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Seo B, Rioux W, Teare A, Rider N, Jones S, Taplay P, Ghosh SM. Perspectives of key interest groups regarding supervised Consumption sites (SCS) and novel virtual harm reduction services / overdose response hotlines and applications: a qualitative Canadian study. Harm Reduct J 2024; 21:141. [PMID: 39068494 PMCID: PMC11282589 DOI: 10.1186/s12954-024-01053-3] [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: 10/13/2023] [Accepted: 07/01/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Supervised consumption sites (SCS) and overdose prevention sites (OPS) have been implemented across Canada to mitigate harms associated with illicit substance use. Despite their successes, they still contend with challenges that limit their accessibility and uptake. Overdose response hotlines and apps are novel virtual technologies reminiscent of informal "spotting" methods that may address some of the limitations. Here, we strove to qualitatively examine the factors that may encourage or deter utilization of these virtual services and SCS. METHODS A total of 52 participants across Canada were recruited using convenience and snowball sampling methods. These included people with lived and living experience of substance use, family members of people with lived experience, healthcare providers, community harm reduction workers, and virtual harm reduction operators. Semi-structured telephone interviews were conducted and inductive thematic analysis was performed to identify the themes pertaining to SCS and virtual harm reduction. RESULTS Participants viewed overdose response hotline and apps as an opportunity to consume substances without being hindered by logistical barriers (e.g., wait times), fear of law enforcement, invasion of privacy, and more. They also noted that these virtual services provided more flexibility for clients who opt for routes of consumption that are not supported by SCS, such as smoking. Overall, SCS was perceived to be better than virtual services at facilitating social connection, providing additional resources/referrals, as well as prompt response to overdose. CONCLUSION In sum, participants viewed SCS and virtual services as filling different needs and gaps. This study adds to a growing body of literature which informs how virtual harm reduction services can serve as useful adjunct to more standard harm reduction methods.
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Affiliation(s)
- Boogyung Seo
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Adrian Teare
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nathan Rider
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada.
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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Patel EU, Grieb SM, Winiker AK, Ching J, Schluth CG, Mehta SH, Kirk GD, Genberg BL. Structural and social changes due to the COVID-19 pandemic and their impact on engagement in substance use disorder treatment services: a qualitative study among people with a recent history of injection drug use in Baltimore, Maryland. Harm Reduct J 2024; 21:91. [PMID: 38720307 PMCID: PMC11077846 DOI: 10.1186/s12954-024-01008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Substance use disorder treatment and recovery support services are critical for achieving and maintaining recovery. There are limited data on how structural and social changes due to the COVID-19 pandemic impacted individual-level experiences with substance use disorder treatment-related services among community-based samples of people who inject drugs. METHODS People with a recent history of injection drug use who were enrolled in the community-based AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland participated in a one-time, semi-structured interview between July 2021 and February 2022 about their experiences living through the COVID-19 pandemic (n = 28). An iterative inductive coding process was used to identify themes describing how structural and social changes due to the COVID-19 pandemic affected participants' experiences with substance use disorder treatment-related services. RESULTS The median age of participants was 54 years (range = 24-73); 10 (36%) participants were female, 16 (57%) were non-Hispanic Black, and 8 (29%) were living with HIV. We identified several structural and social changes due the pandemic that acted as barriers and facilitators to individual-level engagement in treatment with medications for opioid use disorder (MOUD) and recovery support services (e.g., support group meetings). New take-home methadone flexibility policies temporarily facilitated engagement in MOUD treatment, but other pre-existing rigid policies and practices (e.g., zero-tolerance) were counteracting barriers. Changes in the illicit drug market were both a facilitator and barrier to MOUD treatment. Decreased availability and pandemic-related adaptations to in-person services were a barrier to recovery support services. While telehealth expansion facilitated engagement in recovery support group meetings for some participants, other participants faced digital and technological barriers. These changes in service provision also led to diminished perceived quality of both virtual and in-person recovery support group meetings. However, a facilitator of recovery support was increased accessibility of individual service providers (e.g., counselors and Sponsors). CONCLUSIONS Structural and social changes across several socioecological levels created new barriers and facilitators of individual-level engagement in substance use disorder treatment-related services. Multilevel interventions are needed to improve access to and engagement in high-quality substance use disorder treatment and recovery support services among people who inject drugs.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Suzanne M Grieb
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abigail K Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Ching
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Catherine G Schluth
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Skinner A, Nolen S, Cerdá M, Rich JD, Marshall BD. A simple heuristic for allocating opioid settlement funding to reduce overdose mortality in the United States. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:269-275. [PMID: 38940829 PMCID: PMC11305910 DOI: 10.1080/00952990.2024.2364338] [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: 12/26/2023] [Revised: 04/26/2024] [Accepted: 06/01/2024] [Indexed: 06/29/2024]
Abstract
As resolution for opioid-related claims and litigation against pharmaceutical manufacturers and other stakeholders, state and local governments are newly eligible for millions of dollars of settlement funding to address the overdose crisis in the United States. To inform effective use of opioid settlement funds, we propose a simple framework that highlights the principal determinants of overdose mortality: the number of people at risk of overdose each year, the average annual number of overdoses per person at risk, and the average probability of death per overdose event. We assert that the annual number of overdose deaths is a function of these three determinants, all of which can be modified through public health intervention. Our proposed heuristic depicts how each of these drivers of drug-related mortality - and the corresponding interventions designed to address each term - operate both in isolation and in conjunction. We intend for this framework to be used by policymakers as a tool for identifying and evaluating public health interventions and funding priorities that will most effectively address the structural forces shaping the overdose crisis and reduce overdose deaths.
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Affiliation(s)
- Alexandra Skinner
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, US
| | - Josiah D. Rich
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Department of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Zang X, Skinner A, Krieger MS, Behrends CN, Park JN, Green TC, Walley AY, Morgan JR, Linas BP, Yedinak JL, Schackman BR, Marshall BDL. Evaluation of Strategies to Enhance Community-Based Naloxone Distribution Supported by an Opioid Settlement. JAMA Netw Open 2024; 7:e2413861. [PMID: 38814644 PMCID: PMC11140538 DOI: 10.1001/jamanetworkopen.2024.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/28/2024] [Indexed: 05/31/2024] Open
Abstract
Importance Many US states are substantially increasing community-based naloxone distribution, supported in part through settlements from opioid manufacturers and distributors. Objectives To evaluate the potential impact of increased naloxone availability on opioid overdose deaths (OODs) and explore strategies to enhance this impact by integrating interventions to address solitary drug use. Design, Setting, and Participants This decision analytical modeling study used PROFOUND (Prevention and Rescue of Fentanyl and Other Opioid Overdoses Using Optimized Naloxone Distribution Strategies), a previously published simulation model, to forecast annual OODs between January 2023 and December 2025. The simulated study population included individuals from Rhode Island who misused opioids and stimulants and were at risk for opioid overdose. Exposures The study modeled expanded naloxone distribution supported by the state's opioid settlement (50 000 naloxone nasal spray kits each year). Two approaches to expanding naloxone distribution were evaluated: one based on historical spatial patterns of naloxone distribution (supply-based approach) and one based on the spatial distribution of individuals at risk (demand-based approach). In addition, hypothetical interventions to enhance the likelihood of witnessed overdoses in private or semiprivate settings were considered. Main Outcomes and Measures Annual number of OODs and ratio of fatal to nonfatal opioid overdoses. Results Modeling results indicated that distributing more naloxone supported by the state's opioid settlement could reduce OODs by 6.3% (95% simulation interval [SI], 0.3%-13.7%) and 8.8% (95% SI, 1.8%-17.5%) in 2025 with the supply-based and demand-based approaches, respectively. However, increasing witnessed overdoses by 20% to 60% demonstrated greater potential for reducing OODs, ranging from 8.5% (95% SI, 0.0%-20.3%) to 24.1% (95% SI, 8.6%-39.3%). Notably, synergistic associations were observed when combining both interventions: increased naloxone distribution with the 2 approaches and a 60% increase in witnessed overdoses could reduce OODs in 2025 by 33.5% (95% SI, 17.1%-50.4%) and 37.4% (95% SI, 19.6%-56.3%), respectively. Conclusions and Relevance These findings suggest that interventions to address solitary drug use are needed to maximize the impact of continued efforts to increase community-based naloxone distribution, which may be particularly important for jurisdictions that have strong community-based naloxone distribution programs.
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Affiliation(s)
- Xiao Zang
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Alexandra Skinner
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Maxwell S. Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Czarina N. Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, New York
| | - Ju N. Park
- Department of Medicine, Brown University, Providence, Rhode Island
| | - Traci C. Green
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Alexander Y. Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Jake R. Morgan
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Jesse L. Yedinak
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, New York
| | - Brandon D. L. Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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Seo B, Rioux W, Rider N, Teare A, Jones S, Taplay P, Ghosh SM. Bridging the Gap in Harm Reduction Using Mobile Overdose Response Services (MORS) in the Context of the COVID-19 Pandemic: A Qualitative Study. J Urban Health 2024; 101:252-261. [PMID: 38514599 PMCID: PMC11052954 DOI: 10.1007/s11524-024-00846-y] [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] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
The COVID-19 pandemic introduced additional health challenges for people who use substances (PWUS) amid the overdose crisis. Numerous harm reduction services, including supervised consumption sites (SCS) across Canada, faced shutdowns and reduced operating capacity in order to comply with public health measures. Mobile Overdose Response Services (MORS) are novel overdose prevention technologies that allow those who are unable to access alternative means of harm reduction to consume substances under the virtual supervision of a trained operator. Here, we examine the role of MORS in the context of the COVID-19 pandemic. A total of 59 semi-structured interviews were conducted with the following key interest groups: PWUS, healthcare providers, harm reduction workers, MORS operators, and the general public. Inductive thematic analysis informed by grounded theory was used to identify major themes pertaining to the perception of MORS. As the pandemic shifted the public focus away from harm reduction, many participants viewed MORS as an acceptable strategy to reduce the harms associated with solitary substance and alleviate the sense of isolation driven by social distancing measures. While the pandemic may have increased the utility of MORS, concerns surrounding personal privacy and confidentiality remained. Overall, MORS were perceived as a useful adjunct service to address the unmet needs PWUS during the pandemic and beyond.
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Affiliation(s)
- Boogyung Seo
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nathan Rider
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adrian Teare
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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Viguerie A, Jacobson EU, Hicks KA, Bates L, Carrico J, Honeycutt A, Lyles C, Farnham PG. Assessing the Impact of COVID-19 on HIV Outcomes in the United States: A Modeling Study. Sex Transm Dis 2024; 51:299-304. [PMID: 38301638 DOI: 10.1097/olq.0000000000001935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND The COVID-19 pandemic impacted sexual behaviors and the HIV continuum of care in the United States, reducing HIV testing and diagnosis, and use of preexposure prophylaxis and antiretroviral therapy. We aimed to understand the future implications of these effects through a modeling study. METHODS We first ran our compartmental model of HIV transmission in the United States accounting for pandemic-related short-term changes in transmission behavior and HIV prevention and care provision in 2020 to 2021 only. We then ran a comparison scenario that did not apply pandemic effects but assumed a continuation of past HIV prevention and care trends. We compared results from the 2 scenarios through 2024. RESULTS HIV incidence was 4·4% lower in 2020 to 2021 for the pandemic scenario compared with the no-pandemic scenario because of reduced levels of transmission behavior, despite reductions in HIV prevention and care caused by the pandemic. However, reduced care led to less viral load suppression among people with HIV in 2020, and in turn, our model resulted in a slightly greater incidence of 2·0% from 2022 to 2024 in the COVID-19 scenario, as compared with the non-COVID scenario. DISCUSSION Disruptions in HIV prevention and care services during COVID-19 may lead to somewhat higher postpandemic HIV incidence than assuming prepandemic trends in HIV care and prevention continued. These results underscore the importance of continuing to increase HIV prevention and care efforts in the coming years.
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Affiliation(s)
- Alex Viguerie
- From the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Evin U Jacobson
- From the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Laurel Bates
- RTI International, Research Triangle Park, Durham, NC
| | | | | | - Cindy Lyles
- From the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paul G Farnham
- From the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Friedman J. Looking Back on COVID-19 and the Evolving Drug Overdose Crisis: Updated Trends Through 2022. Am J Public Health 2024; 114:280-283. [PMID: 38382024 PMCID: PMC10882379 DOI: 10.2105/ajph.2023.307559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Joseph Friedman
- Joseph Friedman is with the David Geffen School of Medicine, University of California, Los Angeles
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8
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Daigre C, Palma-Álvarez RF, Sorribes-Puertas M, Ortega-Hernández G, Perea-Ortueta M, Ros-Cucurull E, Segura L, Colom J, Braquehais MD, Ramos-Quiroga JA, Grau-López L. Abstinence duration and psychopathology among addiction outpatients during 18 months of COVID-19. Front Psychiatry 2024; 15:1339730. [PMID: 38389986 PMCID: PMC10881849 DOI: 10.3389/fpsyt.2024.1339730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Background The COVID-19 pandemic has impacted the mental health of patients with substance use disorder (SUD). However, few longitudinal studies have been done which examine associations between the pandemic, SUD patients' mental health and their drug use. Objectives This study aimed to examine duration of abstinence according to psychiatric status among SUD outpatients followed-up for 18 months from the pandemic related lockdown. Methods A follow-up study of 316 SUD outpatients was undertaken. Sociodemographic features, and clinical and consumption related variables were recorded. Pre, during and post lockdown information was evaluated. Abstinence/substance use was monitored at the patient's scheduled follow-up appointments, and psychiatric disorders and psychological variables were revaluated at 18 months. Results Survival analyses were used to compare the duration of abstinence (in months) from the beginning of the lockdown. It was observed that 70% of patients consumed the main substance for which they were being treated at some point during the follow-up. Men, younger patients, those with more symptoms of anxiety and personality disorders, and patients who experienced increased craving during follow-up, showed shorter duration of abstinence. While patients who had previously maintained at least one year of abstinence, achieved better results. Conclusions During the first year and a half of the pandemic, SUD outpatients presented alterations in mental health, such us anxiety, depression and maladaptive personality traits and a high rate of relapse. For this reason, despite the health and social crisis and their restrictive measures, a comprehensive treatment should be ensured.
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Affiliation(s)
- Constanza Daigre
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Biomedical Network Research Center on Mental Health (CIBERSAM), Barcelona, Spain
| | - Raul Felipe Palma-Álvarez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Biomedical Network Research Center on Mental Health (CIBERSAM), Barcelona, Spain
| | - Marta Sorribes-Puertas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - German Ortega-Hernández
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Marta Perea-Ortueta
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Elena Ros-Cucurull
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Lidia Segura
- Subdirecció general de Drogodependències, Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Joan Colom
- Subdirecció general de Drogodependències, Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Maria Dolores Braquehais
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Biomedical Network Research Center on Mental Health (CIBERSAM), Barcelona, Spain
| | - Lara Grau-López
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Biomedical Network Research Center on Mental Health (CIBERSAM), Barcelona, Spain
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Xu JJ, Seamans MJ, Friedman JR. Drug overdose mortality rates by educational attainment and sex for adults aged 25-64 in the United States before and during the COVID-19 pandemic, 2015-2021. Drug Alcohol Depend 2024; 255:111014. [PMID: 38142465 DOI: 10.1016/j.drugalcdep.2023.111014] [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: 06/16/2023] [Revised: 10/01/2023] [Accepted: 10/24/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Dramatic increases in U.S. drug overdose deaths involving synthetic opioids, especially fentanyl, beginning around 2014 have driven a marked progression in overall drug overdose deaths in the U.S., which sharply rose to unprecedented levels amid the COVID-19 pandemic. Disparities in drug overdose deaths by educational attainment (EA) during the fentanyl era of the drug overdose epidemic and its intersection with the COVID-19 pandemic have not been widely scrutinized. METHODS Utilizing restricted-use mortality data from the National Vital Statistics System and population estimates from the American Community Survey, we estimated annual national age-adjusted mortality rates (AAMRs) from drug overdoses jointly stratified by EA and sex for adults aged 25-64 from 2015 to 2021. State-level AAMRs in 2015 and 2021 were also estimated to examine the geographic variation in the cumulative evolution of EA-related disparities over the course of the analysis period. RESULTS Nationally, AAMRs rose fastest among persons with at most a high school-level education, whereas little to no change was observed for bachelor's degree holders, widening pre-existing disparities. During the analysis period, the difference in national AAMRs between persons with at most a high school-level education and bachelor's degree holders increased from less than 8-fold (2015) to approximately 13-fold (2021). The national widening of EA-related disparities accelerated amid the COVID-19 pandemic, and they widened in nearly every state. Among non-bachelor's degree holders, national AAMRs increased markedly faster for males. CONCLUSIONS The widening disparities in drug overdose deaths by EA are a likely indicator of a rapidly increasing socioeconomic divide in drug overdose mortality more broadly. Policy strategies should address upstream socioeconomic drivers of drug use and overdose, particularly among males.
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Affiliation(s)
- Jay J Xu
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Marissa J Seamans
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Joseph R Friedman
- Center for Social Medicine and Humanities, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Rebucini A, Origo F, Schionato F, Romolo FS. Restrictive measures and substance use reporting: New evidence from the COVID-19 pandemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104238. [PMID: 37890390 DOI: 10.1016/j.drugpo.2023.104238] [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: 04/05/2023] [Revised: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Since the beginning of the COVID-19 pandemic, several studies have been conducted on the impact of lockdown and containment measures on various aspects of individual and social behaviour, including substance use. The increasing body of literature investigating this phenomenon emphasizes the need for additional studies at the local level. We investigate changes in reported illicit drug consumption following changes in public measures limiting individual mobility in the province of Bergamo, one of the regions that faced the most severe consequences in terms of number of cases and death toll in the early stages of the pandemic. METHODS The empirical analysis is based on a unique dataset covering all people recorded by police forces as drug users between January 2019 and December 2021 in the province of Bergamo. Data relate to reports for illicit drug consumption and not criminal activities. RESULTS Estimates show that, during periods when individual mobility was severely limited, the probability of reported cannabis consumption decreased by 8-9%, while that of reported cocaine use increased by 6-12%. No significant changes emerge in the reported consumption of heroin or polysubstance. Furthermore, while reported cannabis use returned to pre-pandemic levels once the restrictive measures were eased, the increased likelihood of reported cocaine use appears to have been more long-lasting. These findings are robust to alternative estimation strategies and different model specifications. Our study also reveals significant gender, age and housing status disparities in reported drug use. CONCLUSION We provide a novel and distinctive perspective on the topic by using previously unexploited administrative data sources. We show that the relationship between restrictions and reported drug use varies by type of substance. Our methodology and findings can support the design of targeted policies for better resource allocation and improved public health outcomes.
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Affiliation(s)
- Andrea Rebucini
- Department of Economics, Università degli Studi di Bergamo, Via dei Caniana 2, 24127 Bergamo, Italy.
| | - Federica Origo
- Department of Economics, Università degli Studi di Bergamo, Via dei Caniana 2, 24127 Bergamo, Italy; IZA, Bonn, Germany
| | - Francesca Schionato
- Department of Law, Università degli Studi di Bergamo, Via dei Caniana 2, 24127 Bergamo, Italy
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Mannes ZL, Wheeler-Martin K, Terlizzi K, Hasin DS, Perry A, Pamplin JR, Crystal S, Cerdá M, Martins SS. Risks of opioid overdose among New York State Medicaid recipients with chronic pain before and during the COVID-19 pandemic. Prev Med 2023; 177:107789. [PMID: 38016582 PMCID: PMC10842754 DOI: 10.1016/j.ypmed.2023.107789] [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: 08/01/2023] [Revised: 10/27/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The COVID-19 pandemic contributed to healthcare disruptions for patients with chronic pain. Following initial disruptions, national policies were enacted to expand access to long-term opioid therapy (LTOT) for chronic pain and opioid use disorder (OUD) treatment services, which may have modified risk of opioid overdose. We examined associations between LTOT and/or OUD with fatal and non-fatal opioid overdoses, and whether the pandemic moderated overdose risk in these groups. METHODS We analyzed New York State Medicaid claims data (3/1/2019-12/31/20) of patients with chronic pain (N = 236,391). We used generalized estimating equations models to assess associations between LTOT and/or OUD (neither LTOT or OUD [ref], LTOT only, OUD only, and LTOT and OUD) and the pandemic (03/2020-12/2020) with opioid overdose. RESULTS The pandemic did not significantly (ns) affect opioid overdose among patients with LTOT and/or OUD. While patients with LTOT (vs. no LTOT) had a slight increase in opioid overdose during the pandemic (pre-pandemic: aOR:1.65, 95% CI:1.05, 2.57; pandemic: aOR:2.43, CI:1.75,3.37, ns), patients with OUD had a slightly attenuated odds of overdose during the pandemic (pre-pandemic: aOR:5.65, CI:4.73, 6.75; pandemic: aOR:5.16, CI:4.33, 6.14, ns). Patients with both LTOT and OUD also experienced a slightly reduced odds of opioid overdose during the pandemic (pre-pandemic: aOR:5.82, CI:3.58, 9.44; pandemic: aOR:3.70, CI:2.11, 6.50, ns). CONCLUSIONS Findings demonstrated no significant effect of the pandemic on opioid overdose among people with chronic pain and LTOT and/or OUD, suggesting pandemic policies expanding access to chronic pain and OUD treatment services may have mitigated the risk of opioid overdose.
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Affiliation(s)
- Zachary L Mannes
- Department of Emergency Medicine, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA
| | - Katherine Wheeler-Martin
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - Kelly Terlizzi
- Department of Population Health, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016, USA
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Allison Perry
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - John R Pamplin
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA
| | - Stephen Crystal
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; Department of Health Behavior, Society and Policy, School of Public Health, Rutgers University, 683 Hoes Ln W, Piscataway, NJ 08854, USA; School of Social Work, Rutgers University, 120 Albany St, New Brunswick, NJ 08901, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA.
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Feder KA, Patel EU, Buresh M, Kirk GD, Mehta SH, Genberg BL. Trends in self-reported non-fatal overdose and patterns of substance use before and during the COVID-19 pandemic in a prospective cohort of adults who have injected drugs - Baltimore, Maryland, 2014-2022. Drug Alcohol Depend 2023; 251:110954. [PMID: 37716287 PMCID: PMC10538370 DOI: 10.1016/j.drugalcdep.2023.110954] [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: 04/18/2023] [Revised: 07/25/2023] [Accepted: 08/26/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Overdose deaths increased during the COVID-19 pandemic in the United States. Less is known about drug use behavior changes during the same time period. We examined differences in non-fatal overdose and drug use behaviors before and after the start of the COVID-19 pandemic in a community-recruited cohort of adults who have injected drugs. METHODS 721 participants attended 7401 visits between Jan 2014 and Mar 2022. Outcomes (non-fatal overdose, drug route of administration, type of drugs used) were assessed via self-report in the last six months. We compared pre-pandemic (Jan 2014-Mar 2020) to inter-pandemic (Dec 2020-Mar 2022) prevalence of each outcome using Cohcrane-Maentel-Haeszel odds ratios (CMH-OR). We then estimated probabilities for transitioning between specific behaviors from participants' last pre-pandemic visit to their first inter-pandemic visit. RESULTS Comparing pre-pandemic visits to inter-pandemic visits, the prevalence of non-fatal overdose did not change (CMH-OR 1.06, 95% CI 0.75-1.50); the prevalence of injection (CMH-OR 0.13, 95% CI 0.1-0.17) and non-injection (CMH-OR 0.51, 95% CI 0.42-0.61) drug use declined. More than a third (35.7%) of persons using both injection and non-injection drugs pre-pandemic transitioned to exclusive non-injection use during the pandemic. By contrast, few (4.0%) persons using non-injection drugs exclusively pre-pandemic transitioned to injecting during the pandemic. CONCLUSION Among adults who have injected drugs, the start of the COVID-19 pandemic was associated with a reduced drug use prevalence and transitions from injection to non-injection use. Average overdose prevalence was unchanged, but these behavior changes may have helped mitigate overdose harm.
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Affiliation(s)
- Kenneth A Feder
- Department of Mental Health, Bloomberg School of Public Health, USA.
| | - Eshan U Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Megan Buresh
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
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13
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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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Fraser M, Nzemenoh B, Jackson S, Chaikijurajai T, Halmosi R, Toth K, Khan WJ, Alexy T. Substance Use-Associated Mortality among Heart Donors after the COVID-19 National Emergency Increased but Did Not Affect Peri-Transplant Outcomes. J Cardiovasc Dev Dis 2023; 10:jcdd10050222. [PMID: 37233189 DOI: 10.3390/jcdd10050222] [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: 04/20/2023] [Revised: 05/07/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic and consequent social isolation prompted a surge in mental health disorders and substance use in the general population and, therefore, in potential organ donors. We aimed to evaluate if this led to a change in donor characteristics, including the mechanism and circumstance of death, and how this may have affected clinical outcomes following heart transplantation. METHODS We identified all heart donors from the SRTR database between 18 October 2018 and 31 December 2021, excluding those who donated immediately after the US national emergency declaration. Donors were stratified into pre-COVID-19 (Pre-Cov; through 12 March 2020) and post-COVID-19 national emergency declaration cohorts (Post-Cov; 1 August 2020 through 31 December 2021) based on the heart procurement date. Relevant demographics, cause of death, and substance use history were collected in addition to graft cold ischemic time, the incidence of primary graft dysfunction (PGD), and recipient survival at 30 days post-transplant. RESULTS A total of 10,314 heart donors were identified; 4941 were stratified into the Pre-Cov and 5373 into the Post-Cov cohorts. There was no difference in demographics, but illicit drug use was significantly higher in the Post-Cov group, leading to an increased incidence of death from drug intoxication. Fatal gunshot wounds were also more common. Despite these changes, the incidence of PGD remained similar (p = 0.371), and there was no difference in 30 days recipient survival (p = 0.545). CONCLUSION Our findings confirm that COVID-19 had a major impact on mental health and psychosocial life with an associated increase in illicit substance use and fatal intoxication rates in heart transplant donors. These changes did not alter peri-operative mortality following heart transplantation. Future studies are needed to ensure that long-term outcomes remain unaffected.
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Affiliation(s)
- Meg Fraser
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Bellony Nzemenoh
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Scott Jackson
- Analytics Consulting Services, MHealth Fairview, Minneapolis, MN 55455, USA
| | | | - Robert Halmosi
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Kalman Toth
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Wahab J Khan
- Department of Medicine, Avera Health, Sioux Falls, SD 57105, USA
| | - Tamas Alexy
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA
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