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Haider MR, Jayawardhana J. Opioid and benzodiazepine misuse in the United States: The impact of socio-demographic characteristics. Am J Addict 2024; 33:71-82. [PMID: 37689992 DOI: 10.1111/ajad.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In 2021, drug overdose deaths in the United States reached a new record of 107,622. Misuse of opioids and benzodiazepines accounts for a large portion of drug overdose deaths. However, the effects of socio-demographic characteristics on misuse of opioids and benzodiazepines are not evident. Thus, this study examines the socio-demographic characteristics associated with misuse of opioids and benzodiazepines among adults in the United States. METHODS Data from 2015-2019 National Survey on Drug Use and Health was utilized in the multinomial logistic regression analysis and included 202,935 adults ages ≥18 years. RESULTS During 2015-2019, 3.3% of the adults misused opioids, 1.2% misused benzodiazepines, and 0.9% misused both drugs in the preceding year of the survey. Those who were younger, bisexual, non-Hispanic White, had a history of delinquency in the past year, had alcohol dependence/abuse, marijuana dependence/abuse, nicotine dependence and use, and experienced major depressive episodes were more likely to misuse opioids, benzodiazepines, or both. CONCLUSION AND SCIENTIFIC SIGNIFICANCE A large portion of US adults are misusing opioids, benzodiazepines, and both drugs. Specifically, bisexual individuals experience higher odds of opioid misuse, benzodiazepine misuse and misuse of both drugs compared with heterosexuals, while males are experiencing lower odds of benzodiazepine misuse compared with females. Individuals aged 26-49 experience the highest odds of opioid misuse, though misuse of both drugs was higher among the 18-25 age group. Findings underscore the use of targeted preventive measures to reduce misuse of these drugs among at-risk populations identified in this study.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Health Policy and Management, University of Georgia, Athens, Georgia, USA
| | - Jayani Jayawardhana
- College of Public Health & College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
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Ali F, Kaura A, Russell C, Bonn M, Bruneau J, Dasgupta N, Imtiaz S, Martel-Laferrière V, Rehm J, Shahin R, Elton-Marshall T. Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study. Harm Reduct J 2023; 20:99. [PMID: 37516836 PMCID: PMC10387201 DOI: 10.1186/s12954-023-00826-6] [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: 04/22/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. METHODS Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. RESULTS Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. CONCLUSION PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.
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Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada.
| | - Ashima Kaura
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul, Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Nabarun Dasgupta
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sameer Imtiaz
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, & Institute of Medical Science (IMS), Toronto, Canada
- 1 King's College Circle, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | | | - Tara Elton-Marshall
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Sánchez-Valdivia N, Barbaglia MG, Olivella-Cirici M, Girona Marcos N, Gotsens M, Garrido Albaina A, Rius C, Bartroli M, Pérez G. Community outbreak of COVID-19 among people who use drugs attending a harm reduction centre in Barcelona, Spain. Harm Reduct J 2023; 20:74. [PMID: 37316829 PMCID: PMC10264877 DOI: 10.1186/s12954-023-00804-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] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic particularly affected the health of vulnerable population, such as people who use drugs. Due to compromised baseline health status, certain drug uses and settings and socioeconomic deprivation related to poverty and homelessness, drug users faced higher risk of COVID-19 infection. They had difficulty in adhering to the public health measures (i.e. physical distancing, hand hygiene and mask use). Also, the struggle to implement non-pharmaceutical actions (i.e. test-trace-isolate-quarantine strategy) among SARS-COV-2-infected drug users and their close contacts challenged the public health response. Therefore, this study aimed to describe a community COVID-19 outbreak and its approach among drug users of a harm reduction programme in an outpatient drug treatment centre in Barcelona, Spain. METHODS We conducted an observational descriptive study of an outbreak of COVID-19 among people who use drugs attending the harm reduction programme of an outpatient drug treatment centre in the city of Barcelona, between July and October 2021 (n = 440). A passive search for cases was carried out with rapid antigens tests targeting symptomatic users who attended the facilities. RESULTS Nineteen positive COVID-19 cases were identified among symptomatic drug users, between July and October 2021, with an attack rate of 4.3%. Specific measures were taken to control the outbreak, such as offering accommodation to self-isolate in a low-threshold residential resource to homeless drug users who tested positive and intensifying the vaccination strategy. The management of the outbreak was carried out in close collaboration between the outpatient centre and the main public health stakeholders in the city of Barcelona. CONCLUSIONS This study shows the complexity of managing and investigating COVID-19 outbreaks in vulnerable population groups. Epidemiological control measures, such as the test-trace-isolate-quarantine strategy, were challenging to implement due to technology-related barriers and socioeconomic vulnerabilities, especially homelessness. Community-based interventions, cooperation among stakeholders and housing-related policies were helpful in tackling outbreaks among people who use drugs. When addressing vulnerable and hidden populations, the perspective of inequalities should be included in epidemiological surveillance and outbreak control strategies.
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Affiliation(s)
| | - Maria Gabriela Barbaglia
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain.
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Madrid, Spain.
| | - Marc Olivella-Cirici
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Noelia Girona Marcos
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Madrid, Spain
| | | | - Cristina Rius
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Madrid, Spain
| | - Gloria Pérez
- Agència de Salut Pública de Barcelona, Pl. de Lesseps, 1, 08023, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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Mason R, Roberts A, Spaight R, Shaw D, Whitley GA, Hogue TE, Siriwardena AN, Rogers J, Law GR. Ambulance attendance for substance and/or alcohol use in a pandemic: Interrupted time series analysis of incidents. Drug Alcohol Rev 2022; 41:932-940. [PMID: 35231136 PMCID: PMC9111577 DOI: 10.1111/dar.13453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The ambulance attendance for substance and/or alcohol use in a pandemic (ASAP) study explores incidents during the COVID-19 lockdown in the East Midlands region of the United Kingdom (23 March-4 July 2020). METHOD Retrospective cross-sectional count per day of ambulance attendances from the East Midlands Ambulance Service Trust. Ambulance attendances relating to alcohol or other drug use in the year prior, during lockdown and weeks following, were examined using interrupted time series analysis by patient demographics and geographical location. RESULTS A total of 36 104 records were identified (53.7% male, 84.5% ethnicity classified as White, mean age 38.4 years). A significant drop in the number of attendances per day at the start of lockdown (-25.24, confidence interval - 38.16, -12.32) was observed, followed by a gradual increase during the ongoing lockdown period (0.36, confidence interval 0.23, 0.46). Similar patterns were found across genders, age groups 16-64 and urban/rural locations. DISCUSSION AND CONCLUSION The pattern of ambulance attendances for alcohol or other drug use changed during the COVID-19 lockdown period. Lockdown significantly affected the use of ambulances for incidents involving alcohol or other drug use, impacting on health-care services. Further research into hazardous use of alcohol or other drugs during the lockdown periods is needed to inform policy, planning and public health initiatives.
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Affiliation(s)
- Rachael Mason
- School of Health and Social CareCollege of Social Science, University of LincolnLincolnUK
| | - Amanda Roberts
- School of PsychologyCollege of Social Science, University of LincolnLincolnUK
| | | | - Debbie Shaw
- East Midlands Ambulance Service NHS TrustLincolnUK
| | - Gregory Adam Whitley
- School of Health and Social CareCollege of Social Science, University of LincolnLincolnUK,East Midlands Ambulance Service NHS TrustLincolnUK
| | - Todd E. Hogue
- School of PsychologyCollege of Social Science, University of LincolnLincolnUK
| | | | - Jim Rogers
- School of Health and Social CareCollege of Social Science, University of LincolnLincolnUK
| | - Graham R. Law
- School of Health and Social CareCollege of Social Science, University of LincolnLincolnUK
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Krausz RM, Westenberg JN, Mathew N, Budd G, Wong JSH, Tsang VWL, Vogel M, King C, Seethapathy V, Jang K, Choi F. Shifting North American drug markets and challenges for the system of care. Int J Ment Health Syst 2021; 15:86. [PMID: 34930389 PMCID: PMC8685808 DOI: 10.1186/s13033-021-00512-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
Drug markets are dynamic systems which change based on demand, competition, legislation and revenue. Shifts that are not met with immediate and appropriate responses from the healthcare system can lead to public health crises with tragic levels of morbidity and mortality, as experienced Europe in the early 1990s and as is the case in North America currently. The major feature of the current drug market shift in North America is towards highly potent synthetic opioids such as fentanyl and fentanyl analogues. An additional spike in stimulant use further complicates this issue. Without understanding the ever-changing dynamics of drug markets and consequent patterns of drug use, the healthcare system will continue to be ineffective in its response, and morbidity and mortality will continue to increase. Economic perspectives are largely neglected in research and clinical contexts, but better treatment alternatives need to consider the large-scale macroeconomic conditions of drug markets as well as the behavioural economics of individual substance use. It is important for policy makers, health authorities, first responders and medical providers to be aware of the clinical implications of drug market changes in order to best serve people who use drugs. Only with significant clinical research, a comprehensive reorganization of the system of care across all sectors, and an evidence-driven governance, will we be successful in addressing the challenges brought on by the recent shifts in drug markets.
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Affiliation(s)
- R Michael Krausz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jean N Westenberg
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, UBC, David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Nickie Mathew
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada
| | - George Budd
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - James S H Wong
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Vivian W L Tsang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marc Vogel
- University of Basel Psychiatric Clinics, Basel, Switzerland
- Division of Substance Use Disorders, Psychiatric Services of Thurgovia, Münsterlingen, Switzerland
| | - Conor King
- Victoria Police Department, Victoria, BC, Canada
| | - Vijay Seethapathy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Kerry Jang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Fiona Choi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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6
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Imtiaz S, Nafeh F, Russell C, Ali F, Elton-Marshall T, Rehm J. The impact of the novel coronavirus disease (COVID-19) pandemic on drug overdose-related deaths in the United States and Canada: a systematic review of observational studies and analysis of public health surveillance data. Subst Abuse Treat Prev Policy 2021; 16:87. [PMID: 34844624 PMCID: PMC8628272 DOI: 10.1186/s13011-021-00423-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There are preliminary indications that the trajectory of drug overdose-related deaths in North America has been exacerbated due to the novel coronavirus disease pandemic (COVID-19). As such, the impact of COVID-19 on drug overdose-related deaths was examined through a systematic review of the literature and percentage change analyses of surveillance data. METHODS Systematic searches in electronic databases were conducted, a topical issue brief and bibliography were reviewed, reference lists of included studies were searched and expert consultations were held to identify studies (Registration # CRD42021230223). Observational studies from the United States and Canada were eligible for inclusion if drug overdose-related deaths were assessed in quantitative or qualitative analyses onwards from at least March 2020. In addition, percentage changes comparing drug overdose-related deaths in the second annual quarter (Q2 2020 [April to June]) with the first annual quarter (Q1 2020 [January to March]) were generated using national and subnational data from public health surveillance systems and reports from jurisdictions in the United States and Canada. RESULTS Nine studies were included in the systematic review, eight from the United States and one from Canada. The maximum outcome assessment period in the included studies extended until September 2020. Drug overdose-related deaths after the onset of COVID-19 were higher compared with the months leading up to the pandemic in 2020 and the comparative months in 2019. In additional percentage change analyses, drug overdose-related deaths increased by 2 to 60% in jurisdictions in the United States and by 58% in Canada when comparing Q2 2020 with Q1 2020. CONCLUSIONS Drug overdose-related deaths increased after the onset of COVID-19. The current situation necessitates a multi-pronged approach, encompassing expanded access to substance use disorder treatment, undisrupted access to harm reduction services, emphasis on risk reduction strategies, provision of a safe drug supply and decriminalization of drug use.
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Affiliation(s)
- Sameer Imtiaz
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1 Canada
| | - Frishta Nafeh
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1 Canada
| | - Cayley Russell
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1 Canada
| | - Farihah Ali
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1 Canada
| | - Tara Elton-Marshall
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7 Canada ,grid.39381.300000 0004 1936 8884Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, London, Ontario N6A 5C1 Canada ,grid.258900.60000 0001 0687 7127Department of Health Sciences, Lakehead University, SN 1006, 955 Oliver Road, Thunder Bay, Ontario P7B 5E1 Canada
| | - Jürgen Rehm
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1 Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7 Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Room 2374, 1 King’s College Circle, Toronto, Ontario M5S 1A8 Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario M5T 1R8 Canada ,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany ,grid.448878.f0000 0001 2288 8774Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, B. 2, Moscow, Russian Federation 119992 ,grid.13648.380000 0001 2180 3484Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
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Aydoğdu M, Aslan R, Can Ö, Altunci YA, Annette Akgür S. Evaluation of substance use in Izmir during the COVID-19 pandemic. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1983045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Melike Aydoğdu
- Ege University Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Izmir, Turkey
| | - Rukiye Aslan
- Ege University Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Izmir, Turkey
| | - Özge Can
- Department of Emergency Faculty of Medicine, Ege University, Bornova, Turkey
| | - Yusuf Ali Altunci
- Department of Emergency Faculty of Medicine, Ege University, Bornova, Turkey
| | - Serap Annette Akgür
- Ege University Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Izmir, Turkey
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8
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Supporting Persons Who Use Drugs During the COVID-19 Pandemic: A Rapid Review of International Guidelines. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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9
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Simon FAJ, Schenk M, Palm D, Faltraco F, Thome J. The Collateral Damage of the COVID-19 Outbreak on Mental Health and Psychiatry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4440. [PMID: 33922054 PMCID: PMC8122618 DOI: 10.3390/ijerph18094440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/20/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Abstract
The potential consequences of the COVID-19 outbreak are multifarious and remain largely unknown. Deaths as a direct result of the condition are already in the millions, and the number of indirect deaths is likely to be even higher. Pre-existing historical inequalities are compounded by the virus, driving increased rates of infection and deaths amongst people who use drugs and alcohol, those belonging to racial-ethnic minority groups, poorer communities, LBGTQ+ populations, healthcare workers, and other members of the care economy; all of whom are already at increased risk of adverse mental health effects. In this paper we suggest that a central role of mental health practitioners is advocacy: both for people who use psychiatric services and for those who, due to the effects of the pandemic, are at an increased risk of needing to do so.
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Affiliation(s)
- Frederick A. J. Simon
- Clinic and Polyclinic for Psychiatry and Psychotherapy, University of Rostock, 18147 Rostock, Germany; (M.S.); (D.P.); (F.F.); (J.T.)
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10
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Ali F, Russell C, Nafeh F, Rehm J, LeBlanc S, Elton-Marshall T. Changes in substance supply and use characteristics among people who use drugs (PWUD) during the COVID-19 global pandemic: A national qualitative assessment in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103237. [PMID: 33893026 DOI: 10.1016/j.drugpo.2021.103237] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND People who use drugs (PWUD) may be at an increased risk of experiencing negative effects related to COVID-19. Border and non-essential service closures may have placed PWUD at an increased risk of experiencing unintended consequences regarding drug consumption and supply patterns, as well as related outcomes. However, the extent of these effects upon this population is unknown. The current study examined how COVID-19 has impacted substance use supply and use characteristics among a national cohort of PWUD in Canada. METHODS We conducted semi-structured one-on-one telephone-based interviews with 200 adult PWUD across Canada who were currently using a licit or illicit psychoactive substance at least weekly, and/or currently receiving opioid agonist treatment (OAT). Thematic analyses were conducted using qualitative software. RESULTS PWUD attributed adverse changes to their substance use frequency, supply, use patterns, and risk behaviors and outcomes to COVID-19. Many participants noted supply disruptions with the majority indicating a decrease in potency and availability, and an increase in the price of substances since COVID-19. Nearly half of participants specified that they had increased their substance use, with some experiencing relapses. In terms of changes to risk level, many participants perceived they were at a greater risk for experiencing an overdose. CONCLUSION This study demonstrated the impacts of COVID-19 on PWUD, including a significant disruption substance supply. For many, these changes led to increased use and substitution for toxic and adulterated substances, which ultimately amplified PWUD's risk for experiencing related harms, including overdoses. These findings warrant the need for improved supports and services, as well as accessibility of safe supply programs, take home naloxone kits, and novel approaches to ensure PWUD have the tools necessary to mitigate risk when using substances.
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Affiliation(s)
- Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Frishta Nafeh
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College St., Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19с1119146 Moscow, Russia
| | - Sean LeBlanc
- Drug Users Advocacy League, #309-180 Bruyere, Ottawa, ON K1N 5E1, Canada; Canadian Association of People who Use Drugs (CAPUD), ON, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College St., Toronto, ON M5T 1R8, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., ON M6A 5C1, Canada; Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada
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11
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[Consequences of the COVID-19 pandemic for people with schizophrenia, dementia and substance use disorders]. DER NERVENARZT 2021; 92:571-578. [PMID: 33779773 PMCID: PMC8006113 DOI: 10.1007/s00115-021-01105-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/10/2023]
Abstract
Die COVID-19(„coronavirus disease 2019“)-Pandemie stellt die Sozial- und Gesundheitssysteme weltweit vor unerwartete Herausforderungen. Die direkten und indirekten medizinischen Folgen einer Infektion mit dem neuartigen Coronavirus bringen die Versorgungssysteme vielerorts an die Grenze ihrer Leistungsfähigkeit. Die neurotropen Effekte von COVID-19 können nicht nur neurologische, sondern auch psychische Akut- und Langzeitfolgen nach sich ziehen. Im psychiatrischen Kontext sind zusätzlich die psychischen und psychosozialen Folgen von Kontaktbeschränkungen und Lockdowns sowie die Auswirkungen täglicher medialer Berichterstattung auf Menschen mit psychischen Störungen zu berücksichtigen. In diesem Beitrag werden die Konsequenzen der COVID-19-Pandemie für Menschen mit psychischen Erkrankungen, insbesondere mit Schizophrenie, Demenz und Abhängigkeitserkrankungen, erörtert.
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12
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Perri M, Guta A, Gagnon M, Bonn M, Leece P, Bayoumi AM, Rai N, Touesnard N, Strike C. Developing a digital health strategy for people who use drugs: Lessons from COVID-19. Digit Health 2021; 7:20552076211028404. [PMID: 34262782 PMCID: PMC8243112 DOI: 10.1177/20552076211028404] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 has significantly exacerbated negative health and social outcomes for people who use drugs (PWUD) around the world. The closure of harm reduction services, ongoing barriers to employment and housing, and pre-existing physical and mental health conditions have increased harms for diverse communities of PWUD. Adapting current models of health and human service delivery to better meet the needs of PWUD is essential in minimizing not only COVID-19 but also drug-related morbidity and mortality. This article draws on research, practice, and advocacy experiences, and discusses the potential for digital health tools such as remote monitoring and telecare to improve the continuum of care for PWUD. We call for a digital health strategy for PWUD and provide recommendations for future program development and implementation.
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Affiliation(s)
- Melissa Perri
- Dalla Lana School of Public Health, University of Toronto,
Toronto, Canada
- MAP Center for Urban Health Solutions, St. Michael’s Hospital,
Toronto, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor,
Canada
| | - Marilou Gagnon
- Canadian Institute for Substance Use Research, Victoria,
Canada
| | - Matt Bonn
- Canadian Association of People Who Use Drugs, Dartmouth,
Canada
- Canadian Students for Sensible Drug Policy, Ottawa, Canada
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto,
Toronto, Canada
- Public Health Ontario, Toronto, Canada
- Department of Family and Community Medicine, University of
Toronto Faculty of Medicine, Toronto, Canada
| | - Ahmed M Bayoumi
- MAP Center for Urban Health Solutions, St. Michael’s Hospital,
Toronto, Canada
- Institute of Health Policy, Management and Evaluation,
University of Toronto, Toronto, Canada
| | - Nanky Rai
- Department of Family and Community Medicine, University of
Toronto Faculty of Medicine, Toronto, Canada
| | | | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto,
Toronto, Canada
- MAP Center for Urban Health Solutions, St. Michael’s Hospital,
Toronto, Canada
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13
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Wilkinson R, Hines L, Holland A, Mandal S, Phipps E. Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID-19 response. Harm Reduct J 2020; 17:95. [PMID: 33261636 PMCID: PMC7705852 DOI: 10.1186/s12954-020-00445-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND People who inject drugs are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. METHODS A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic-type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. RESULTS In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly; for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. CONCLUSIONS This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.
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Affiliation(s)
- Rebecca Wilkinson
- Rebecca Wilkinson, Public Health Registrar, School of Primary Care, Population Sciences and Medical Education, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - Lindsey Hines
- Lindsey Hines, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Holland
- Adam Holland Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sema Mandal
- Sema Mandal Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
| | - Emily Phipps
- Emily Phipps Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
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14
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Li HK. Keeping the alcohol and other drug workforce resilient after the COVID-19 emergency. Drug Alcohol Rev 2020; 40:685-686. [PMID: 33215791 PMCID: PMC7753455 DOI: 10.1111/dar.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hoiyan Karen Li
- Insight: Centre for Alcohol and Other Drug Training and Workforce Development, Queensland Health, Brisbane, Australia
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15
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Guilamo-Ramos V, Benzekri A, Thimm-Kaiser M, Abram M, Hagan H. Participation of the nursing workforce to address COVID-19 among people who use alcohol, tobacco, and drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102831. [PMID: 32654929 PMCID: PMC7332926 DOI: 10.1016/j.drugpo.2020.102831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, New York University, 15 Washington Place, New York, NY, USA; Adolescent AIDS Program, Children's Hospital at Montefiore Medical Center, 3514 Wayne Avenue, Bronx, NY, USA; Center for Drug Use and HIV Research, New York University, 665 Broadway, New York, NY, USA; U.S. Presidential Advisory Council on HIV/AIDS, Washington, DC, USA.
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, New York University, 15 Washington Place, New York, NY, USA
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, New York University, 15 Washington Place, New York, NY, USA; City University of New York, School of Public Health and Health Policy, New York, NY, USA
| | - Marissa Abram
- College of Nursing and Public Health, Adelphi University, 1 South Avenue, Garden City, NY, USA; Pulse Center for Patient Safety Education and Advocacy, PO Box 353, Wantagh, NY, USA
| | - Holly Hagan
- Center for Drug Use and HIV Research, New York University, 665 Broadway, New York, NY, USA; College of Global Public Health, New York University, 665 Broadway, New York, NY, USA
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16
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Majbar AM, Benkabbou A, Mohsine R, Souadka A. Resuming Elective Oncologic Surgery After CoVID-19 Outbreak: What Precautions Should be Taken? JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2020. [DOI: 10.46327/msrjg.1.000000000000161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The COVID 19 outbreak has caused the cancellation of most elective oncological surgery around the world to limit the risk of virus dissemination. As we are exiting the crisis, surgical teams will face strong challenges while resuming normal elective surgery. The accumulation of cases will have to be managed by defining strong selection criteria, taking into account the patient and the disease conditions. In order to reduce the risk of infection, non-COVID patients should be treated in dedicated non-COVID areas, preferably in separate buildings or hospitals. Departments, units and operative theaters should put in place rigorous actions and protocols to protect the patient and healthcare workers. Adequate protective equipment must be readily available for healthcare workers and patients. Finally, teams should keep an adaptive mindset by preparing strategies to maintain surgical activity in case of repeated COVID 19 waves.
Keywords: COVID 19, Guidelines, Lockdown ease, Surgical oncology
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