1
|
Delabre RM, Di Ciaccio M, Lorente N, Villes V, Castro Avila J, Yattassaye A, Bonifaz C, Ben Moussa A, Sikitu IZ, Khodabocus N, Freitas R, Spire B, Veras MA, Sagaon-Teyssier L, Girard G, Roux P, Velter A, Delpech V, Ghosn J, Riegel L, Rojas Castro D. Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program). JMIR Res Protoc 2023; 12:e45204. [PMID: 38096016 PMCID: PMC10755648 DOI: 10.2196/45204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/18/2023] [Accepted: 08/10/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. OBJECTIVE This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enquêtes Pour évaluer l'Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. METHODS A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. RESULTS From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). CONCLUSIONS The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45204.
Collapse
Affiliation(s)
| | | | - Nicolas Lorente
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Agència de Salut Pública de Catalunya, Badalona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Virginie Villes
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | | | - Adam Yattassaye
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association pour la Résilience des Communautés pour l'Accès au Développement et à la Santé PLUS, Bamako, Mali
| | - César Bonifaz
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Corporación Kimirina, Quito, Ecuador
| | - Amal Ben Moussa
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association de Lutte Contre le Sida, Casablanca, Morocco
| | - Ingrid-Zaïre Sikitu
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association Nationale de Soutien aux Séropositifs et Malades du Sida, Bujumbura, Burundi
| | - Niloufer Khodabocus
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Prévention Information Lutte contre le SIDA, Port Louis, Mauritius
| | - Rosa Freitas
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Bruno Spire
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Association pour la Résilience des Communautés pour l'Accès au Développement et à la Santé PLUS, Bamako, Mali
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Gabriel Girard
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Perrine Roux
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Annie Velter
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
- Santé Publique France, Saint-Maurice, France
| | - Valérie Delpech
- Director of Population and Public Health Directorate, North Coast North South Wales, Australia
| | - Jade Ghosn
- Assistance Publique - Hôpitaux de Paris Nord, Service des Maladies Infectieuses, Center Hospitalier Universitaire Bichât - Claude Bernard, Paris, France
- Infection, Antimicrobials, Modelling, Evolution, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Université Paris Cité, Paris, France
| | - Lucas Riegel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| |
Collapse
|
2
|
Garcia V, McCann L, Lauber E, Vaccaro C, Swauger M, Heckert AD. High-risk Individuals and Naloxone Use: Implications for THN Programs in Rural Appalachian Communities. JOURNAL OF APPALACHIAN HEALTH 2023; 5:9-21. [PMID: 38784143 PMCID: PMC11110902 DOI: 10.13023/jah.0503.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Introduction Take-home naloxone (THN) is being made available across rural Appalachia to curb opioid overdose fatalities. Despite this initiative, some opioid users do not possess naloxone, and if they do, do not administer it to others. Purpose Research findings on risk factors that contribute to opioid overdose are presented. These factors, identified in a sample of 16 overdose cases, are (1) early onset age of opioid use; (2) progressive opioid use; (3) a transition from pain medication to heroin and fentanyl; (4) fears of being arrested at a naloxone intervention if first responders are contacted, and (5) limited knowledge of Good Samaritan Laws. Methods The findings are based on a subsample 16 overdose victims who were identified during a one-year (2018) qualitative study on the decline of overdose fatalities in four rural counties in Western Pennsylvania. They were recruited from a larger sample of 50 current and former substance users and were interviewed a second time using a semi-structured interview guide about their overdose experiences. All interview data were analyzed using thematic analysis via NVivo. Results Findings reveal that risk factors contribute to a severe opioid dependence that interferes with naloxone use. These factors also hinder adherence to proper naloxone protocol, designed to place overdose victims in contact with treatment providers. Implications Recommendations are made for additional research and for pursuing measures to increase efficacy of naloxone interventions. They include developing naloxone campaigns aimed at high-risk individuals, improving their knowledge of Good Samaritan Laws, increasing adherence to THN protocols that improve the possibility of treatment, and using community harm reduction specialists for community outreach.
Collapse
|
3
|
Heidari O, Shah H, Bhagwat A, Ahmad NJ, Whaley S, Sherman SG, Morris M, Saloner B. Changes in opioid treatment programs and harm reduction provider services during the COVID-19 pandemic: Findings from 10 states. Psychol Serv 2023:2024-15613-001. [PMID: 37824245 PMCID: PMC11009379 DOI: 10.1037/ser0000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Harm reduction and opioid treatment programs (OTPs) modified service delivery based on rapid changes to state and federal regulations during the COVID-19 pandemic. There is little evidence on how these regulations changed the delivery of medication for opioid use disorder and harm reduction services and whether certain regulations should be made permanent. This study explores how harm reduction OTPs across the United States leveraged changes in regulations and responded to impacts of COVID-19 to continue providing services and perspectives on future legislation that regulates their practice and practice sites. The COVID Harm Reduction and Treatment programs Survey study administered a survey that included closed-ended and free-response questions to 22 sites between August 2020 and January 2021. Program demographics and responses to survey items pertaining to site and service modifications were tabulated and proportions reported. A qualitative descriptive method was used to analyze free-response questions. All (100%) surveyed providers reported the need to modify their services. The majority (68%) reported an increase or no change in client volume; 68% reported increases in naloxone services and 77% reported increases in syringe services programs. Qualitative themes included (a) flexibility in reaching clients due to regulatory changes, (b) benefits and drawbacks of telehealth, and (c) increased vulnerabilities of their clients during the pandemic. Despite difficulties during the COVID-19 pandemic, harm reduction and OTP sites found that regulatory changes provided flexibility in service delivery and that they were better able to serve their clients. Future policies should bolster these sites to continue to provide low-barrier and high-quality services. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Omeid Heidari
- University of Washington, School of Nursing, Department of Child, Family, and Population Health
| | - Hridika Shah
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - Atharva Bhagwat
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - N. Jia Ahmad
- Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital and Brigham and Women’s Hospital
| | - Sara Whaley
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins University, Bloomberg School of Public Health
| | - Miles Morris
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - Brendan Saloner
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| |
Collapse
|
4
|
Byregowda H, Tomko C, Schneider KE, Russell E, Johnson RM, Susukida R, Rouhani S, Parnham T, Park JN. Disruptions to naloxone training among lay and occupational responders in Maryland during the emergence of COVID-19: early impacts, recovery, and lessons learned. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023:100173. [PMID: 37362079 PMCID: PMC10271935 DOI: 10.1016/j.dadr.2023.100173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
Background : Opioid overdose death rates increased during the COVID-19 pandemic. Disruptions in community-based naloxone trainings could have reduced the likelihood of overdose reversal and increased the chances of a fatal overdose. We investigated changes in the number of people trained in naloxone administration and distribution in Maryland before, during, and after COVID-related stay-at-home orders. Methods : Data on naloxone training are from the Maryland Department of Health. We used interrupted time series models to estimate changes in average monthly number of people trained: [1] pre-interruption (4/2019-3/2020), [2] 1-month post-interruption (4/2020-5/2020), and [3] 12-months post-interruption (4/2020-3/2021). Trainees were classified as lay (e.g., people who use drugs) or occupational (e.g., law enforcement officers and harm reduction workers) responders. Results : There were 101,332 trainees; 54.1% lay, 21.5% occupational, and 23.4% unknown responder status. We observed a decrease in the average monthly number of trainees in the pre-interruption period (-235, p<0.001), a larger decrease of 93.2% during the 1-month post-interruption (-846, p=0.013), and an increase 12-months post-interruption (+217, p<0.001). There was a significant decrease among occupational responders 1-month post-interruption, and a significant increase among lay responders in the 12-month post-interruption period. Conclusions : Findings suggest a marked decrease in naloxone trainees immediately after stay-at-home order, followed by a moderate rebound in the 12-months after stay-at-home order. The decrease in occupational responders trained may have limited access to naloxone, but would likely have been offset by increases in number of lay responders trained. Strengthening lay and occupational responder connections could maintain naloxone distribution during public health crises.
Collapse
Affiliation(s)
- Himani Byregowda
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Erin Russell
- Center for Harm Reduction Services, Maryland Department of Health
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Saba Rouhani
- Department of Epidemiology, New York University School of Global Public Health
| | - Taylor Parnham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Ju Nyeong Park
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University
| |
Collapse
|
5
|
Mathias CW, Cavazos DM, McGlothen-Bell K, Crawford AD, Flowers-Joseph B, Wang Z, Cleveland LM. Opioid overdose prevention education in Texas during the COVID-19 pandemic. Harm Reduct J 2023; 20:37. [PMID: 36964600 PMCID: PMC10037395 DOI: 10.1186/s12954-023-00769-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Distribution of naloxone and training on its proper use are evidence-based strategies for preventing opioid overdose deaths. In-person naloxone training was conducted in major metropolitan areas and urban centers across Texas as part of a state-wide targeted opioid response program. The training program transitioned to a live, virtual format during the COVID-19 public health emergency declaration. This manuscript describes the impact of this transition through analyses of the characteristics of communities reached using the new virtual training format. CASE PRESENTATION Training participant addresses were compared to county rates of opioid overdose deaths and broadband internet access, and census block comparison to health services shortages, rural designation, and race/ethnicity community characteristics. CONCLUSIONS The virtual training format reached more learners than the in-person events. Training reached nearly half of the counties in Texas, including all with recent opioid overdose deaths. Most participants lived in communities with a shortage of health service providers, and training reached rural areas, those with limited broadband internet availability, and majority Hispanic communities. In the context of restrictions on in-person gathering, the training program successfully shifted to a live, online format. This transition increased participation above rates observed pre-pandemic and reached communities with the need for equipping those most likely to witness an opioid overdose with the proper use of naloxone.
Collapse
Affiliation(s)
- Charles W Mathias
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7793, San Antonio, TX, 78229, USA.
| | - Diana M Cavazos
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Kelly McGlothen-Bell
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Allison D Crawford
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Brieanna Flowers-Joseph
- Graduate School of Biomedical Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Zhan Wang
- Population Health Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Lisa M Cleveland
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| |
Collapse
|
6
|
Giordano NA, Febres-Cordero S, Baker H, Pfeiffer KM, Walsh LM, Gish A, Axson SA. Opioid-involved overdose trainings delivered using remote learning modalities. Nurs Open 2023; 10:4132-4136. [PMID: 36681653 PMCID: PMC10170917 DOI: 10.1002/nop2.1615] [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: 10/26/2021] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/23/2023] Open
Abstract
AIM This education-focused study examined changes in nursing students' knowledge and attitudes towards responding to opioid-involved overdoses following participation in trainings delivered using remote learning modalities. DESIGN This pre-post study examined learning outcomes among 17 nursing students. METHODS Participants completed the Opioid Overdose Attitude Scale and Opioid Overdose Knowledge Scale to assess attitudes and knowledge, respectively. Trainings were delivered to two separate groups, one via virtual reality immersive video and another over video conferencing. RESULTS Attitude scores increased by an average of 12.2 points and knowledge scores increased by 1.65 points. Within the virtual reality group, attitude scores increased by an average of 10 points, while no significant changes were observed in knowledge scores. The video conferencing group improved in both attitude and knowledge scores, by an average of 16.2 points and 2.1 points, respectively. CONCLUSIONS These hypothesis generating results illustrate the utility of remote learning approaches to deliver trainings, while maintaining social distance during the ongoing COVID-19 pandemic.
Collapse
Affiliation(s)
- Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Helen Baker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Katherine M Pfeiffer
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Lisa Marie Walsh
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Andy Gish
- Independent Harm Reduction Expert, Atlanta, Georgia, USA
| | - Sydney A Axson
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| |
Collapse
|
7
|
Torres-Leguizamon M, Favaro J, Coello D, Reynaud EG, Néfau T, Duplessy C. Remote harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA. Harm Reduct J 2023; 20:1. [PMID: 36611167 PMCID: PMC9823260 DOI: 10.1186/s12954-023-00732-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Harm Reduction (HR) policies for People Who Use Drugs (PWUD) have a significant positive impact on their health. Such approaches limit the spread of infections and reduce opioid overdose mortality. These policies have led to the opening of specialized structures located mainly in big cities and urbanized zones. The COVID-19 pandemic reduced access to HR structures in locations undergoing lockdown. Before the pandemic, HR services in France and in the USA were complemented by the development of remote HR programs: HaRePo (Harm Reduction by Post) for France, implemented in 2011, and NEXT Distro for the USA founded in 2017. These programs are free and specifically designed for people who have difficulties accessing HR tools and counseling in-person. PWUD can access HaRePo program by phone and/or email. NEXT Distro users can access the program through its dedicated website. The aim of the study is to test if and possibly how COVID-19 pandemic and the associated lockdowns have impacted the HR services in both countries. METHODS By using t-test comparing the year 2019 with the year 2020, we analyzed how lockdowns impacted the number of new users entering the programs, as well as the numbers of parcels sent and naloxone distributed, by using records of both structures. RESULTS We showed that the activity of both programs was significantly impacted by the pandemic. Both show an increase in the number of new users joining the programs (+ 77.6% for HaRePo and + 247.7% for NEXT Distro) as well as for the number of parcels sent per month (+ 42.7% for HaRePo and + 211.3% for NEXT Distro). It shows that remote HR was able to partially compensate for the reduced HR activities due to COVID-19. We also observed that the distribution of naloxone per parcel tends to increase for both structures. CONCLUSION With the ability to reach PWUD remotely, HaRePo and NEXT Distro were particularly effective at maintaining service continuity and scaling up services to meet the needs of PWUD during the COVID-19 pandemic. By studying two independent structures in France and in the USA sharing similar objectives (remote HR), we showed that this approach can be a key solution to crises that impact classical HR structures despite various differences in operating procedures between countries.
Collapse
Affiliation(s)
| | | | | | - Emmanuel G. Reynaud
- grid.7886.10000 0001 0768 2743School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Thomas Néfau
- SAFE, 11 Avenue de la Porte de la Plaine, 75015 Paris, France
| | | |
Collapse
|
8
|
May T, Dawes J, Fancourt D, Burton A. A qualitative study exploring the impact of the COVID-19 pandemic on People Who Inject Drugs (PWID) and drug service provision in the UK: PWID and service provider perspectives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103752. [PMID: 35653821 PMCID: PMC9135844 DOI: 10.1016/j.drugpo.2022.103752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND People Who Inject Drugs (PWID) are subject to distinct socio-structural inequalities that can expose them to high risks of COVID-19 transmission and related health and social complications. In response to COVID-19 mitigation strategies, these vulnerabilities are being experienced in the context of adapted drug treatment service provision, including reduced in-person support and increased regulatory flexibility in opioid substitution therapy (OST) guidelines. This study aimed to explore the longer-term impact of the pandemic on the health and wellbeing of PWID in the UK, including provider and client experiences of treatment changes. METHODS Interviews were conducted with 19 PWID and 17 drug treatment providers between May and September 2021, recruited from drug and homelessness charities providing treatment services and healthcare in the UK. Data were analysed using reflexive thematic analysis. RESULTS Most participants expressed ongoing fears of COVID-19 transmission, although socio-structural inequalities limited the contexts in which physical distancing could be practised. In addition, virus mitigation strategies altered the risk environment for PWID, resulting in ongoing physical (e.g. changing drug use patterns, including transitions to crack cocaine, benzodiazepine and pregabalin use) and socio-economic harms (e.g. limited opportunities for sex work engagement and income generation). Finally, whilst clients reported some favourable experiences from service adaptations prompted by COVID-19, including increased regulatory flexibility in OST guidelines, there was continued scepticism and caution among providers toward sustaining any treatment changes beyond the pandemic period. CONCLUSIONS Whilst our findings emphasize the importance of accessible harm reduction measures attending to changing indices of drug-related harm during this period, there is a need for additional structural supports to ensure pre-existing disparities and harms impacting PWID are not exacerbated further by the conditions of the pandemic. In addition, any sustained policy and service delivery adaptations prompted by COVID-19 will require further attention if they are to be acceptable to both service users and providers.
Collapse
Affiliation(s)
- Tom May
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, United Kingdom
| | - Jo Dawes
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, United Kingdom
| | - Daisy Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, United Kingdom
| | - Alexandra Burton
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, United Kingdom.
| |
Collapse
|
9
|
McDonald R, Eide D, Abel-Ollo K, Barnsdale L, Carter B, Clausen T, Day E, Fonseca F, Holmén E, Horsburgh K, Kelleher M, Kåberg M, Ladenhauf M, McAuley A, Metrebian N, Neale J, Parkin S, Ratcliffe K, Rintoul C, Smith J, Stifanoviciute V, Torrens M, Thiesen H, Strang J. A rapid assessment of take-home naloxone provision during COVID-19 in Europe. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103787. [PMID: 35849935 PMCID: PMC9247228 DOI: 10.1016/j.drugpo.2022.103787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Rebecca McDonald
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Desiree Eide
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - Katri Abel-Ollo
- Drug Abuse and Infectious Diseases Prevention Centre, National Institute for Health Development, Tallinn, Estonia
| | | | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - Ed Day
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Francina Fonseca
- Addiction Research Group, Neuroscience Research Program, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Elin Holmén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | | | - Mike Kelleher
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Martin Kåberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | - Martin Ladenhauf
- Caritas Kontaktladen und Streetwork im Drogenbereich, Graz, Austria
| | - Andrew McAuley
- Public Health Scotland, UK; School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Nicola Metrebian
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Josie Smith
- Substance Misuse Programme, Public Health Wales, Cardiff, UK
| | | | - Marta Torrens
- Addiction Research Group, Neuroscience Research Program, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Henrik Thiesen
- Health Team for the Homeless, Center for Marginalized Adults and Families, Copenhagen City Social Services, Denmark
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
10
|
Shapira B, Rosca P. Transformation of substance use disorder treatment services during COVID-19 - A lasting change? JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2070875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Barak Shapira
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | - Paola Rosca
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| |
Collapse
|
11
|
Hughes TM, Kalicki A, Huxley-Reicher Z, Toribio W, Samuels DL, Weiss JJ, Herscher M, Wang L. A medical student-led model for telephone-based opioid overdose education and naloxone distribution during the COVID-19 pandemic. Subst Abus 2022; 43:988-992. [DOI: 10.1080/08897077.2022.2060426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Terence M. Hughes
- MD-Candidate, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Kalicki
- MD-Candidate, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zina Huxley-Reicher
- MD-Candidate, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Wilma Toribio
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Don L. Samuels
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey J. Weiss
- MD-Candidate, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Herscher
- MD-Candidate, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Hospital Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Linda Wang
- MD-Candidate, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
12
|
Cremer LJ, Board A, Guy GP, Schieber L, Asher A, Parker EM. Trends in pharmacy-based dispensing of buprenorphine, extended-release naltrexone, and naloxone during the COVID-19 pandemic by age and sex - United States, March 2019 - December 2020. Drug Alcohol Depend 2022; 232:109192. [PMID: 35065513 PMCID: PMC8620097 DOI: 10.1016/j.drugalcdep.2021.109192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND COVID-19 stay-at-home orders may reduce access to substance use treatment and naloxone, an opioid overdose reversal drug. The objective of this analysis was to compare monthly trends in pharmacy-based dispensing rates of medications for opioid use disorder (MOUD) (buprenorphine and extended-release [ER] naltrexone) and naloxone in the United States during March 2019-December 2020 by age and sex. METHODS We calculated monthly prescription dispensing rates per 100,000 persons using IQVIA New to Brand. We used Joinpoint regression to calculate monthly percent change in dispensing rates and Wilcoxon Rank Sum tests to examine differences in median monthly rates overall, and by age and sex between March 2019-December 2019 and March 2020-December 2020. RESULTS Buprenorphine dispensing increased among those aged 40-64 years and ≥ 65 years from March 2019 to December 2020. Median rates of total ER naltrexone dispensing were lower in March 2020-December 2020 compared to March 2019-December 2019 for the total population, and for females and males. From March 2019 to December 2020, ER naltrexone dispensing decreased and naloxone dispensing increased for those aged 20-39 years. CONCLUSIONS Dispensing ER naltrexone declined during the study period. Given the increase in substance use during the COVID-19 pandemic, maintaining equivalent access to MOUD may not be adequate to accommodate rising numbers of new patients with opioid use disorder. Access to all MOUD and naloxone could be further expanded to meet potential needs during and after the public health emergency, given their importance in preventing opioid overdose-related harms.
Collapse
Affiliation(s)
- Laura J. Cremer
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Atlanta, GA, USA,Correspondence to: Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA
| | - Amy Board
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Atlanta, GA, USA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gery P. Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Atlanta, GA, USA
| | - Lyna Schieber
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Atlanta, GA, USA
| | - Alice Asher
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA
| | - Erin M. Parker
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Atlanta, GA, USA
| |
Collapse
|
13
|
de Vargas D, Pereira CF, Volpato RJ, Lima AVC, da Silva Ferreira R, de Oliveira SR, Aguilar TF. Strategies Adopted by Addiction Facilities during the Coronavirus Pandemic to Support Treatment for Individuals in Recovery or Struggling with a Substance Use Disorder: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212094. [PMID: 34831850 PMCID: PMC8624445 DOI: 10.3390/ijerph182212094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
This review aimed to identify and synthesize strategies and actions adopted by addiction facilities to support and maintain treatment during the coronavirus disease 2019 (COVID-19) pandemic. A scoping review was conducted using the following information sources: Virtual Health Library, SCOPUS, Web of Science, PubMed, CINAHL, and Latin American and Caribbean Health Science Literature. From a total of 971 articles, 28 studies were included. The strategies to maintain the care offer were telehealth/telemedicine, counselling/screening, 24-h telephone, webinars, conducting group therapy and support among users, adaptation for electronic health records, increased methadone/naloxone dispensing, restriction in the number of medication dispensing/day, and electronic prescription and home delivery medications. These strategies can be used to support health professionals in addressing the impact of the pandemic on the treatment of those in recovery or struggling with a substance use disorder when in-person treatment is not possible.
Collapse
Affiliation(s)
- Divane de Vargas
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
- Correspondence:
| | - Caroline Figueira Pereira
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Rosa Jacinto Volpato
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Ana Vitória Corrêa Lima
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Rogério da Silva Ferreira
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Sheila Ramos de Oliveira
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Thiago Faustino Aguilar
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| |
Collapse
|
14
|
Krawczyk N, Fawole A, Yang J, Tofighi B. Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review. Addict Sci Clin Pract 2021; 16:68. [PMID: 34774106 PMCID: PMC8590133 DOI: 10.1186/s13722-021-00275-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. METHODS Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. RESULTS Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. CONCLUSIONS The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.
Collapse
Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, Room 4-12, New York, NY, USA.
| | - Adetayo Fawole
- New York University, School of Global Public Health, New York, NY, USA
| | - Jenny Yang
- NYU Grossman School of Medicine, New York, NY, USA
| | - Babak Tofighi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
15
|
Curran JA, Somerville M, Boulos L, Caudarella A, Crowther D, Johnson C, Wozney L, MacPhee S, Sinclair D, Elliott Rose A, Jose C, Joudrey M. Identifying harm reduction strategies for alcohol and drug-use in inpatient care settings and emergency departments: a scoping review protocol. BMJ Open 2021; 11:e055654. [PMID: 34711603 PMCID: PMC8557290 DOI: 10.1136/bmjopen-2021-055654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People who use alcohol and/or drugs (PWUAD) are at high risk of medical complications, frequent hospitalisation and drug-related death following discharge from inpatient settings and emergency departments (EDs). Harm reduction strategies implemented in these settings may mitigate negative health outcomes for PWUAD. However, the scope of harm reduction strategies used globally within inpatient settings and EDs is unknown. The objective of this review is to identify and synthesise reported harm reduction strategies that have been implemented across inpatient settings and EDs for PWUAD. METHODS AND ANALYSIS This review will include studies from any country and health service reporting on harm reduction strategies implemented in inpatient settings or EDs. The population of interest includes people of any race, gender and age identifying as PWUAD, or individuals who provided care to PWUAD. Studies which describe implementation strategies and barriers and enablers to implementation will be included. Studies published in English, or those available for English translation will be included. The following databases will be searched: MEDLINE All (Ovid), Embase (Elsevier Embase.com), CINAHL with Full Text (EBSCOhost), PsycINFO (EBSCOhost) and SCOPUS (Elsevier Scopus.com). A grey literature search will be conducted. There will be no date restrictions on the search. Titles, abstracts and full texts will be screened in duplicate. Data will be extracted using a standardised form. The results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews. ETHICS AND DISSEMINATION Scoping reviews do not require ethical approval. Patient partners with lived experience and relevant knowledge users will be engaged as research team members throughout all phases of the research process. A report detailing context, methodology and findings from this review will be disseminated to knowledge users and relevant community stakeholders. This review will be submitted for publication to a relevant peer-reviewed journal.
Collapse
Affiliation(s)
- Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Quality and Patient Safety, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Mari Somerville
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR Support Unit, Halifax, Nova Scotia, Canada
| | - Alexander Caudarella
- Mental Health and Addictions Service, St Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel Crowther
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Catie Johnson
- Quality and Patient Safety, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Mental Health and Addictions Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Shannon MacPhee
- Quality and Patient Safety, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Douglas Sinclair
- Quality and Patient Safety, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Caroline Jose
- Maritime SPOR Support Unit, Halifax, Nova Scotia, Canada
| | - Morgan Joudrey
- Quality and Patient Safety, IWK Health Centre, Halifax, Nova Scotia, Canada
| |
Collapse
|
16
|
Brandt L, Yanagida T, Campbell ANC, Jones JD, Schultes MT, Martinez S, Comer SD. Multi-informant Implementation and Intervention Outcomes of Opioid Overdose Education and Naloxone Distribution in New York City. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2021; 1:209-222. [PMID: 34622215 PMCID: PMC8450721 DOI: 10.1007/s43477-021-00021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
Overdose Education and Naloxone Distribution (OEND) is an effective public health intervention to reduce opioid overdose fatalities (McDonald and Strang, Addiction 111:1177-1187, 2016). However, we know little about OEND implementation outcomes (i.e., indicators of implementation success), specifically the fidelity of training delivery, and how these may relate to intervention outcomes (i.e., indicators of the success or effectiveness of an intervention), such as overdose knowledge and attitudes. This study evaluated 16 OEND trainings conducted at different Opioid Overdose Prevention Programs in New York City. Trainees (N = 75) completed the Opioid Overdose Knowledge and Attitude Scales before and after training (intervention outcomes). Implementation outcomes were fidelity (competence and adherence of the trainer, N = 10; modified Fidelity Checklist) and acceptability of OEND (Acceptability of Intervention Measure), assessed from multiple perspectives (trainees, trainers, and an independent observer). Trainees' overdose knowledge, t(71) = - 8.12, p < 0.001, 95% CI [- 6.54, - 3.96], and attitudes, t(65) = - 6.85, p < 0.001, 95% CI [- 0.59, - 0.33], improved significantly from pre- to post-training. Stepwise multiple regression models indicated that adherence of the trainer rated from the observer perspective added significantly to the prediction of changes in overdose knowledge, F(1, 67) = 9.81, p = 0.003, and explained 13% of the variance in outcome. However, fidelity measures from the perspective of trainees or trainers and acceptability of OEND were not associated with changes in trainees' overdose knowledge or attitudes. OEND implementation outcomes and their relationship with intervention outcomes differed depending on the role of the fidelity rater in relation to the intervention. Specifically, our findings indicate that fidelity should be measured from an independent perspective (i.e., an individual who is experienced with fidelity rating but not directly involved in the intervention). SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43477-021-00021-4.
Collapse
Affiliation(s)
- Laura Brandt
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| | - Takuya Yanagida
- Department of Developmental and Educational Psychology, University of Vienna, Universitaetsstrasse 7 (NIG), 1010 Vienna, Austria
| | - Aimee N. C. Campbell
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| | - Jermaine D. Jones
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| | - Marie-Therese Schultes
- Department of Developmental and Educational Psychology, University of Vienna, Universitaetsstrasse 7 (NIG), 1010 Vienna, Austria
- Institute for Implementation Science in Healthcare, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland
| | - Suky Martinez
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| | - Sandra D. Comer
- Division on Substance Use Disorders, Department of Psychiatry & New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit #120, New York, NY 10032 USA
| |
Collapse
|
17
|
Shreffler J, Shreffler M, Murfree JR, Huecker M. A Global Pandemic and Substance Use Disorder: Healthcare Professionals' Viewpoints on the Merging of Two Crises. Subst Use Misuse 2021; 56:1476-1482. [PMID: 34130597 DOI: 10.1080/10826084.2021.1936052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
COVID-19 has resulted in extraordinary adversities. Mandates such as distancing and variations to treatment services were implemented to slow transmission of the virus, but created new challenges for persons with Substance Use Disorder (SUD). To better understand this phenomenon, we surveyed healthcare professionals on how they believe COVID-19 has impacted persons with SUD and what needs to occur to effectively treat this vulnerable population. Methods: Attending physicians, residents, nurses, medical and nursing students, and other healthcare professionals were asked to respond to three open-ended questions related to the impact of COVID-19 on persons with SUD. Two independent coders reviewed the comments utilizing constant comparative analysis to develop themes. Results: Common themes of concern were found from the respective participants (n = 205) including: lack of access to treatment, feelings of isolation, negative impacts on mental health, and the possibility of relapse. Healthcare strategies to effectively treat and help persons with SUD included increasing access to treatment including telehealth, development of peer support groups, availability of mental health resources, development of enhanced communication channels between providers and patients, and systematic changes. Conclusion: During the COVID-19 pandemic, overdose deaths have dramatically increased. As the short-term and long-term effects of the pandemic become more apparent, swift and comprehensive responses and policies must be enacted. This study provides insight from healthcare providers on the effects of the pandemic for persons with SUD. Many preexisting issues remain unresolved (e.g. stigma and healthcare disparities), and now the pandemic has presented new obstacles as noted by the providers. The findings from this study provide implications for important discussion regarding the development of strategies for substance use treatment and harm reduction.
Collapse
Affiliation(s)
- Jacob Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Megan Shreffler
- Department of Health and Sport Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Jessica R Murfree
- Department of Health and Sport Sciences, University of Louisville, Louisville, Kentucky, USA.,Department of Health and Kinesiology, Texas A&M University, College Station Texas, USA
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|