 and People Who Use Drugs - A Commentary. HEALTH BEHAVIOR AND POLICY REVIEW 2020; 7:489-497. [PMID: 33134405 PMCID: PMC7595339 DOI: 10.14485/hbpr.7.5.11] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE People who use drugs (PWUD) face increased risk of exposure to COVID-19, but also elevated risk associated from injection drug use. We describe factors underlying their increased risk and identify mechanisms for reducing or minimizing rates of COVID-19 transmission and other health outcomes. METHODS Our commentary draws upon empirical data, governmental and other reports, and field-based unpublished data from our own studies to inform our conclusion and recommendations. RESULTS Co-morbid health conditions (eg, diabetes), structural challenges (eg, homelessness, criminal justice involvement), stigma (eg, social devaluation, discrediting), and syndemic clustering of of overdose, HCV, and HIV among PWUD are exacerbated by COVID-19. CONCLUSIONS Beyond the many challenges all people face to remain safe and healthy during the COVID-19 pandemic, PWUD face additional barriers to remaining safe not only from COVID-19 but from negative health outcomes associated with their living environments, socioeconomic positions, and injection drug use. Collaborative efforts among governmental agencies, health providers, SSPs, CBOs, and other agencies providing services to PWUD is essential to the development of programs and services to meet the many needs of PWUD, which have been particularly accentuated during the COVID-19 pandemic.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - David W Seal
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, United States
| | - Megan E Murphy
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Wiley D Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, United States
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47
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Jacka BP, Phipps E, Marshall BDL. Drug use during a pandemic: Convergent risk of novel coronavirus and invasive bacterial and viral infections among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102895. [PMID: 32741718 PMCID: PMC7388892 DOI: 10.1016/j.drugpo.2020.102895] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Brendan P Jacka
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street (Box G-S121-2), Providence 02912, RI, USA.
| | - Emily Phipps
- National Infection Service, Public Health England
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street (Box G-S121-2), Providence 02912, RI, USA
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