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Collins AB, Macon EC, Levin S, Wunsch C, Wightman RS. "It gets you high as a kite but not unsick": Characterizations of and responses to a changing local drug supply by people who use drugs in Rhode Island. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104391. [PMID: 38490014 PMCID: PMC11127783 DOI: 10.1016/j.drugpo.2024.104391] [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: 12/07/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The North American overdose crisis has continued at unprecedented rates with more than 100,000 overdose deaths occurring in the United States (US) in 2022. Overdose deaths have increasingly been polysubstance-involved, with novel substances (e.g., xylazine) complicating overdose risk and health outcomes. Understanding the effects of-and responses to-a changing drug supply among people who use drugs is critical to modifying harm reduction strategies to be more responsive to people's needs. METHODS This qualitative study draws on data collected from May to December 2022 in Rhode Island. Data include in-depth interviews with 50 people who use drugs and observational fieldwork in spaces frequented by participants (e.g., encampments, drop-in centers). Qualitative data were analyzed thematically drawing on concepts of situated rationality. RESULTS Participants described significant changes in the drug supply, with many attributing these transitions to COVID-19. Most participants characterized the local supply as "synthetic" with textures, color, and taste evolving. Notably, participants emphasized adverse outcomes related to available supplies, including during use (e.g., intense burning sensations) and post-consumption (e.g., heavy sedation, ongoing withdrawal, necrosis). Given the complex supply, participants highlighted the increased risk of overdose and shared how they altered their use practices to manage evolving health risks. CONCLUSION Our results underscore how people who use drugs characterized the local drug supply, including perceived changes to supply contents. Implementing and scaling up harm reduction interventions that reduce risk and reinforce the agency of people who use drugs are urgently needed to effectively address the overdose crisis.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA.
| | - E Claire Macon
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA
| | - Stacey Levin
- Parent Support Network of Rhode Island, Warwick, RI, USA
| | - Caroline Wunsch
- Lifespan Department of Psychiatry and Behavioral Health Services, Division of Addiction Medicine, Providence, RI, USA
| | - Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Nygaard-Christensen M. "More Concerned About Mr. and Mrs. Denmark": Coping with Pandemic Crisis at the Intersection of Homelessness and Drug Use. Med Anthropol 2024; 43:17-30. [PMID: 37831438 DOI: 10.1080/01459740.2023.2266860] [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] [Indexed: 10/14/2023]
Abstract
This article builds on fieldwork conducted during lockdown in Denmark among users of services at the intersection of homelessness and drug use. The paper bridges two distinct approaches to understanding the relation between marginalization and crisis, with one focused on the impact of "big events" on marginalized populations, and another on everyday strategies employed to survive situations of homelessness and drug use. The paper shows how past experiences of hardship became relevant for coping with pandemic crisis. It further exploreshow, through critical engagement with dominant accounts of vulnerability, research participants carved out a space for negotiating their marginality in the Danish welfare state.
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Collins AB, Kaplowitz E, Bastani P, McKee H, Whitaker D, Hallowell BD, McKenzie M. "I Don't Go Overboard": Perceptions of Overdose Risk and Risk Reduction Strategies among People Who Use Drugs in Rhode Island. Subst Use Misuse 2023; 59:673-679. [PMID: 38124349 PMCID: PMC10922331 DOI: 10.1080/10826084.2023.2294968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background: North America experiencing an unprecedented overdose epidemic, with data estimating almost 110,000 overdose deaths occurring in 2022 in the United States (US). To address fatal overdoses in the US, community organizations and local health departments in some jurisdictions have expanded community distribution of naloxone, and increased overdose prevention education, and other harm reduction supplies and services (e.g., fentanyl test strips, drug checking programs) to reduce harm for people who use drugs (PWUD). Objectives: Understanding how PWUD manage overdose risk within the context of these expanded services is important for ensuring public health services are meeting their needs. Semi-structured qualitative interviews were conducted with 25 PWUD who were accessing harm reduction services in Rhode Island. Data were imported into NVivo where they were coded and analyzed thematically. Results: Our findings demonstrate the complexity of managing overdose risk in the context of a fentanyl drug supply. While most participants were concerned about overdosing, they sought to manage overdose risk through their own harm reduction practices (e.g., testing their drugs, going slow) and drug purchasing dynamics, even when using alone. Conclusions: Study findings point to the need to implement and scale-up community-level interventions to better support PWUD within the context of the current US overdose crisis.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Eliana Kaplowitz
- Center for Health and Justice Transformation, Providence, Rhode Island, USA
| | - Parsa Bastani
- Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Haley McKee
- The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Delaney Whitaker
- Center for Health and Justice Transformation, Providence, Rhode Island, USA
| | - Benjamin D Hallowell
- Center For Health Data and Analysis, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Michelle McKenzie
- The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Teti M, Myroniuk TW, Kirksey G, Pratt M, Schatz E. Using peer-ethnography to explore the health and well-being of college students affected by COVID-19. Int J Qual Stud Health Well-being 2023; 18:2261841. [PMID: 37742341 PMCID: PMC10519263 DOI: 10.1080/17482631.2023.2261841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE COVID-19 continues to infect and affect college-aged youth. We lack information about how students experienced the pandemic day-to-day and what they need for recovery, from their own perspectives. This study employed peer ethnography to explore student's insights for current and future prevention and care. METHODS A team of eight students were trained as peer ethnographers to observe and record conversations with their peers in 15-minute increments during the COVID-19 pandemic. Transcripts of 200 conversations were collated and analysed via theme analysis to identify patterns. RESULTS Student conversations revealed dichotomous perspectives about COVID-19. Some students prioritized safety, captured via three themes-caution, rethinking routines, and protecting others. Other students struggled to follow prevention guidelines and took risks, also captured by three themes-parties, denial, and misinformation. A third category of themes captured the results of this dichotomy-tense campus relationships and a health leadership vacuum. CONCLUSIONS Our findings identify specific locations for intervention (e.g., off campus parties) and needed community collaborations (e.g., bars and universities) for COVID-19 and future pandemics. Our findings suggest that overarching approaches, like harm reduction or affirmation (versus shame), are helpful intervention frameworks. Findings also celebrate the value of peer-ethnography, to learn about pandemics and solutions from the ground up.
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Affiliation(s)
- Michelle Teti
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Tyler W. Myroniuk
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Grace Kirksey
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Mariah Pratt
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Enid Schatz
- Department of Public Health, University of Missouri, Columbia, MO, USA
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5
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Latimore AD, Salisbury-Afshar E, Duff N, Freiling E, Kellett B, Sullenger RD, Salman A. Primary, Secondary, and Tertiary Prevention of Substance Use Disorders through Socioecological Strategies. NAM Perspect 2023; 2023:202309b. [PMID: 38784638 PMCID: PMC11114594 DOI: 10.31478/202309b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Affiliation(s)
| | | | | | | | | | | | - Aisha Salman
- National Academy of Medicine; and the Prevention, Treatment, and Recovery Services Working Group of the National Academy of Medicine's Action Collaborative on Countering the U.S. Opioid Epidemic
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6
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Frueh L, Collins AB, Newman R, Barnett NP, Rich JD, Clark MA, Marshall BDL, Macmadu A. Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation. Harm Reduct J 2023; 20:14. [PMID: 36739417 PMCID: PMC9898862 DOI: 10.1186/s12954-023-00741-w] [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: 12/07/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing factors such as isolation and job loss in these behaviors. Here, we use qualitative methods to examine the impact of the COVID-19 pandemic and pandemic-related response measures on drug use behaviors in a sample of PWUD in Rhode Island. Using a social-ecological framework, we highlight the nested, interactive levels of the pandemic's influence on increased overdose risk behaviors. METHODS From July to October 2021, semi-structured interviews were conducted with 18 PWUD who self-reported any increase in behaviors associated with overdose risk (e.g., increased use, change in drug type and/or more solitary drug use) relative to before the pandemic. Thematic analysis was conducted using a codebook with salient themes identified from interview guides and those that emerged through close reading of transcribed interviews. Guided by a social-ecological framework, themes were grouped into individual, network, institutional, and policy-level influences of the pandemic on drug use behaviors. RESULTS Individual-level influences on increased overdose risk behaviors included self-reported anxiety and depression, isolation and loneliness, and boredom. Network-level influences included changes in local drug supply and changes in social network composition specific to housing. At the institutional level, drug use patterns were influenced by reduced access to harm reduction or treatment services. At the policy level, increased overdose risk behaviors were related to financial changes, job loss, and business closures. All participants identified factors influencing overdose risk behaviors that corresponded to several nested social-ecological levels. CONCLUSIONS Participants identified multi-level influences of the COVID-19 pandemic and pandemic-related response measures on their drug use behavior patterns and overdose risk. These findings suggest that effective harm reduction during large-scale crises, such as the COVID-19 pandemic, must address several levels of influence concurrently.
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Affiliation(s)
- Lisa Frueh
- grid.166341.70000 0001 2181 3113Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA 19104 USA
| | - Alexandra B. Collins
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Roxxanne Newman
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Nancy P. Barnett
- grid.40263.330000 0004 1936 9094Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI USA
| | - Josiah D. Rich
- grid.240267.50000 0004 0443 5079The Center for Health + Justice Transformation, The Miriam Hospital, 1125 North Main Street, Providence, RI USA
| | - Melissa A. Clark
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI USA
| | - Brandon D. L. Marshall
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Ackley C, Rodriguez DG, Villa G. "I didn't Notice that You Were Watching Me": Exploring a User Acceptance Study to Conduct Cultural Domain Analysis Online During the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2023; 22:16094069231164602. [PMID: 37122441 PMCID: PMC10116222 DOI: 10.1177/16094069231164602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This article explores the implementation process of a User Acceptance Study to evaluate the feasibility of conducting cultural domain analysis (CDA) online during the COVID-19 pandemic. We conducted 19 cultural domain analysis sessions involving three techniques: free listing, pile sorts, and rank ordering. A diverse set of participants were recruited to help assess requirements and needs that researching online involves. We found that conducting CDA online is a feasible research method that offers benefits such as generating large amounts of data, making participants feel comfortable joining sessions from a safe space, providing anonymity, reducing research costs such as time and travel, and eliciting large numbers of responses. We also identified several factors for consideration when implementing CDA online and provide recommendations for improvement, including the aesthetics of the digital software employed, user accessibility and digital literacy, participants' environments, Internet connection, and online-specific ethical issues.
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Affiliation(s)
- Caroline Ackley
- Department of Global Health & Infection, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
- Caroline Ackley, Department of Global Health & Infection, Brighton & Sussex Medical School, 94 N - S Rd, Falmer, Brighton BN1 9PX, UK.
| | - Diego Garcia Rodriguez
- Department of Global Health & Infection, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Giovanni Villa
- Department of Global Health & Infection, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
- Department of Genitourinary Medicine & Infectious Diseases, St James’s Hospital, Dublin, Ireland
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Scott MA, Olszowy KM, Dancause KN, Roome A, Chan C, Taylor HK, Marañon-Laguna A, Montoya E, Garcia A, Mares C, Tosiro B, Tarivonda L. Challenges and opportunities in rapid disaster research: lessons from the field in New Mexico and Vanuatu. FRONTIERS IN SOCIOLOGY 2023; 8:983972. [PMID: 37152207 PMCID: PMC10157172 DOI: 10.3389/fsoc.2023.983972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/28/2023] [Indexed: 05/09/2023]
Abstract
Rapid research is essential to assess impacts in communities affected by disasters, particularly those communities made "hard-to-reach" due to their active marginalization across history and in contemporary practices. In this article, we describe two rapid research projects developed to assess needs for and experiences of communities hard-hit by disasters. The first is a project on the COVID-19 pandemic in southern New Mexico (USA) that was developed to provide information to local agencies that are deploying programs to rebuild and revitalize marginalized communities. The second is a project on population displacement due to a volcanic eruption in Vanuatu, a lower-middle income country in the South Pacific, with mental and physical health outcomes data shared with the Vanuatu Ministry of Health. We describe the similar and unique challenges that arose doing rapid research in these two different contexts, the potential broader impacts of the research, and a synthesis of lessons learned. We discuss the challenges of rapidly changing rules and regulations, lack of baseline data, lack of survey instruments validated for specific populations and in local languages, limited availability of community partners, finding funding for rapid deployment of projects, rapidly training and working with research assistants, health and safety concerns of researchers and participants, and communicating with local and international partners. We also specifically discuss how we addressed our own personal challenges while also conducting time-intensive rapid research. In both studies, researchers shared results with governmental and non-governmental partners who may use the data to inform the design of their own relief programs. While different in context, type of disaster, and research strategy, our discussion of these projects provides insights into common lessons learned for working with communities at elevated risk for the worst outcomes during disasters, such as the need for flexibility, compromise, and good working relationships with community partners.
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Affiliation(s)
- Mary Alice Scott
- Department of Anthropology, New Mexico State University, Las Cruces, NM, United States
| | - Kathryn M. Olszowy
- Department of Anthropology, New Mexico State University, Las Cruces, NM, United States
- Department of Anthropology, Binghamton University, Binghamton, NY, United States
- Department of Criminology, Anthropology, and Sociology, Cleveland State University, Cleveland, OH, United States
- *Correspondence: Kathryn M. Olszowy
| | - Kelsey N. Dancause
- Département des sciences de l'activité physique, Université du Québec à Montréal, Montreal, QC, Canada
| | - Amanda Roome
- Department of Anthropology, Binghamton University, Binghamton, NY, United States
- Bassett Research Institute, Basset Healthcare Network, New York, NY, United States
| | - Chim Chan
- Department of Parasitology and Virology, Osaka Metropolitan University, Osaka, Japan
| | - Hailey K. Taylor
- Department of Anthropology, New Mexico State University, Las Cruces, NM, United States
| | - Andrea Marañon-Laguna
- Department of Anthropology, New Mexico State University, Las Cruces, NM, United States
| | - Emilee Montoya
- Department of Anthropology, New Mexico State University, Las Cruces, NM, United States
| | - Alysa Garcia
- Department of Anthropology, New Mexico State University, Las Cruces, NM, United States
| | - Claudia Mares
- Department of Health and Human Services, Las Cruces, NM, United States
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Norman G, Mason T, Dumville JC, Bower P, Wilson P, Cullum N. Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries. BMJ Open 2022; 12:e064345. [PMID: 36600433 PMCID: PMC10580278 DOI: 10.1136/bmjopen-2022-064345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic increased the demand for rapid evaluation of innovation in health and social care. Assessment of rapid methodologies is lacking although challenges in ensuring rigour and effective use of resources are known. We mapped reports of rapid evaluations of health and social care innovations, categorised different approaches to rapid evaluation, explored comparative benefits of rapid evaluation, and identified knowledge gaps. DESIGN Scoping review. DATA SOURCES MEDLINE, EMBASE and Health Management Information Consortium (HMIC) databases were searched through 13 September 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included publications reporting primary research or methods for rapid evaluation of interventions or services in health and social care in high-income countries. DATA EXTRACTION AND SYNTHESIS Two reviewers developed and piloted a data extraction form. One reviewer extracted data, a second reviewer checked 10% of the studies; disagreements and uncertainty were resolved through consensus. We used narrative synthesis to map different approaches to conducting rapid evaluation. RESULTS We identified 16 759 records and included 162 which met inclusion criteria.We identified four main approaches for rapid evaluation: (1) Using methodology designed specifically for rapid evaluation; (2) Increasing rapidity by doing less or using less time-intensive methodology; (3) Using alternative technologies and/or data to increase speed of existing evaluation method; (4) Adapting part of non-rapid evaluation.The COVID-19 pandemic resulted in an increase in publications and some limited changes in identified methods. We found little research comparing rapid and non-rapid evaluation. CONCLUSIONS We found a lack of clarity about what 'rapid evaluation' means but identified some useful preliminary categories. There is a need for clarity and consistency about what constitutes rapid evaluation; consistent terminology in reporting evaluations as rapid; development of specific methodologies for making evaluation more rapid; and assessment of advantages and disadvantages of rapid methodology in terms of rigour, cost and impact.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
| | - Thomas Mason
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
| | - Peter Bower
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Paul Wilson
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
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10
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Austin EJ, Corcorran MA, Briggs ES, Frost MC, Behrends CN, Juarez AM, Frank ND, Healy E, Prohaska SM, LaKosky PA, Kapadia SN, Perlman DC, Schackman BR, Jarlais DCD, Williams EC, Glick SN. Barriers to engaging people who use drugs in harm reduction services during the COVID-19 pandemic: A mixed methods study of syringe services program perspectives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103825. [PMID: 35977459 PMCID: PMC9364718 DOI: 10.1016/j.drugpo.2022.103825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/12/2022] [Accepted: 08/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) provide critical evidence-based public health services that decrease harms from drug use for people who use drugs (PWUD). Many SSPs have experienced significant and evolving COVID-19-related disruptions. We aimed to characterize the impacts of COVID-19 on SSP operations in the United States approximately one year into the pandemic. METHODS Participating sites, selected from a national sample of SSPs, completed a semi-structured interview via teleconference and brief survey evaluating the impacts of COVID-19 on program operations. Data collection explored aspects of program financing, service delivery approaches, linkages to care, and perspectives on engaging PWUD in services one year into the pandemic. Interview data were analyzed qualitatively using Rapid Assessment Process. Survey data were analyzed using descriptive statistics and triangulated with qualitative findings. RESULTS 27 SSPs completed study-related interviews and surveys between February 2021 - April 2021. One year into the pandemic, SSPs reported continuing to adapt approaches to syringe distribution in response to COVID-19, and identified multiple barriers that hindered their ability to engage program participants in services, including 1) isolation and decreased connectivity with participants, 2) resource restrictions that limit responsiveness to participant needs, 3) reduced capacity to provide on-site HIV/HCV testing and treatment linkages, and 4) changing OUD treatment modalities that were a "double-edged sword" for PWUD. Quantitative survey responses aligned with qualitative findings, highlighting increases in the number of syringes distributed, increases in mobile and home delivery services, and reductions in on-site HIV and HCV testing. CONCLUSION These data illuminate persistent and cascading risks of isolation, reduced access to services, and limited engagement with program participants that resulted from COVID-19 and continue to create barriers to the delivery of critical harm reduction services. Findings emphasize the need to ensure SSPs have the resources and capacity to adapt to changing public health needs, particularly as the COVID-19 pandemic continues to evolve.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA.
| | - Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Elsa S Briggs
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA
| | - Madeline C Frost
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA; Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Alexa M Juarez
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Noah D Frank
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Elise Healy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Stephanie M Prohaska
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street, Tacoma, WA, USA
| | - Paul A LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street, Tacoma, WA, USA
| | - Shashi N Kapadia
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA; Division of Infectious Diseases, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - David C Perlman
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, 708 Broadway, New York, NY, USA; Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, New York, NY, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA; Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
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11
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Kelly EL, Reed MK, Schoenauer KM, Smith K, Scalia-Jackson K, Kay Hill S, Li E, Weinstein L. A Qualitative Exploration of the Functional, Social, and Emotional Impacts of the COVID-19 Pandemic on People Who Use Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9751. [PMID: 35955107 PMCID: PMC9367729 DOI: 10.3390/ijerph19159751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
Since 2020, people who use drugs (PWUD) experienced heightened risks related to drug supply disruptions, contamination, overdose, social isolation, and increased stress. This study explored how the lives of PWUD changed in Philadelphia over a one-year period. Using semi-structured interviews with 20 participants in a Housing First, low-barrier medication for opioid use (MOUD) program in Philadelphia, the effects of the first year of the COVID-19 pandemic on the daily lives, resources, functioning, substance use, and treatment of PWUD were explored. Interviews were analyzed using a combination of directed and conventional content analysis. Six overarching themes emerged during data analysis: (1) response to the pandemic; (2) access to MOUD and support services; (3) substance use; (4) impacts on mental health, physical health, and daily functioning; (5) social network impacts; and (6) fulfillment of basic needs. Participants reported disruptions in every domain of life, challenges meeting their basic needs, and elevated risk for adverse events. MOUD service providers offset some risks and provided material supports, treatment, social interaction, and emotional support. These results highlight how there were significant disruptions to the lives of PWUD during the first year of the COVID-19 pandemic and identified critical areas for future intervention and policies.
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Affiliation(s)
- Erin L. Kelly
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Center for Social Medicine and Humanities, Department of Psychiatry, Semel Institute, University of California, Los Angeles, CA 90024, USA
| | - Megan K. Reed
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Kathryn M. Schoenauer
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kelsey Smith
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | - Sequoia Kay Hill
- Project HOME Health Services, Pathways to Housing PA, Philadelphia, PA 19141, USA
| | - Erica Li
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Lara Weinstein
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Minoyan N, Høj SB, Zolopa C, Vlad D, Bruneau J, Larney S. Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada. Harm Reduct J 2022; 19:38. [PMID: 35436936 PMCID: PMC9013973 DOI: 10.1186/s12954-022-00620-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People who use drugs (PWUD) are at high risk of experiencing indirect harms of measures implemented to curb the spread of COVID-19, given high reliance on services and social networks. This study aimed to document short-term changes in behaviours and health-related indicators among PWUD in Montreal, Canada following declaration of a provincial health emergency in Quebec. METHODS We administered a structured rapid assessment questionnaire to members of an existing cohort of PWUD and individuals reporting past-year illicit drug use recruited via community services. Telephone and in-person interviews were conducted in May-June and September-December 2020. Participants were asked to report on events and changes since the start of the health emergency (March 13, 2020). Descriptive analyses were performed. RESULTS A total of 227 participants were included (77% male, median age = 46, 81% Caucasian). 83% and 41% reported past six-month illicit drug use and injection drug use, respectively. 70% of unstably housed participants reported increased difficulty finding shelter since the start of the health emergency. 48% of opioid agonist treatment recipients had discussed strategies to avoid treatment disruptions with providers; 22% had missed at least one dose. Many participants perceived increased difficulty accessing non-addiction health care services. Adverse changes were also noted in indicators pertaining to income, drug markets, drug use frequency, and exposure to violence; however, many participants reported no changes in these areas. Among persons reporting past six-month injection drug use, 79% tried to access needle-syringe programmes during the health emergency; 93% of those obtained services. 45% tried to access supervised injection sites, of whom 71% gained entry. CONCLUSIONS This snapshot suggests mixed impacts of the COVID-19 pandemic on PWUD in Montreal in the months following declaration of a provincial health emergency. There were signals of increased exposure to high-risk environments as well as deteriorations in access to health services. Pandemic-related measures may have lasting impacts among vulnerable subgroups; continued monitoring is warranted.
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Affiliation(s)
- Nanor Minoyan
- Université de Montréal Hospital Research Centre (CRCHUM), 900 Rue Saint Denis, Montreal, QC, H2X 0A9, Canada.,Department of Social and Preventive Medicine, École de Santé Publique, Université de Montréal, 7101 Ave Parc, Montreal, QC, H3N 1X9, Canada
| | - Stine Bordier Høj
- Université de Montréal Hospital Research Centre (CRCHUM), 900 Rue Saint Denis, Montreal, QC, H2X 0A9, Canada
| | - Camille Zolopa
- Université de Montréal Hospital Research Centre (CRCHUM), 900 Rue Saint Denis, Montreal, QC, H2X 0A9, Canada
| | - Dragos Vlad
- Université de Montréal Hospital Research Centre (CRCHUM), 900 Rue Saint Denis, Montreal, QC, H2X 0A9, Canada.,Department of Social and Preventive Medicine, École de Santé Publique, Université de Montréal, 7101 Ave Parc, Montreal, QC, H3N 1X9, Canada
| | - Julie Bruneau
- Université de Montréal Hospital Research Centre (CRCHUM), 900 Rue Saint Denis, Montreal, QC, H2X 0A9, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul. Édouard-Montpetit, Montreal, QC, H3C 3J7, Canada
| | - Sarah Larney
- Université de Montréal Hospital Research Centre (CRCHUM), 900 Rue Saint Denis, Montreal, QC, H2X 0A9, Canada. .,Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul. Édouard-Montpetit, Montreal, QC, H3C 3J7, Canada.
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