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Rahmani A, Janatolmakan M, Rezaei E, Allahqoli L, Fallahi A, Ebrahimi E, Motamedi M, Yousefi F, Apay SE. Challenges of the COVID-19 pandemic on women's HIV harm reduction centers: a mixed-methods study. Harm Reduct J 2024; 21:139. [PMID: 39049029 PMCID: PMC11267809 DOI: 10.1186/s12954-024-01060-4] [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: 12/03/2023] [Accepted: 07/14/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed significant challenges to nations worldwide, affecting various sectors of society. Women's HIV harm reduction centers, which provide critical services, have also been affected by these difficulties. This study aimed to examine the challenges of the COVID-19 pandemic on the services offered by women's HIV harm reduction centers from the perspective of clients. METHODS A convergent mixed-method design was utilized to gain in-depth insights into the challenges of COVID-19 on the services provided by women's HIV harm reduction centers, counseling centers, and night shelters that cater to women at risk, such as drug users, sex workers, and the homeless population, in three provinces (Tehran, Khuzestan, and Kermanshah) in Iran. The study was conducted from January to May 2023. The quantitative aspect of the study employed a cross-sectional method with a sample size of 430 individuals. A researcher-developed questionnaire was used to assess a range of services. The qualitative part of the study involved traditional content analysis and included 32 individual interviews. The integration of qualitative and quantitative results was performed during the interpretation phase to provide a comprehensive understanding of the challenges of COVID-19 on women's HIV harm reduction centers. RESULTS In the quantitative phase, the mean age of women was 39.0 ± 10.2 years. 165 women reported a history of COVID-19, which accounts for 38.4% of the total. More than half of them (n = 102, 61.8%) recovering at home. The majority of women (n = 365, 84.9%) mentioned receiving the COVID-19 vaccine. COVID-19 diagnostic tests were conducted for 74.2% (n = 319) of women. Women expressed higher satisfaction with the services (HIV prevention services, and accommodation services) before the COVID-19 pandemic compared to the satisfaction during the pandemic. The qualitative analysis identified emerging challenges related to the COVID-19 pandemic in two categories: personal challenges and mismanagement of services, comprising nineteen subcategories. CONCLUSION The findings of this study highlight the adverse impact of the COVID-19 pandemic on the services provided by women's HIV harm reduction centers, in contrast to the pre-pandemic period. To mitigate these negative effects, it is crucial to implement preventive measures and practical solutions. This may involve addressing the personal and management challenges of the centers.
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Affiliation(s)
- Azam Rahmani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elham Rezaei
- Midwifery department, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Arezoo Fallahi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Elham Ebrahimi
- Department of Reproductive Health Midwifery, School of Nursing & Midwifery Nursing and Midwifery Care Research Center, Tehran, Iran
| | - Mahnaz Motamedi
- HIV/STIs Department, Communicable Disease Control Center, Ministry of Health and Medical Education of Iran, Tehran, Iran
| | - Fatemeh Yousefi
- Department of midwifery, reproductive health promotion research center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Serap Ejdar Apay
- Faculty of Health Sciences, Atatürk University & Atateknokent Company, Erzurum, Turkey
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Morrow RL, Binka M, Li J, Irvine M, Bartlett SR, Wong S, Jeong D, Makuza JD, Wong J, Yu A, Krajden M, Janjua NZ. Impact of the COVID-19 Pandemic on Hepatitis C Treatment Initiation in British Columbia, Canada: An Interrupted Time Series Study. Viruses 2024; 16:655. [PMID: 38793537 PMCID: PMC11125629 DOI: 10.3390/v16050655] [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: 04/02/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024] Open
Abstract
We investigated the impacts of the COVID-19 pandemic on hepatitis C (HCV) treatment initiation, including by birth cohort and injection drug use status, in British Columbia (BC), Canada. Using population data from the BC COVID-19 Cohort, we conducted interrupted time series analyses, estimating changes in HCV treatment initiation following the introduction of pandemic-related policies in March 2020. The study included a pre-policy period (April 2018 to March 2020) and three follow-up periods (April to December 2020, January to December 2021, and January to December 2022). The level of HCV treatment initiation decreased by 26% in April 2020 (rate ratio 0.74, 95% confidence interval [CI] 0.60 to 0.91). Overall, no statistically significant difference in HCV treatment initiation occurred over the 2020 and 2021 post-policy periods, and an increase of 34.4% (95% CI 0.6 to 75.8) occurred in 2022 (equating to 321 additional people initiating treatment), relative to expectation. Decreases in HCV treatment initiation occurred in 2020 for people born between 1965 and 1974 (25.5%) and people who inject drugs (24.5%), relative to expectation. In summary, the pandemic was associated with short-term disruptions in HCV treatment initiation in BC, which were greater for people born 1965 to 1974 and people who inject drugs.
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Affiliation(s)
- Richard L. Morrow
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Julia Li
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
| | - Mike Irvine
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Sofia R. Bartlett
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
| | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jean Damascene Makuza
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Naveed Zafar Janjua
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
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Adams A, Blawatt S, Magel T, MacDonald S, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review. Subst Abuse Treat Prev Policy 2023; 18:56. [PMID: 37777766 PMCID: PMC10543348 DOI: 10.1186/s13011-023-00564-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to an unprecedented relaxation of restrictions on take-home doses in opioid agonist treatment (OAT). We conducted a mixed methods systematic review to explore the impact of these changes on program effectiveness and client experiences in OAT. METHODS The protocol for this review was registered in PROSPERO (CRD42022352310). From Aug.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, Cochrane Register of Controlled Trials, and the grey literature. We included studies reporting quantitative measures of retention in treatment, illicit substance use, overdose, client health, quality of life, or treatment satisfaction or using qualitative methods to examine client experiences with take-home doses during the pandemic. We critically appraised studies using the Mixed Methods Appraisal Tool. We synthesized quantitative data using vote-counting by direction of effect and presented the results in harvest plots. Qualitative data were analyzed using thematic synthesis. We used a convergent segregated approach to integrate quantitative and qualitative findings. RESULTS Forty studies were included. Most were from North America (23/40) or the United Kingdom (9/40). The quantitative synthesis was limited by potential for confounding, but suggested an association between take-home doses and increased retention in treatment. There was no evidence of an association between take-home doses and illicit substance use or overdose. Qualitative findings indicated that take-home doses reduced clients' exposure to unregulated substances and stigma and minimized work/treatment conflicts. Though some clients reported challenges with managing their medication, the dominant narrative was one of appreciation, reduced anxiety, and a renewed sense of agency and identity. The integrated analysis suggested reduced treatment burden as an explanation for improved retention and revealed variation in individual relationships between take-home doses and illicit substance use. We identified a critical gap in quantitative measures of patient-important outcomes. CONCLUSION The relaxation of restrictions on take-home doses was associated with improved client experience and retention in OAT. We found no evidence of an association with illicit substance use or overdose, despite the expansion of take-home doses to previously ineligible groups. Including patient-important outcome measures in policy, program development, and treatment planning is essential to ensuring that decisions around take-home doses accurately reflect their value to clients.
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Affiliation(s)
- Alison Adams
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Sarin Blawatt
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Tianna Magel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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Sekeris A, Algahtani T, Aldabergenov D, Rock KL, Auwal F, Aldewaissan F, Williams BD, Kalk NJ, Copeland CS. Trends in deaths following drug use in England before, during, and after the COVID-19 lockdowns. Front Public Health 2023; 11:1232593. [PMID: 37841731 PMCID: PMC10570433 DOI: 10.3389/fpubh.2023.1232593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Aim This research aimed to describe how the characteristics of deaths following drug use changed during the COVID-19 pandemic in England, and how this can inform future strategy to support the health and social care of people who use drugs in future emergency scenarios. Method All deaths reported to the National Programme on Substance Abuse Deaths which occurred between January 2018 and December 2021 inclusive were extracted for analysis. Exponential smoothing models were constructed to determine any differences between forecasted vs. actual trends. Key results Following the first lockdown period in England there were significant increases in the proportion of people who died at home beyond the 95% confidence bounds of the exponential smoothing model and concurrent decreases in the proportion of people who died in hospital. Whilst the overall proportion of deaths attributable to opioids did not significantly deviate from the forecasted trend, there were significant increases in methadone-related deaths and decreases in heroin/morphine-related death beyond the 95% confidence bounds. The proportion of deaths concluded as suicide increased, as did those implicating antidepressant use. There were no changes in the proportion of deaths following use of other drug classes, alcohol use in combination with psychoactive drugs, or on decedent demographics (gender, age, and drug user status). A small number of deaths due to drug use had COVID-19 infection itself listed as a cause of death (n = 23). Conclusion For people who use drugs, the impact of the restrictions due to the COVID-19 pandemic was greater than that of infection from the virus itself. The health and social care strategy for these people needs to be pre-emptively adapted to mitigate against the specific risk factors for fatal drug overdose associated with future emergency scenarios.
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Affiliation(s)
- Athanasios Sekeris
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Thikra Algahtani
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Daniyar Aldabergenov
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Kirsten L. Rock
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Fatima Auwal
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Farah Aldewaissan
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Bryn D. Williams
- Department of Anaesthetics, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Nicola J. Kalk
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Caroline S. Copeland
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
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Rance J, Bryant J, Caruana T, Brener L. Practising care in a pandemic: Accounting for everyday life during COVID-19 among people who inject drugs. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:791-809. [PMID: 36738164 DOI: 10.1111/1467-9566.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 01/04/2023] [Indexed: 05/04/2023]
Abstract
From the outset of the COVID-19 pandemic, fears have been raised worldwide regarding the unique challenges facing socially marginalised people such as those who inject drugs. This article draws on in-depth interviews conducted during the first year of the pandemic with people who inject drugs living in urban and regional Australia. Perhaps the most surprising finding to emerge was the number of participants who reported minimal disruption to their everyday lives, even improved wellbeing in some instances. Attempting to make sense of this unanticipated finding, our analysis draws on the concept of 'care', not as a moral disposition or normative code but as something emergent, contingent and realised in practice. Working with Foucault's ethics and recent feminist insights on the politics of care from the field of Science and Technology Studies, we explore how care was enacted in the everyday lives of our participants. We examine how participants' daily routines became objects of care and changed practice in response to the pandemic; how their ongoing engagement with harm reduction services afforded not only clinical support but vital forms of social and affective connection; and how for some, care was realised through an ethos and practice of constrained sociality and solitude.
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Affiliation(s)
- Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
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Giang K, Charlesworth R, Thulien M, Mulholland A, Barker B, Brar R, Pauly B, Fast D. Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104023. [PMID: 37059025 PMCID: PMC10067449 DOI: 10.1016/j.drugpo.2023.104023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
Across North America, overlapping overdose and COVID-19 emergencies have had a substantial impact on young people who use drugs (YPWUD). New risk mitigation guidance (RMG) prescribing practices were introduced in British Columbia, Canada, in 2020 to allow people to decrease risk of overdose and withdrawal and better self-isolate. We examined how the prescribing of hydromorphone tablets specifically impacted YPWUD's substance use and care trajectories. Between April 2020 and July 2021, we conducted virtual interviews with 30 YPWUD who had accessed an RMG prescription of hydromorphone in the previous six months and 10 addiction medicine physicians working in Vancouver. A thematic analysis was conducted. YPWUD participants highlighted a disjuncture between risk mitigation prescriptions and the safe supply of unadulterated substances such as fentanyl, underscoring that having access to the latter is critical to reducing their reliance on street-based drug markets and overdose-related risks. They described re-appropriating these prescriptions to meet their needs, stockpiling hydromorphone so that it could be used as an “emergency backup” when they were unable to procure unregulated, illicit opioids. In the context of entrenched poverty, hydromorphone was also used to generate income for the purchase of drugs and various necessities. For some YPWUD, hydromorphone prescriptions could be used alongside opioid agonist therapy (OAT) to reduce withdrawal and cravings and improve adherence to OAT. However, some physicians were wary of prescribing hydromorphone due to the lack of evidence for this new approach. Our findings underscore the importance of providing YPWUD with a safe supply of the substances they are actively using alongside a continuum of substance use treatment and care, and the need for both medical and community-based safe and safer supply models.
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Affiliation(s)
- Karen Giang
- Department of Family Practice, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Reith Charlesworth
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Madison Thulien
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Alanna Mulholland
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Vancouver Coastal Health Authority, 520 West 6(th) Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Brittany Barker
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Canadian Institute of Substance Use Research, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada
| | - Rupinder Brar
- Department of Family Practice, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Vancouver Coastal Health Authority, 520 West 6(th) Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Bernie Pauly
- Canadian Institute of Substance Use Research, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada; School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria BC V8W 2Y2, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine (Division of Social Medicine), 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
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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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Dawes J, May T, Fancourt D, Burton A. The Impact of the COVID-19 Pandemic and Associated Societal Restrictions on People Experiencing Homelessness (PEH): A Qualitative Interview Study with PEH and Service Providers in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15526. [PMID: 36497601 PMCID: PMC9739517 DOI: 10.3390/ijerph192315526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
People experiencing homelessness (PEH) faced unique challenges during the COVID-19 pandemic, including changes to accommodation availability, societal restrictions impacting access to essentials like food, and services moving to online and remote access. This in-depth qualitative research aims to add to the existing, but limited research exploring how the pandemic affected PEH. 33 semi-structured qualitative interviews (22 with PEH during the pandemic and 11 with homelessness sector service providers) were undertaken in the United Kingdom between April 2021 and January 2022. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. To ensure consistency of coding, 10% of interviews were coded by two researchers. The PEH sample was 50% female, aged 24-59 years, 59% white British, and included people who had lived in hostels/hotels, with friends/family, and on the streets during the COVID-19 pandemic. Providers came from varied services, including support charities, housing, and addiction services. Five key themes were identified: (i) the understanding of and adherence to public health guidance and restrictions; (ii) the experience of people accommodated by the 'Everyone In' initiative; (iii) the impact of social distancing guidelines on PEH experiences in public spaces; (iv) the importance of social support and connections to others; and (v) how homelessness services adapted their provision. Policy makers and public health communicators must learn from PEH to maximize the effectiveness of future public health strategies. Housing providers and support services should recognize the implications of imposing a lack of choice on people who need accommodation during a public health emergency. The loss of usual support for PEH triggered a loss of ability to rely on usual 'survival strategies', which negatively influenced their health. This research highlights successes and difficulties in supporting PEH during the COVID-19 pandemic and informs planning for similar public health events.
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Affiliation(s)
- Jo Dawes
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London (UCL), London WC1E 7HB, UK
| | - Tom May
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London WC1E 7HB, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London WC1E 7HB, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London WC1E 7HB, UK
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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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