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Ray BR, Humphrey JL, Patel SV, Akiba CF, Bluthenthal RN, Tookes H, LaKosky PA, Wenger LD, Kral AH, Lambdin BH. Comparing harm reduction and overdose response services between community-based and public health department syringe service programmes using a national cross-sectional survey. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100757. [PMID: 38745887 PMCID: PMC11091529 DOI: 10.1016/j.lana.2024.100757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
Background Syringe services programmes (SSPs) are an evidence-based strategy to reduce infectious diseases and deliver overdose prevention interventions for people who use drugs. They face regulatory, administrative, and funding barriers that limit their implementation in the US, though the federal government recently began providing funding to support these efforts. In this study we aim to understand whether the organisational characteristics of SSPs are associated with the provision of syringe and other overdose response strategies. Methods We examine four outcomes using the National Survey of Syringe Services Programs (NSSSP) (N = 472): syringe distribution, naloxone distribution, fentanyl test strip (FTS) availability, and buprenorphine implementation. These outcomes are assessed across three organizational categories of SSPs-those operated by public health departments (DPH), community-based organizations (CBOs) with government funding, and CBOs without government funding-while adjusting for community-level confounders. Findings The proportion of SSPs by organizational category was 36% DPH, 42% CBOs with government funding, and 22% CBOs without government funding. Adjusting for community-level differences, we found that CBO SSPs with government funding had significantly higher provision of all four syringe and overdose response services as compared to DPH SSPs and across three of the four services as compared to CBO SSPs without government funding. CBO SSPs without government funding still had significantly higher provision of three of the four services as compared to programmes maintained by the DPH. Interpretation CBO SSPs have strong potential to expand overdose response services nationally, particularly if provided with sustained and adequate funding. Communities should aim to provide funding that does not hinder SSP innovation so they can remain flexible in responding to local needs. Funding This study was supported by Arnold Ventures (20-05172).
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Affiliation(s)
- Bradley R. Ray
- RTI International, Research Triangle Park, NC, United States
| | | | - Sheila V. Patel
- RTI International, Research Triangle Park, NC, United States
| | | | | | - Hansel Tookes
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Paul A. LaKosky
- North American Syringe Exchange Network, Tacoma, WA, United States
| | - Lynn D. Wenger
- RTI International, Research Triangle Park, NC, United States
| | - Alex H. Kral
- RTI International, Research Triangle Park, NC, United States
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Hatch MA, Laschober TC, Ertl MM, Paschen-Wolff MM, Norman G, Wright L, Tross S. Program Director Reports of COVID-19 Lockdown-Driven Service Changes in Community-Based STI Clinics and Syringe Services Programs in the Southeastern U.S. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:129-140. [PMID: 38648174 DOI: 10.1521/aeap.2024.36.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The COVID-19 pandemic strained the U.S. health care system, posing logistical challenges for community-based programs. This study surveyed 11 program directors in sexually transmitted infection (STI) clinics and syringe services programs (SSPs) that served people who use substances and are at risk for HIV in five southeastern U.S. states. Brief survey questions asked about programs' use of in-person and telehealth services. Results indicated widespread reduction of in-person services and concomitant adoption of telehealth services. In STI clinics, telehealth replaced in-person visits for all but urgent treatment of active symptoms. In SSPs, in-person contact continued or increased from pre-pandemic volumes. In both programs, the most salient telehealth use barrier was limited device or internet access and limited technological ease. Services were sustained through innovative adaptations. This snapshot of response to the early COVID-19 lockdown phase offers actionable guidance about service preparedness for future public health catastrophes in community-based programs serving vulnerable populations.
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Affiliation(s)
- Mary A Hatch
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Tanja C Laschober
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Melissa M Ertl
- Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, Minnesota
| | - Margaret M Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York
| | - Gaia Norman
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Lynette Wright
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York
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Hill K, Dunham K, Grau LE, Heimer R. "It's starting to weigh on me": Exploring the Experiences and Support Needs of Harm Reduction Staff in Connecticut using the Social-Ecological Model. Harm Reduct J 2023; 20:168. [PMID: 37964261 PMCID: PMC10644636 DOI: 10.1186/s12954-023-00898-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The experiences and perceived support needs of harm reduction workers in the USA have been understudied. While previous research has explored staff burnout and role-related stress, there is a research gap around potential supports for staff wellbeing and individual longevity in their roles. This is especially critical given the growing overdose crisis and the need for sustainable harm reduction programming. Thus, we sought to describe the experiences of harm reduction staff and identify the perceived support that could empower harm reduction staff to successfully navigate their roles. METHODS Purposive sampling methods were used to recruit harm reduction staff working in Connecticut. Seventeen semi-structured, one-on-one interviews were conducted between December 2022 and March 2023. Participants were asked about their experiences with role-related stressors and supports. Informed by the Social-Ecological Model, transcripts were coded using both inductive and deductive codes, and themes were developed using thematic analysis approaches. RESULTS Study participants described their experiences working in harm reduction and the numerous ways they already are or could be receiving support in their roles. These experiences were organized into eight themes according to the levels of the Social-Ecological Model. At the individual level, participants explained that support could help them navigate the variability of the physical environment, boundary setting, and self-care. Relationships between clients and co-workers were both identified as means of support at the interpersonal level, helping participants navigate difficult situations and feelings of stress. At the organizational level, study participants explained how they look to their organization to provide sufficient support by way of training, staffing, compensation, and benefits. Additionally, participants stressed the importance of having supervisors who valued their work and provided emotional support. Lastly, at the community level, participants discussed how support was needed to help them navigate complex systems while working with a stigmatized population in an often-stigmatized field. CONCLUSIONS To best support harm reduction staff in their day-to-day roles, our findings underscore the need for support on multiple levels. Future research could explore how the provision of support to harm reduction staff impacts not only staff perceptions of support but also the success of clients accessing harm reduction services.
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Affiliation(s)
- Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - Katherine Dunham
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Lauretta E Grau
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Bartholomew TS, Tookes HE, Chueng TA, Bluthenthal RN, Wenger LD, Kral AH, Lambdin BH. Availability of telehealth-based services at syringe services programs under the COVID-19 Public Health Emergency. Harm Reduct J 2023; 20:122. [PMID: 37660029 PMCID: PMC10475193 DOI: 10.1186/s12954-023-00861-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION The expanded capacity of syringe services programs (SSPs) in the USA to integrate telehealth services was largely related to flexibility of buprenorphine prescription in response to the COVID-19 pandemic. SSPs demonstrated the potential of using telehealth to reach participants with both medical and non-medical services. The present study examines the implementation of medical and non-medical telehealth-based health services in 2020 at SSPs in the USA and organizational characteristics associated with adopting specific telehealth services. METHODS We administered a cross-sectional survey among all known SSPs operating in the USA as of 2021. The two primary study outcomes were (1) implementation of medical telehealth and (2) implementation of non-medical telehealth in 2020. Medical services included HIV counseling/care, hepatitis C virus (HCV) counseling/care, and buprenorphine. Non-medical services included wellbeing/check-ins, overdose prevention training, health navigation, harm reduction and psychological counseling. Bivariate and multivariable mixed effects logistic regression models were used to directly estimate the odds ratio associated with organizational characteristics on the implementation of telehealth-based health services. RESULTS Thirty percent of programs (n = 290) reported implementing telehealth-based health services. In multivariable logistic regression models, community-based organization SSPs had higher odds of implementing medical (aOR = 4.69, 95% CI [1.96, 11.19]) and non-medical (aOR = 2.18, 95% CI [1.10, 4.31]) health services compared to public health department SSPs. SSPs that received governmental funding had higher odds of implementing medical services via telehealth (aOR = 2.45, 95% CI [1.35, 4.47]) compared to programs without governmental funding. CONCLUSION Community-based organization SSPs and those with government funding had the highest odds of telehealth implementation in response to the COVID-19 Public Health Emergency. Federal, state, and local governments must increase funding for low-barrier venues like SSPs to support telehealth implementation to serve the needs of people who use drugs.
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Affiliation(s)
| | - Hansel E Tookes
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA.
| | - Teresa A Chueng
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
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Cooper L, Rosen JG, Zhang L, Pelaez D, Olatunde PF, Owczarzak J, Park JN, Glick JL. Exploring the impact of the COVID-19 pandemic on healthcare and substance use service access among women who inject drugs: a qualitative study. Harm Reduct J 2023; 20:71. [PMID: 37296423 PMCID: PMC10251329 DOI: 10.1186/s12954-023-00793-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted healthcare and substance use services engagement, including primary and mental health services as well as residential and outpatient drug treatment. Women who inject drugs (WWID) face known barriers to healthcare and substance use service engagement, which pre-date the COVID-19 pandemic. The impact of COVID-19 on WWID's engagement with healthcare and substance use services, however, remains understudied. METHODS To explore the impact of the COVID-19 pandemic on service-seeking and utilization, we conducted in-depth interviews with 27 cisgender WWID in Baltimore, Maryland, in April-September 2021. Iterative, team-based thematic analysis of interview transcripts identified disruptions and adaptations to healthcare and substance use services during the COVID-19 pandemic. RESULTS The COVID-19 pandemic disrupted service engagement for WWID through service closures, pandemic safety measures restricting in-person service provision, and concerns related to contracting COVID-19 at service sites. However, participants also described various service adaptations, including telehealth, multi-month prescriptions, and expanded service delivery modalities (e.g., mobile and home delivery of harm reduction services), which overwhelmingly increased service engagement. CONCLUSION To build upon service adaptations occurring during the pandemic and maximize expanded access for WWID, it is vital for healthcare and substance use service providers to continue prioritizing expansion of service delivery modality options, like telehealth and the provision of existing harm reduction services through alternative platforms (e.g., mobile services), that facilitate care continuity and increase coverage.
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Affiliation(s)
- Lyra Cooper
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
- Oakland, USA
| | - Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Praise F. Olatunde
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Ju Nyeong Park
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI USA
- Center for Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI USA
| | - Jennifer L. Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
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Olding M, Joshi N, Castellanos S, Valadao E, Hall L, Guzman L, Knight K. Saving lives in our homes: Qualitative evaluation of a tenant overdose response program in supportive, single-room occupancy (SRO) housing. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104084. [PMID: 37300920 DOI: 10.1016/j.drugpo.2023.104084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND People using opioids alone in private settings are at elevated risk of dying in the event of an overdose. In San Francisco, single room occupancy (SRO) tenants are 19 times more likely to die of overdose than non-SRO residents. The "SRO Project" pilot aimed to reduce fatal overdoses in SROs by recruiting and training tenants to distribute naloxone and provide overdose education in their buildings. We explore the implementation and program impacts of the SRO Project pilot in two permanent supportive housing SROs. METHODS We conducted eight months of ethnographic fieldwork (May 2021 - Feb 2022), including 35 days observing SRO Project pilot activities, and semi-structured interviews with 11 housing staff and 8 tenant overdose prevention specialists ('specialists'). Data were analyzed using a grounded theory approach to characterize program impacts, implementation strengths, and implementation challenges from the perspective of specialists and housing staff. FINDINGS We found that the SRO project increased awareness, access to, and understanding of naloxone; facilitated other mutual-aid practices; supported privacy and autonomy of tenants regarding their drug use; and improved rapport, communication and trust between tenants and housing staff. Strengths of the implementation process included involvement of tenants with diverse social locations and skill sets and, at one site, a team-based approach that fostered program innovation, tenant solidarity and a sense of collective ownership over the project. Program implementation was challenged by frequent turnover and capacity constraints of housing staff, particularly during overnight shifts when overdose risks were greatest. Additional challenges arose due to the psychosocial burden of overdose response work, gendered violence, issues with compensation methods, and scope creep in specialists' roles. CONCLUSION This evaluation contributes further evidence regarding the effectiveness of tenant-led naloxone distribution and overdose education in permanent supportive and SRO housing environments. Findings indicate program implementation and sustainability can be improved by expanding tenant specialist training, compensating specialists in cash, and building stronger psychosocial support for tenants responding to overdoses in their homes.
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Affiliation(s)
- Michelle Olding
- Division of Social and Behavioral Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Humanities and Social Sciences, University of California, San Francisco, CA, United States.
| | - Neena Joshi
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, United States
| | - Stacy Castellanos
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, United States; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
| | - Emily Valadao
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Lauren Hall
- Delivering Innovation in Supportive Housing (DISH), San Francisco, CA, United States
| | - Laura Guzman
- DOPE Project, National Harm Reduction Coalition, San Francisco, CA, United States
| | - Kelly Knight
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, United States
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Carroll JJ, Rossi SL, Vetrova MV, Blokhina E, Sereda Y, Lioznov D, Luoma J, Kiriazova T, Lunze K. The impacts of COVID-19 on structural inequities faced by people living with HIV who inject drugs: A qualitative study in St. Petersburg, Russia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104060. [PMID: 37210965 DOI: 10.1016/j.drugpo.2023.104060] [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: 08/08/2022] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND People who inject drugs (PWID) living with HIV may be disproportionately impacted by pandemic restrictions. This study qualitatively explored the impacts of the SARS-CoV-2 pandemic on PWID with HIV in St. Petersburg, Russia. METHODS In March and April 2021, we conducted remote, semi-structured interviews with PWID with HIV, health care providers, and harm reductionists. RESULTS We interviewed 25 PWID with HIV (aged 28-56 years, 46% female) and 11 providers. The pandemic exacerbated economic and psychological challenges experienced by PWID with HIV. Simultaneously, barriers to HIV care access, ART prescription refill and dispensing and police violence, which hindered the health and safety of PWID with HIV, were themselves hindered from normal operations by the pandemic, significantly reducing these burdens. CONCLUSION Pandemic responses should account for the unique vulnerabilities of PWID with HIV to avoid worsening the structural violence they already experience. Wherever the pandemic decreased structural barriers, such as institutional, administrative, and bureaucratic challenges and state violence enacted by police and other elements of the criminal justice system, such changes should be protected.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology and Anthropology, North Carolina State University, 10 Current Drive, Raleigh, NC, 27695, USA; Warren Alpert School of Medicine at Brown University, 222 Richmond St, Providence, RI, 02903 USA.
| | - Sarah L Rossi
- Department of Medicine, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Marina V Vetrova
- Pavlov University, 11 Komendantsky pr., office 45N, St. Petersburg, 197227, Russia
| | - Elena Blokhina
- Pavlov University, 11 Komendantsky pr., office 45N, St. Petersburg, 197227, Russia
| | - Yuliia Sereda
- Ukrainian Institute on Public Health Policy, 10 B. Khmelnytskoho St., Apt. 60, Kyiv, 01054, Ukraine; Smorodintsev Research Institute of Influenza, 15/17 Popov St., St. Petersburg, 197376, Russia
| | - Dmitry Lioznov
- Pavlov University, 11 Komendantsky pr., office 45N, St. Petersburg, 197227, Russia
| | - Jason Luoma
- Portland Psychotherapy Clinic, Training, and Research Center, 3700N Williams Ave, Portland, OR, 97227, USA
| | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, 10 B. Khmelnytskoho St., Apt. 60, Kyiv, 01054, Ukraine
| | - Karsten Lunze
- Department of Medicine, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA; School of Medicine, Boston University, 72 E Concord St, Boston, MA, 02118, USA
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Pietrantoni D, Barroca C, Lynch S, Byrne J, Ortner M, Kotwani R, Limbrick K, Kaldas P, Moussa M, Fredrickson T, Schaefer J, Jacobs RJ. A Scoping Review on the Effects of COVID-19 on Syringe Service Programs in the United States. Cureus 2023; 15:e39023. [PMID: 37378253 PMCID: PMC10292154 DOI: 10.7759/cureus.39023] [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: 04/18/2023] [Accepted: 05/14/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic has had worldwide impacts, including disrupting community services. One interrupted service was syringe service programs (SSPs), community-established initiatives that provide sterile supplies and aid in overcoming addiction in drug-using participants. In the United States (U.S.), SSPs have been key in combating the recent opioid use crisis and associated infections such as the human immunodeficiency virus (HIV) and hepatitis C. While some published reports on the pandemic's overall impacts on SSPs exist, certain aspects such as operational changes and repercussions on staff and participants may still be lacking. Information about the impact of interrupted SSP services due to the pandemic may provide insight into how to prepare to mitigate similar outcomes during possible future health outbreaks. The aim of this scoping review was thus to explore the effects of the COVID-19 pandemic on the operations, staff, and participants of SSPs in the U.S. The initial search of the databases PubMed, Embase, and Web of Science with selected keywords yielded 117 articles published in English between January 1, 2020, and August 31, 2022. After screening each article for study eligibility, 11 articles were included in the final review. Of the seven articles exploring SSP operational impacts from the pandemic, five acknowledged that mitigation strategies influenced functions, seven highlighted supply changes, and four emphasized the resulting staffing changes. Four studies inspected the pandemic's impacts on SSP participants, which included two articles highlighting participants' struggles with isolation and loneliness, one referencing the fear of exposure to the SARS-CoV-2 virus, and two examining the overall negative psychological effects experienced during this time. SSPs in various settings and regions across the U.S. experienced changes due to the COVID-19 pandemic. Many of these modifications negatively impacted operations, staffing, and participant relationships. Examining the issues that individual SSPs encountered highlights opportunities for structured solutions for the present and in the case of future infectious disease outbreaks. With the severity of the opioid use crisis in the U.S. and the dependence on SSPs for its mitigation, future work in this space should be prioritized.
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Affiliation(s)
- Dylan Pietrantoni
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Crystal Barroca
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sarah Lynch
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jonathan Byrne
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Miranda Ortner
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Roshni Kotwani
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Kolin Limbrick
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Paul Kaldas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Michael Moussa
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Tatem Fredrickson
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jeffrey Schaefer
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Allen ST, Schneider KE, Morris M, Saloner B, Sherman SG. Factors Associated with HIV Testing Among People Who Inject Drugs: Findings from a Multistate Study at the Start of the COVID-19 Pandemic. AIDS Behav 2023; 27:1674-1681. [PMID: 36327014 PMCID: PMC9632597 DOI: 10.1007/s10461-022-03899-9] [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] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Few studies have examined HIV testing among people who inject drugs (PWID) during the COVID-19 pandemic. This study examines factors associated with PWID who have been recently (past six months) tested for HIV during the COVID-19 pandemic. PWID were recruited between August 2020 and January 2021 from 22 drug treatment and harm reduction programs in nine states and the District of Columbia. We used logistic regression to identify correlates of recent HIV testing among PWID (n = 289). Most (52.9%) PWID reported having been recently tested for HIV. Factors associated with recent HIV testing included: having attended college [adjusted odds ratio (aOR) 2.32, 95% confidence interval (95% CI) 1.32-4.10], weekly hunger (aOR 2.08, 95% CI 1.20-3.60), crystal methamphetamine injection (aOR 2.04, 95% CI 1.05-3.97), and non-metropolitan residence (aOR 0.33, 95% CI 0.13, 0.88). Findings suggest HIV testing initiatives should be expanded during times of crisis, such as global pandemics.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA.
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., 21205, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
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Lambdin BH, Wenger L, Bluthenthal R, Bartholomew TS, Tookes HE, LaKosky P, O'Neill S, Kral AH. How do contextual factors influence naloxone distribution from syringe service programs in the USA: a cross-sectional study. Harm Reduct J 2023; 20:26. [PMID: 36855181 PMCID: PMC9972698 DOI: 10.1186/s12954-023-00755-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Naloxone is a medication that can quickly reverse an opioid overdose. Syringe service programs (SSPs) are community-based prevention programs that provide a range of evidence-based interventions in the USA, including naloxone distribution. Attributes of SSPs make them ideal settings for naloxone distribution-they have staff and delivery models that are designed to reach people who use drugs where they are. We assessed which outer and inner setting factors of SSPs were associated with naloxone distribution in the USA. METHODS We surveyed SSPs in the USA known to the North American Syringe Exchange Network in 2019. Using the exploration, preparation, implementation and maintenance framework, we assessed inner and outer contextual factors associated with naloxone distribution among SSPs (n = 263 or 77% of SSPs). We utilized negative binomial regression to assess which factors were associated with the number of naloxone doses distributed and people receiving naloxone. RESULTS SSPs reported distributing 710,232 naloxone doses to 230,506 people in the prior year. Regarding outer setting, SSPs located in areas with high levels of community support had a higher level of naloxone distribution (aIRR = 3.07; 95% confidence interval (CI): 2.09-4.51; p < 0.001) and 110% (p = 0.022) higher rate of people receiving naloxone (aIRR = 2.10; 95% CI 1.46-3.02; p < 0.001) in the past 12 months. The legal status of SSPs and the level of need was not significantly associated with naloxone distribution. Regarding inner setting, SSPs with proactive refill systems (aIRR = 2.08; 95% CI 1.27-3.41; p = 0.004), greater number of distribution days (aIRR = 1.09 per day; 95% CI 1.06-1.11; p < 0.001) and older programs (aIRR = 1.06 per year; 95% CI 1.02-1.11; p = 0.004) were associated with higher levels of naloxone distribution. Also, SSPs with proactive refill systems (aIRR = 2.23; 95% CI 1.38-3.58; p = 0.001); greater number of distribution days (aIRR = 1.04; 95% CI 1.02-1.07; p < 0.001) and older programs (aIRR = 1.11; 95% CI 1.05-1.17; p < 0.001) were associated with a higher number of people receiving naloxone. CONCLUSION We identified outer and inner setting factors of SSPs that were associated with greater naloxone distribution. It is critical to ensure SSPs are adequately resourced to build community support for services and develop service delivery models that maximize naloxone distribution to address the nation's opioid overdose crisis.
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Affiliation(s)
- Barrot H Lambdin
- RTI International, Berkeley, CA, USA.
- University of California San Francisco, San Francisco, CA, USA.
- University of Washington, Seattle, WA, USA.
| | | | | | | | | | - Paul LaKosky
- North American Syringe Exchange Network, Tacoma, WA, USA
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11
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Crable EL, Grogan CM, Purtle J, Roesch SC, Aarons GA. Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol. Implement Sci Commun 2023; 4:16. [PMID: 36797794 PMCID: PMC9936679 DOI: 10.1186/s43058-023-00396-5] [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: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Policy is a powerful tool for systematically altering healthcare access and quality, but the research to policy gap impedes translating evidence-based practices into public policy and limits widespread improvements in service and population health outcomes. The US opioid epidemic disproportionately impacts Medicaid members who rely on publicly funded benefits to access evidence-based treatment including medications for opioid use disorder (MOUD). A myriad of misaligned policies and evidence-use behaviors by policymakers across federal agencies, state Medicaid agencies, and managed care organizations limit coverage of and access to MOUD for Medicaid members. Dissemination strategies that improve policymakers' use of current evidence are critical to improving MOUD benefits and reducing health disparities. However, no research describes key determinants of Medicaid policymakers' evidence use behaviors or preferences, and few studies have examined data-driven approaches to developing dissemination strategies to enhance evidence-informed policymaking. This study aims to identify determinants and intermediaries that influence policymakers' evidence use behaviors, then develop and test data-driven tailored dissemination strategies that promote MOUD coverage in benefit arrays. METHODS Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we will conduct a national survey of state Medicaid agency and managed care organization policymakers to identify determinants and intermediaries that influence how they seek, receive, and use research in their decision-making processes. We will use latent class methods to empirically identify subgroups of agencies with distinct evidence use behaviors. A 10-step dissemination strategy development and specification process will be used to tailor strategies to significant predictors identified for each latent class. Tailored dissemination strategies will be deployed to each class of policymakers and assessed for their acceptability, appropriateness, and feasibility for delivering evidence about MOUD benefit design. DISCUSSION This study will illuminate key determinants and intermediaries that influence policymakers' evidence use behaviors when designing benefits for MOUD. This study will produce a critically needed set of data-driven, tailored policy dissemination strategies. Study results will inform a subsequent multi-site trial measuring the effectiveness of tailored dissemination strategies on MOUD benefit design and implementation. Lessons from dissemination strategy development will inform future research about policymakers' evidence use preferences and offer a replicable process for tailoring dissemination strategies.
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Affiliation(s)
- Erika L Crable
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA. .,Child and Adolescent Services Research Center, San Diego, CA, USA. .,University of California, San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA.
| | - Colleen M Grogan
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, IL, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York City, NY, USA.,Global Center for Implementation Science, New York University School of Global Public Health, New York City, NY, USA
| | - Scott C Roesch
- Child and Adolescent Services Research Center, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Child and Adolescent Services Research Center, San Diego, CA, USA.,University of California, San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
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12
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The effects of COVID-19 on New York State's Drug User Health Hubs and syringe service programs: a qualitative study. Harm Reduct J 2023; 20:12. [PMID: 36732773 PMCID: PMC9893960 DOI: 10.1186/s12954-023-00742-9] [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: 11/21/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Syringe service programs (SSPs) deliver critical harm reduction services to people who inject drugs (PWID). Some SSPs in New York State received enhanced funding to provide additional services to combat opioid overdose fatalities. These SSPs, known as Drug User Health Hubs, provide buprenorphine for the treatment of opioid use disorder and other health-related services in addition to their syringe services. While the COVID-19 pandemic posed widespread challenges to the delivery of health services nationwide, the effect of the pandemic on SSPs uniquely impacts PWID. This study examines the impact of COVID-19 on service delivery of Drug User Health Hubs and stand-alone SSPs in New York State. METHODS Between July 2020 and September 2020, we performed eleven semi-structured virtual interviews with staff from three Health Hub SSPs and three stand-alone SSPs. The interviews explored the effect of the COVID-19 pandemic on SSPs and their clients as well as the changes implemented in response. Interviews were recorded and transcribed. We performed content analysis to identify emerging themes from the data. RESULTS Due to the COVID-19 pandemic, some SSPs temporarily shut down while others limited their hours of operation. SSPs modified their service delivery to maintain syringe services and naloxone distribution over other services such as STI and HCV testing. They virtualized components of their services, including telemedicine for the provision of buprenorphine. While SSPs found virtualization to be important for maintaining their services, it negatively impacted the intimate nature of client interactions. Participants also described the impact of the pandemic on the well-being of PWID, including isolation, worsened mental health challenges, and increased drug overdoses. CONCLUSIONS In response to the COVID-19 pandemic, SSPs demonstrated innovation, adaptability, and togetherness. Despite the challenges posed by the pandemic, SSPs continued to be key players in maintaining access to sterile supplies, buprenorphine, and other services for PWID. In addition to adapting to COVID-19 restrictions, they also responded to the dynamic needs of their clients. Sustainable funding and recognition of the critical role of SSPs in supporting PWID can help to improve outcomes for PWID.
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13
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Syringe Service Program Perspectives on Barriers, Readiness, and Programmatic Needs to Support Rollout of the COVID-19 Vaccine. J Addict Med 2023; 17:e36-e41. [PMID: 35916422 PMCID: PMC9892351 DOI: 10.1097/adm.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We explored syringe service program (SSP) perspectives on barriers, readiness, and programmatic needs to support coronavirus disease 2019 (COVID-19) vaccine uptake among people who use drugs. METHODS We conducted an exploratory qualitative study, leveraging an existing sample of SSPs in the United States. Semistructured, in-depth interviews were conducted with SSP staff between February and April 2021. Interviews were analyzed using a Rapid Assessment Process, an intensive, iterative process that allows for rapid analysis of time-sensitive qualitative data. RESULTS Twenty-seven SSPs completed a qualitative interview. Many SSP respondents discussed that COVID-19 vaccination was not a priority for their participants because of competing survival priorities, and respondents shared concerns that COVID-19 had deepened participant mistrust of health care. Most SSPs wanted to participate in COVID-19 vaccination efforts; however, they identified needed resources, including adequate space, personnel, and training, to implement successful vaccine programs. CONCLUSIONS Although SSPs are trusted resources for people who use drugs, many require additional structural and personnel support to address barriers to COVID-19 vaccination among their participants. Funding and supporting SSPs in the provision of COVID-19 prevention education and direct vaccine services should be a top public health priority.
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14
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Tomko C, Clouse E, Haney K, Galai N, Footer K, Ferryman K, Smith KC, Sherman SG. A study protocol to explore and implement community-based point-of-care COVID-19 testing for women who use drugs in Baltimore, Maryland: The CARE study. PLoS One 2022; 17:e0277605. [PMID: 36542613 PMCID: PMC9770432 DOI: 10.1371/journal.pone.0277605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022] Open
Abstract
Women who use drugs (WWUD) experience structural vulnerabilities (e.g., housing, food insecurities) and comorbidities that elevate their susceptibility to more severe COVID-19 symptoms or fatality compared to similarly-aged women who do not use illicit drugs. Testing is a cornerstone of effective COVID prevention, however, entrenched barriers to healthcare utilization means that WWUD may have diminished accessing to COVID testing. The CARE (COVID Action Research Engagement) study first examines predisposing and enabling factors that predict COVID testing uptake over six months (baseline, 3-, and 6-month follow-up) among a cohort of WWUD (N = 250) in Baltimore, Maryland, providing a nuanced and holistic understanding of how to meaningfully engage WWUD in COVID testing. Then, point-of-care COVID testing will be implemented on a mobile outreach van affiliated with a local community-based organization primarily serving WWUD; anonymous surveys of mobile outreach guests (N = 100) will assess feasibility and acceptability of this integrated testing. The study is grounded in the Behavioral Model for Vulnerable Populations and the Theoretical Framework of Acceptability. We hypothesize that point-of-care COVID testing integrated into a low-barrier harm reduction service, such as a mobile outreach program, will be an enabling environment for COVID testing uptake in part by reducing structural impediments to testing and will be highly feasible and acceptable to participants. Strengths, limitations, and plans for results dissemination are discussed.
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Affiliation(s)
- Catherine Tomko
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Emily Clouse
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Haney
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Footer
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kadija Ferryman
- Berman Institute of Bioethics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Clegg Smith
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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15
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The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in an rural American state. Harm Reduct J 2022; 19:80. [PMID: 35869523 PMCID: PMC9305035 DOI: 10.1186/s12954-022-00660-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
Background The impact of public health policies during the COVID-19 pandemic on people who inject drugs (PWID) has varied across regions. In other countries, recent research has shown that PWID access to harm reduction services, despite rapid adaptations, has been negatively impacted. Our study describes these impacts in a rural state. Methods We conducted semi-structured interviews with PWID, community partners, and healthcare providers in the rural state of Maine (USA). We explored how changes made during the pandemic impacted access to harm reduction services, including basic services (i.e., shelter), syringe service programs, safe drug supply, low barrier treatment, and peer support. Interviews were analyzed using the framework method to apply Penchansky’s model of access, with Saurman’s modification, which includes six dimensions of access—accessibility, availability, acceptability, affordability, accommodation, awareness. Results We interviewed thirty-six stakeholders (N = 9 community partners, N = 9 healthcare providers, N = 18 PWID). Policies such as mobile outreach expansion, mail delivery of equipment, and relaxed telemedicine regulations facilitated accessibility to syringe service programs and low barrier buprenorphine treatment. Public health policies, such as social distancing and screening policies, reduced contact, which subsequently reduced acceptability and awareness of many services. Elimination of the one-for-one needle exchange in some areas increased, acceptability (i.e., perception of service), and affordability for PWID. However, some areas actually began enforcing a one-for-one needle exchange policy, which reduced affordability, acceptability, and awareness of services. Conclusions Changes resulting from the COVID-19 pandemic have impacted all dimensions of access to harm reduction services among PWID. While some barriers to harm reduction services were unavoidable during the pandemic, we found that specific policy decisions mitigated service barriers, while other policies exacerbated them. Relaxing needle exchange policies were particularly helpful in facilitating access to harm reduction services by giving community organizations flexibility to adapt to the evolving needs of PWID. These results can inform policies and service delivery to optimally mitigate the negative impacts on PWID during, and beyond, the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00660-2.
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16
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Austin EJ, Corcorran MA, Briggs ES, Frost MC, Behrends CN, Juarez AM, Frank ND, Healy E, Prohaska SM, LaKosky PA, Kapadia SN, Perlman DC, Schackman BR, Jarlais DCD, Williams EC, Glick SN. Barriers to engaging people who use drugs in harm reduction services during the COVID-19 pandemic: A mixed methods study of syringe services program perspectives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103825. [PMID: 35977459 PMCID: PMC9364718 DOI: 10.1016/j.drugpo.2022.103825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/12/2022] [Accepted: 08/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) provide critical evidence-based public health services that decrease harms from drug use for people who use drugs (PWUD). Many SSPs have experienced significant and evolving COVID-19-related disruptions. We aimed to characterize the impacts of COVID-19 on SSP operations in the United States approximately one year into the pandemic. METHODS Participating sites, selected from a national sample of SSPs, completed a semi-structured interview via teleconference and brief survey evaluating the impacts of COVID-19 on program operations. Data collection explored aspects of program financing, service delivery approaches, linkages to care, and perspectives on engaging PWUD in services one year into the pandemic. Interview data were analyzed qualitatively using Rapid Assessment Process. Survey data were analyzed using descriptive statistics and triangulated with qualitative findings. RESULTS 27 SSPs completed study-related interviews and surveys between February 2021 - April 2021. One year into the pandemic, SSPs reported continuing to adapt approaches to syringe distribution in response to COVID-19, and identified multiple barriers that hindered their ability to engage program participants in services, including 1) isolation and decreased connectivity with participants, 2) resource restrictions that limit responsiveness to participant needs, 3) reduced capacity to provide on-site HIV/HCV testing and treatment linkages, and 4) changing OUD treatment modalities that were a "double-edged sword" for PWUD. Quantitative survey responses aligned with qualitative findings, highlighting increases in the number of syringes distributed, increases in mobile and home delivery services, and reductions in on-site HIV and HCV testing. CONCLUSION These data illuminate persistent and cascading risks of isolation, reduced access to services, and limited engagement with program participants that resulted from COVID-19 and continue to create barriers to the delivery of critical harm reduction services. Findings emphasize the need to ensure SSPs have the resources and capacity to adapt to changing public health needs, particularly as the COVID-19 pandemic continues to evolve.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA.
| | - Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Elsa S Briggs
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA
| | - Madeline C Frost
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA; Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Alexa M Juarez
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Noah D Frank
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Elise Healy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Stephanie M Prohaska
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street, Tacoma, WA, USA
| | - Paul A LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street, Tacoma, WA, USA
| | - Shashi N Kapadia
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA; Division of Infectious Diseases, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - David C Perlman
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, 708 Broadway, New York, NY, USA; Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, New York, NY, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA; Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
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Kelly PJA, Pilla J, Otor A, Hoadley A, Bauerle Bass S. "We figured it out as we went along": Staff perspectives of COVID-19 response efforts at a large North American syringe services programme. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4605-e4616. [PMID: 35702040 PMCID: PMC9350032 DOI: 10.1111/hsc.13864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/05/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Syringe services programmes face operational challenges to provide life-sustaining services to people who use substances and those who have substance use disorders. COVID-19 has disrupted operations at these programmes and is a threat to people with substance use disorder because of severe poverty, de-prioritisation of COVID-19 safety and high prevalence of comorbidities. This phenomenological qualitative study describes 16 in-depth interviews with staff of one of the largest syringe services programme in North America-Prevention Point Philadelphia, located in the Kensington neighbourhood of Philadelphia, Pennsylvania. Interviews were conducted from December 2020 to February 2021, audio-recorded, transcribed and coded to develop a thematic framework. Participants were mostly white (71.4%) and female (68.8%) with a median age of 31.5. Three main and four sub-themes related to the impact of COVID-19 on the syringe services programme were identified: (1) COVID-19 altered services provision (sub-theme: select service changes should be retained); (2) unclear or absent COVID-19 response guidance which compromised mitigation (sub-themes: COVID-19 messaging was difficult to translate to practice, learn-as-we-go); and (3) staff and clients experienced elevated mental anguish during the pandemic (sub-theme: already limited resources were further strained). COVID-19 presented complex challenges to an organisation normally strained in pre-pandemic times. A staff culture of resourcefulness and resiliency aided the syringe services programme to balance client needs and staff safety. However, staff experienced a serious psychological impact, largely attributable to being unable to find reprieve from the stressors of COVID-19 and the difficulties associated with navigating and acting-on contradictory public health messaging. Staff also shared a belief that the relaxing of some pre-pandemic barriers allowed staff to link clients more readily with services. Syringe services programmes should embrace the potential for lasting changes to health services delivery brought about by wide-scale changes in service provisions because of COVID-19.
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Affiliation(s)
- Patrick J. A. Kelly
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Jenine Pilla
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
- Department of Social and Behavioral SciencesTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
| | - AnnaMarie Otor
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
- Department of Social and Behavioral SciencesTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Ariel Hoadley
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
- Department of Social and Behavioral SciencesTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Sarah Bauerle Bass
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
- Department of Social and Behavioral SciencesTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
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18
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Montgomery MP, Zhong Y, Roberts E, Asher A, Bixler D, Doshani M, Christensen A, Eckert M, Weng MK, Carry M, Samuel CR, Teshale EH. Vaccination barriers and opportunities at syringe services programs in the United States, June-August 2021-A cross-sectional survey. Drug Alcohol Depend 2022; 237:109540. [PMID: 35753280 DOI: 10.1016/j.drugalcdep.2022.109540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) are an important venue for reaching people who inject drugs (PWID) to offer preventive services; however, not all SSPs offer vaccinations. We aimed to describe barriers and opportunities for SSPs to offer vaccinations. METHODS During June-August 2021, we conducted a descriptive, cross-sectional survey of SSP providers in the United States. SSPs were recruited from national listservs using purposive sampling to ensure geographic diversity. The survey included questions about SSP characteristics, client demographics, existing vaccination resources, resource needs, and staff perspectives on client vaccination barriers. Statistical comparisons were made using Pearson's chi-square test. RESULTS In total, 105 SSPs from 34 states responded to the survey; 46 SSPs (43.8%) offered on-site vaccinations. SSPs without on-site vaccinations were more likely operated by community-based organizations (81.4% vs 30.4%, p < 0.001) in urban areas (71.4% vs 40.0%, p = 0.002) than SSPs offering on-site vaccinations. The most common staffing need was for personnel licensed to administer vaccines (74/98, 75.5%). Over half of SSPs reported vaccine supply, administration supplies, storage equipment, and systems to follow-up clients for multidose series as important resource needs. The most common resource need was for reminder/recall systems for vaccines with multidose series (75/92, 81.5%). Vaccine safety concerns (92/95, 96.8%) and competing priorities (92/96, 95.8%) were the most common staff-reported client barriers to vaccinations. CONCLUSIONS Addressing missed opportunities for offering vaccinations to PWID who use SSPs will require increased numbers of on-site personnel licensed to administer vaccines and additional training, vaccination supplies, and storage and handling equipment.
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Affiliation(s)
- Martha P Montgomery
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.
| | - Yuna Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Emma Roberts
- National Harm Reduction Coalition, 22 West 27th Street, 5th Floor, New York, NY 10001, USA
| | - Alice Asher
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Danae Bixler
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Mona Doshani
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Aleta Christensen
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Maribeth Eckert
- Immunization Services Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Mark K Weng
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Monique Carry
- Division of Global HIV & TB, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Christina R Samuel
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
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Lambdin BH, Bluthenthal RN, Tookes HE, Wenger L, Morris T, LaKosky P, Kral AH. Buprenorphine implementation at syringe service programs following waiver of the Ryan Haight Act in the United States. Drug Alcohol Depend 2022; 237:109504. [PMID: 35688052 PMCID: PMC10878423 DOI: 10.1016/j.drugalcdep.2022.109504] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Among people with an opioid use disorder in the United States, only 10% receive buprenorphine treatment. The Ryan Haight Act is a federal law that has regulated buprenorphine delivery, requiring an in-person examination between a patient and provider before initiating treatment. At the beginning of the COVID-19 pandemic, federal agencies waived in-person examination requirements for buprenorphine treatment initiation. We examined whether Ryan Haight Act waiver improved implementation of telehealth buprenorphine within syringe service programs (SSPs) - organizations that serve people with historically low access to treatment. METHODS We surveyed all known SSPs operating in the US in 2021 (N = 421) of which 77% responded (n = 325). We calculated the prevalence and accompanying 95% confidence intervals (CI) for implementation of telehealth buprenorphine inductions at SSPs in 2020. Multivariable logistic regression was used to assess differences in implementing telehealth buprenorphine inductions by organizational characteristics. RESULTS In 2020, the prevalence of implementing buprenorphine inductions via telehealth was 24% (95% CI:19-30%). Non-governmental SSPs had a higher odds of telehealth buprenorphine inductions (adjusted odds ratio (aOR)= 2.92; 95% CI:1.22-7.00; p = 0.016), compared to governmental SSPs. Furthermore, the larger the organization's annual budget, the higher the odds of telehealth buprenorphine implementation (aOR=2.00 per quartile (95% CI:1.33-2.99; p = 0.001). SSPs located in states with higher opioid overdose mortality rates did not have significantly higher likelihood of telehealth buprenorphine implementation. CONCLUSION A substantial number of SSPs implemented telehealth buprenorphine after waiver of the Ryan Haight Act. Permanent adoption of this waiver will be critical and providing financial resources to SSPs is vital to support implementation of new innovations.
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Affiliation(s)
- Barrot H Lambdin
- RTI International, Berkeley, CA, United States; University of California San Francisco, San Francisco, CA, United States; University of Washington, Seattle, WA, United States.
| | | | | | - Lynn Wenger
- RTI International, Berkeley, CA, United States
| | | | - Paul LaKosky
- North American Syringe Exchange Network, Tacoma, WA, United States
| | - Alex H Kral
- RTI International, Berkeley, CA, United States
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20
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Frost MC, Austin EJ, Corcorran MA, Briggs ES, Behrends CN, Juarez AM, Frank ND, Healy E, Prohaska SM, LaKosky PA, Kapadia SN, Perlman DC, Schackman BR, Des Jarlais DC, Williams EC, Glick SN. Responding to a surge in overdose deaths: perspectives from US syringe services programs. Harm Reduct J 2022; 19:79. [PMID: 35854351 PMCID: PMC9295104 DOI: 10.1186/s12954-022-00664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background US overdose deaths have reached a record high. Syringe services programs (SSPs) play a critical role in addressing this crisis by providing multiple services to people who use drugs (PWUD) that help prevent overdose death. This study examined the perspectives of leadership and staff from a geographically diverse sample of US SSPs on factors contributing to the overdose surge, their organization’s response, and ongoing barriers to preventing overdose death. Methods From 2/11/2021 to 4/23/2021, we conducted semi-structured interviews with leadership and staff from 27 SSPs sampled from the North American Syringe Exchange Network directory. Interviews were transcribed and qualitatively analyzed using a Rapid Assessment Process. Results Respondents reported that increased intentional and unintentional fentanyl use (both alone and combined with other substances) was a major driver of the overdose surge. They also described how the COVID-19 pandemic increased solitary drug use and led to abrupt increases in use due to life disruptions and worsened mental health among PWUD. In response to this surge, SSPs have increased naloxone distribution, including providing more doses per person and expanding distribution to people using non-opioid drugs. They are also adapting overdose prevention education to increase awareness of fentanyl risks, including for people using non-opioid drugs. Some are distributing fentanyl test strips, though a few respondents expressed doubts about strips’ effectiveness in reducing overdose harms. Some SSPs are expanding education and naloxone training/distribution in the broader community, beyond PWUD and their friends/family. Respondents described several ongoing barriers to preventing overdose death, including not reaching certain groups at risk of overdose (PWUD who do not inject, PWUD experiencing homelessness, and PWUD of color), an inconsistent naloxone supply and lack of access to intranasal naloxone in particular, inadequate funding, underestimates of overdoses, legal/policy barriers, and community stigma. Conclusions SSPs remain essential in preventing overdose deaths amid record numbers likely driven by increased fentanyl use and COVID-19-related impacts. These findings can inform efforts to support SSPs in this work. In the face of ongoing barriers, support for SSPs—including increased resources, political support, and community partnership—is urgently needed to address the worsening overdose crisis.
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Affiliation(s)
- Madeline C Frost
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA. .,Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA.
| | - Elizabeth J Austin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Elsa S Briggs
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
| | - Alexa M Juarez
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Noah D Frank
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Elise Healy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Stephanie M Prohaska
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street Suite 113, Tacoma, WA, 98402, USA
| | - Paul A LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street Suite 113, Tacoma, WA, 98402, USA
| | - Shashi N Kapadia
- Department of Population Health Sciences, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA.,Division of Infectious Diseases, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
| | - David C Perlman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.,Center for Drug Use and HIV/HCV Research, 708 Broadway, 4th Floor, New York, NY, 10003, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
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21
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Wang A, Jawa R, Mackin S, Whynott L, Buchholz C, Childs E, Bazzi AR. "We were building the plane as we were flying it, and we somehow made it to the other end": syringe service program staff experiences and well-being during the COVID-19 pandemic. Harm Reduct J 2022; 19:78. [PMID: 35841101 PMCID: PMC9284956 DOI: 10.1186/s12954-022-00661-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syringe service programs (SSPs) provide essential harm reduction and prevention services for people who inject drugs in the USA, where SSP coverage is expanding. During the COVID-19 pandemic, US SSPs underwent unprecedented shifts in operational procedures (e.g., closures of physical sites, staff redeployment into pandemic response efforts). Given the critical role of US SSP workers in the pandemic, we sought to explore the occupational experiences and well-being of SSP staff to inform future emergency response efforts. METHODS From July-October 2020, we conducted semi-structured interviews with staff members of four SSPs in diverse regions of Massachusetts. Trained interviewers administered qualitative interviews virtually. Interviews were coded in NVivo v12 and thematic analysis identified common occupational experiences and related impacts on staff well-being in the context of the COVID-19 pandemic. RESULTS Among 18 participants, 12 (67%) had client-facing roles such as harm reduction specialists and six (33%) worked in program management or leadership. We found that staff were frequently anxious about SARS-CoV-2 transmission, which contributed to staff turnover. SSPs rapidly adapted and expanded their services to meet increasing client needs during the pandemic (e.g., food distribution, COVID-19 testing), leading to staff overexertion. Simultaneously, public health measures such as physical distancing led to staff concerns about reduced social connections with clients and coworkers. Through these challenges, SSPs worked to protect staff well-being by implementing flexible and tangible COVID-19-related policies (e.g., paid sick leave), mental health resources, and frequent communication regarding pandemic-related operational changes. CONCLUSION SSPs in the USA adapted to the COVID-19 pandemic out of necessity, resulting in operational changes that threatened staff well-being. Despite the protective factors revealed in some narratives, our findings suggest that during prolonged, complex public health emergencies, SSPs may benefit from enhanced occupational supports to prevent burnout and promote wellness for this essential public health workforce.
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Affiliation(s)
- Andrea Wang
- Boston University School of Medicine, Boston, MA, USA
| | - Raagini Jawa
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Section of Infectious Disease, Boston Medical Center, Boston, MA, USA
| | - Sarah Mackin
- Access, Harm Reduction, Overdose Prevention and Education (AHOPE), Boston, MA, USA
| | | | - Connor Buchholz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | | | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
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22
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Salvalaggio G, Hyshka E, Brown C, Pinto AD, Halas G, Green L, Kosteniuk B, Perri M, Le Chalifoux N, Halas G, Steiner L, Cavett T, Montesanti S. A comparison of the COVID-19 response for urban underserved patients experiencing healthcare transitions in three Canadian cities. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:846-866. [PMID: 35771364 PMCID: PMC9245871 DOI: 10.17269/s41997-022-00651-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The COVID-19 pandemic and response has highlighted existing strengths within the system of care for urban underserved populations, but also many fault lines, in particular during care transitions. The objectives of this study were to describe COVID-19 response policies for urban underserved populations in three Canadian cities; examine how these policies impact continuity of care for urban underserved populations; determine whether and how urban underserved community members were engaged in policy processes; and develop policy and operational recommendations for optimizing continuity of care for urban underserved populations during public health crises. METHODS Using Walt & Gilson's Policy Triangle framework as a conceptual guide, 237 policy and media documents were retrieved. Five complementary virtual group interview sessions were held with 22 front-line and lived-experience key informants to capture less well-documented policy responses and experiences. Documents and interview transcripts were analyzed inductively for policy content, context, actors, and processes involved in the pandemic response. RESULTS Available documents suggest little focus on care continuity for urban underserved populations during the pandemic, despite public health measures having disproportionately negative impacts on their care. Policy responses were largely reactive and temporary, and community members were rarely involved. However, a number of community-based initiatives were developed in response to policy gaps. Promising practices emerged, including examples of new multi-level and multi-sector collaboration. CONCLUSION The pandemic response has exposed inequities for urban underserved populations experiencing care transitions; however, it has also exposed system strengths and opportunities for improvement to inform future policy direction.
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Affiliation(s)
- Ginetta Salvalaggio
- Department of Family Medicine, University of Alberta, 610 University Terrace, Edmonton, AB T6G 2T4 Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Cara Brown
- Department of Occupational Therapy, University of Manitoba, 771 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
| | - Andrew D. Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Gayle Halas
- Rady Chair, Interprofessional Collaborative Practice, Rady Faculty of Health Sciences, University of Manitoba, P219-770 Bannatyne Ave., Winnipeg, MB R3E 0W3 Canada
| | - Lee Green
- Department of Family Medicine, University of Alberta, 516 University Terrace, Edmonton, AB T6G 2T4 Canada
| | - Brynn Kosteniuk
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7 Canada
| | - Nathaniel Le Chalifoux
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Garrett Halas
- Rady Faculty of Health Sciences, University of Manitoba, 770 Bannatyne University of Manitoba, Winnipeg, R3E 0W3 Canada
| | - Liane Steiner
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Teresa Cavett
- Department of Family Medicine, University of Manitoba, Northern Connection Medical Centre, 2700 McPhillips St, Winnipeg, MB R2V 3M3 Canada
| | - Stephanie Montesanti
- School of Public Health, University of Alberta, 3-266 Edmonton Clinic Health Academy, 11205-87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
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23
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Glick JL, Grieb SM, Harris SJ, Weir BW, Smith KC, Puryear T, Hamilton White R, Allen ST. Exploring the impact of the COVID-19 pandemic on syringe services programs in rural Kentucky. Harm Reduct J 2022; 19:47. [PMID: 35590373 PMCID: PMC9117854 DOI: 10.1186/s12954-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The coronavirus pandemic (COVID-19) exacerbated risks for adverse health consequences among people who inject drugs by reducing access to sterile injection equipment, HIV testing, and syringe services programs (SSPs). Several decades of research demonstrate the public health benefits of SSP implementation; however, existing evidence primarily reflects studies conducted in metropolitan areas and before the COVID-19 pandemic. OBJECTIVES We aim to explore how the COVID-19 pandemic affected SSP operations in rural Kentucky counties. METHODS In late 2020, we conducted eighteen in-depth, semi-structured interviews with persons (10 women, 8 men) involved in SSP implementation in rural Kentucky counties. The interview guide broadly explored the barriers and facilitators to SSP implementation in rural communities; participants were also asked to describe how COVID-19 affected SSP operations. RESULTS Participants emphasized the need to continue providing SSP-related services throughout the pandemic. COVID-19 mitigation strategies (e.g., masking, social distancing, pre-packing sterile injection equipment) limited relationship building between staff and clients and, more broadly, the pandemic adversely affected overall program expansion, momentum building, and coalition building. However, participants offered multiple examples of innovative solutions to the myriad of obstacles the pandemic presented. CONCLUSION The COVID-19 pandemic impacted SSP operations throughout rural Kentucky. Despite challenges, participants reported that providing SSP services remained paramount. Diverse adaptative strategies were employed to ensure continuation of essential SSP services, demonstrating the commitment and ingenuity of program staff. Given that SSPs are essential for preventing adverse injection drug use-associated health consequences, further resources should be invested in SSP operations to ensure service delivery is not negatively affected by co-occurring crises.
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Affiliation(s)
- Jennifer L. Glick
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Suzanne M. Grieb
- grid.21107.350000 0001 2171 9311Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21224 USA
| | - Samantha J. Harris
- grid.21107.350000 0001 2171 9311Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Brian W. Weir
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Katherine C. Smith
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Tyler Puryear
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Rebecca Hamilton White
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Sean T. Allen
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
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24
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Heidari O, Meyer D, O'Conor KJ, Cargill V, Patch M, Farley JE. COVID-19 Vaccination and Communicable Disease Testing Services' Integration Within a Syringe Services Program: A Program Brief. J Assoc Nurses AIDS Care 2022; 33:348-352. [PMID: 35025822 DOI: 10.1097/jnc.0000000000000322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT People who inject drugs often have a higher prevalence of risk factors associated with coronavirus disease 2019 (COVID-19) infection and associated morbidity and mortality, compounded by challenges in health care access. This increased vulnerability underscores the critical need to prioritize people who inject drug in ongoing COVID-19 vaccination efforts. Co-location of syringe services, COVID-19 vaccination services, and other communicable disease testing has proved an effective model to provide necessary interventions without creating additional barriers. Here, we describe a partnership between the Baltimore City Health Department, Johns Hopkins Mobile Vaccine Unit, and the Center for Infectious Disease and Nursing Innovation at the Johns Hopkins School of Nursing to provide COVID-19 vaccination, HIV and sexually transmitted infection testing, wound care, and linkage to care services co-located with a long-running syringe services program. We describe the services offered by each partner and lessons learned from this community-based co-location of services initiative.
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Affiliation(s)
- Omeid Heidari
- Omeid Heidari, PhD, MPH, ANP-C, is a Drug Dependence Epidemiology Training Fellow, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. Diane Meyer, RN, MPH, is a PhD student, Johns Hopkins University School of Nursing and Research Associate, Johns Hopkins Center for Health Security, Baltimore, Maryland, USA. Katie J. O'Conor, MD, is a Research Associate, Departments of Anesthesiology, Critical Care Medicine, and Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Victoria Cargill, MD, MSCE, is the Assistant Commissioner of Health, Baltimore City Health Department, Baltimore, Maryland, USA. Michelle Patch, PhD, MSN, APRN-CNS, ACNS-BC, is an Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA. Jason Farley, PhD, MPH, ANP-BC, FAANP, AACRN, is a Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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25
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Acceptability of a HIV self-testing program among people who use illicit drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103613. [DOI: 10.1016/j.drugpo.2022.103613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/19/2022]
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26
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Walters SM, Frank D, Van Ham B, Jaiswal J, Muncan B, Earnshaw V, Schneider J, Friedman SR, Ompad DC. PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure. AIDS Behav 2022; 26:1308-1320. [PMID: 34626265 PMCID: PMC8501360 DOI: 10.1007/s10461-021-03488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.
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27
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Behrends CN, Lu X, Corry GJ, LaKosky P, Prohaska SM, Glick SN, Kapadia SN, Perlman DC, Schackman BR, Des Jarlais DC. Harm reduction and health services provided by syringe services programs in 2019 and subsequent impact of COVID-19 on services in 2020. Drug Alcohol Depend 2022; 232:109323. [PMID: 35124386 PMCID: PMC8772135 DOI: 10.1016/j.drugalcdep.2022.109323] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study describes harm reduction and health services provided by U.S syringe services programs (SSPs) in 2019 and changes in provision of those services in 2020. METHODS SSPs were invited to participate in the Dave Purchase Memorial survey in August 2020. We collected programmatic data on services provided in 2019 and at the time of the survey in 2020. We conducted descriptive analyses using Chi-square and McNemar's tests. RESULTS At the time of the survey, > 60% of SSPs reported increased monthly syringe and naloxone distribution and expansion of home-based and mail-based naloxone delivery in Fall 2020 compared to 2019. Approximately three-quarters of SSPs decreased or stopped providing on-site HIV and HCV testing. Nearly half of SSPs offering on-site medications for opioid use disorder (MOUD) in 2019 increased provision of MOUD in 2020. The proportion of SSPs offering on-site mental health care services and primary care services statistically significantly decreased from 2019 to Fall 2020, but telehealth offerings of these services increased. CONCLUSIONS Many SSPs that offered health services in 2019 and remained operational in 2020 increased telehealth provision of mental health and primary care services, increased MOUD provision, and expanded harm reduction services, but most SSPs reduced or stopped on-site HIV and HCV testing. Sustaining SSP growth and innovation is paramount for preventing overdose deaths and HIV/HCV outbreaks after the deadliest year of the opioid epidemic in 2020.
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Affiliation(s)
- Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - Xinlin Lu
- College of Global Public Health, New York University, New York, NY, USA
| | - Grace J Corry
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Paul LaKosky
- North American Syringe Exchange Network, Tacoma, WA, USA
| | | | - Sara N Glick
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, WA, USA
| | - Shashi N Kapadia
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA; Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David C Perlman
- Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Don C Des Jarlais
- College of Global Public Health, New York University, New York, NY, USA
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28
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Frost MC, Sweek EW, Austin EJ, Corcorran MA, Juarez AM, Frank ND, Prohaska SM, LaKosky PA, Asher AK, Broz D, Jarlais DCD, Williams EC, Glick SN. Program Adaptations to Provide Harm Reduction Services During the COVID-19 Pandemic: A Qualitative Study of Syringe Services Programs in the U.S. AIDS Behav 2022; 26:57-68. [PMID: 34110506 PMCID: PMC8190167 DOI: 10.1007/s10461-021-03332-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 01/19/2023]
Abstract
Syringe services programs (SSPs) are essential to preventing injection drug use-related infections and overdose death among people who use drugs (PWUD). The novel coronavirus (COVID-19) pandemic initially impeded SSPs' operations. To effectively support these programs, information is needed regarding SSPs' experiences adapting their services and the challenges posed by COVID-19. We conducted qualitative interviews with leadership and staff from a sample of 31 U.S. SSPs. Respondents discussed urgent concerns including reduced reach of services, suspended HIV/hepatitis C testing, high COVID-19 risk among PWUD, and negative impacts of isolation on overdose and mental health. They also noted opportunities to improve future services for PWUD, including shifting to evidence-based distribution practices and maintaining regulatory changes that increased access to opioid use disorder medications post-pandemic. Findings can inform efforts to support SSPs in restoring and expanding services, and provide insight into SSPs' role in engaging PWUD during the COVID-19 response and future emergencies.
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Affiliation(s)
- Madeline C Frost
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Elsa W Sweek
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Elizabeth J Austin
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Maria A Corcorran
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexa M Juarez
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - Noah D Frank
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Paul A LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, Tacoma, WA, USA
| | - Alice K Asher
- Office of Policy, Planning and Partnerships, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention , Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dita Broz
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention , Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, New York, NY, USA
| | - Emily C Williams
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Sara N Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA.
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Aronowitz SV, Engel-Rebitzer E, Lowenstein M, Meisel Z, Anderson E, South E. "We have to be uncomfortable and creative": Reflections on the impacts of the COVID-19 pandemic on overdose prevention, harm reduction & homelessness advocacy in Philadelphia. SSM. QUALITATIVE RESEARCH IN HEALTH 2021; 1:100013. [PMID: 34870265 PMCID: PMC8485140 DOI: 10.1016/j.ssmqr.2021.100013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic and ensuing service delivery interruptions had serious impacts on people who use drugs (PWUD) and people experiencing homelessness, including instability in the drug supply, decreased access to substance use disorder (SUD) treatment and harm reduction supplies, increased substance use and relapse due to stress and isolation, inability to properly isolate and quarantine without stable housing, and risk of COVID-19 spread in congregate living spaces. At the same time, many have noted a potential opportunity for rapid change in health, housing, and drug policy despite previous stagnation—referred to as a “punctuated equilibrium” by Baumgartner and Jones—in response to the pandemic. The pandemic forced some important policy interventions in the United States at both national and local levels, including eviction moratoriums and loosening of drug policy related to substance use treatment. However, to what extent some of these changes will be sustained past the current COVID-19 crisis is still unclear, as is how drug and housing related policy shifts have impacted the work of frontline overdose prevention, substance use treatment, and homelessness advocacy workers. In this qualitative study, we used semi-structured interviews to assess how Philadelphia’s harm reduction advocates, community organizers, and SUD treatment clinicians have responded to the overdose and homelessness crises during COVID-19, and how they predict the pandemic and ensuing policy changes will impact the future of overdose prevention, harm reduction efforts, and homelessness advocacy. We interviewed 30 eligible participants during July and August 2020. The analysis of these data yielded three themes: 1/“None of it should be new to anybody”: COVID-era issues impacting PWUD and people experiencing homelessness are extensions of existing problems; 2/“An opportunity to actually benefit in some way from this crisis”: Possibility for innovation and improved care for PWUD and people experiencing homelessness; and 3/“Nothing we’ve tried has worked, so we have to be uncomfortable and creative”: The uncertain path forward. Despite the many barriers that participants faced to promoting the health and well-being of marginalized communities during the pandemic, they also believed that the pandemic presented an important opportunity for positive policy change that has the potential to promote drug user health into the future, including a continuation of loosened federal restrictions on substance use disorder treatment, legalization of safe consumption spaces, safe supply of substances, and progressive, creative housing solutions.
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Affiliation(s)
- Shoshana V Aronowitz
- University of Pennsylvania School of Nursing, Department of Family and Community Health, 418 Curie Blvd, Room 419, Philadelphia, PA, 19104-6021, USA
| | - Eden Engel-Rebitzer
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Margaret Lowenstein
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Zachary Meisel
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Evan Anderson
- University of Pennsylvania School of Nursing, Department of Family and Community Health, 418 Curie Blvd, Room 419, Philadelphia, PA, 19104-6021, USA
| | - Eugenia South
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
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30
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Bennett AS, Townsend T, Elliott L. The COVID-19 pandemic and the health of people who use illicit opioids in New York City, the first 12 months. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103554. [PMID: 34911010 PMCID: PMC8632599 DOI: 10.1016/j.drugpo.2021.103554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/21/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022]
Abstract
Background Concurrent opioid-related overdose and COVID-19 crises in the U.S. have imposed unprecedented challenges on people who use illicit opioids. Methods Using the experiences of 324 people who use illicit opioids between April 2020 and March 2021, we examined four domains of health and well-being potentially impacted by COVID-19: drug risks and responses, healthcare and related services, material hardship, and mental health. Data were drawn from participants’ completed monthly survey assessments which were grouped into four periods of interest for the unfolding pandemic: April-June 2020, July-October 2020, November-January 2021, and February-March 2021. Results A majority of measures in our four domains showed early COVID-19 related impacts, which quickly diminished as people and agencies responded to the pandemic. Difficulty obtaining food was the most frequently reported material hardship and appeared worst in April-June 2020. Over half of the population reported depression in April-June 2020, but this declined over the study period. Some participants reported changes to the heroin supply, including higher prices, lower quality, difficulty finding the drug, and fentanyl contamination. There was no discernable temporal shift in the frequency of use of each substance or the frequency of withdrawal symptoms. Over the study period, the mean number of overdoses per month decreased while the percent of opioid use events at which both a witness and naloxone were present (i.e., protected events) increased. Most participants receiving MOUD experienced an increase in take-home doses. Conclusions Findings speak to the resilience of people who use drugs as a population with disproportionate experience of trauma and crisis and also to the rapid response of NYC health agencies and service providers working with this population. Despite evident signs of adaptability and resilience, the COVID-19 pandemic has highlighted some of the unique vulnerabilities of people who use illicit opioids and the need for greater rates of “protected” opioid use and greater availability of wrap-around services to efficiently address the safety, food security, mental health, and treatment needs of the population.
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Affiliation(s)
- Alex S Bennett
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, United States; Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, New York University, 708 Broadway, 6th Floor, New York, NY 10012, United States.
| | - Tarlise Townsend
- Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, New York University, 708 Broadway, 6th Floor, New York, NY 10012, United States; Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, United States; Behavioral Science Training Program, NYU Rory College of Nursing, United States
| | - Luther Elliott
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, United States; Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, New York University, 708 Broadway, 6th Floor, New York, NY 10012, United States
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