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Yeo EJ, Hausman E, Noyes E, Chatterjee A. Evaluating mobile harm reduction services for youth and young adults. Front Public Health 2024; 12:1375323. [PMID: 38841665 PMCID: PMC11150819 DOI: 10.3389/fpubh.2024.1375323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
The adolescent and young adult (AYA) population has experienced an increase in both emergency room visits and deaths related to substance use. However, AYA are less likely to engage in existing addiction treatment infrastructure. A youth-specific mobile harm reduction program has the potential to reduce substance-related morbidity and mortality including infections, overdose, and death. Launched in 2019, the Community Care in Reach AYA pilot program seeks to address the difference in patterns of substance use between AYA and adults. The results of this evaluation suggest the importance of a youth-oriented program in increasing AYA engagement with harm reduction.
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Affiliation(s)
- Ellis J. Yeo
- Harvard Medical School, Boston, MA, United States
| | - Elizabeth Hausman
- College of Social Work, University of Kentucky, Lexington, KY, United States
| | - Elizabeth Noyes
- Department of Otolaryngology-Head and Neck Surgery, Mass Eye and Ear, Boston, MA, United States
| | - Avik Chatterjee
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
- Boston Health Care for the Homeless Program, Boston, MA, United States
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Taha S, King S, Atif S, Bate E. Changes in harm reduction service providers professional quality of life during dual public health emergencies in Canada. Harm Reduct J 2024; 21:48. [PMID: 38388932 PMCID: PMC10882723 DOI: 10.1186/s12954-024-00966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/20/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Harm reduction (HR) is a critical response to the pronounced toxicity deaths being experienced in Canada. HR providers report many benefits of their jobs, but also encounter chronic stress from structural inequities and exposure to trauma and death. This research study sought to quantify the emotional toll the toxicity emergency placed on HR providers (Cycle One; 2019). Study objectives were later expanded to determine the impact of the ongoing toxicity as well as the pandemic's impact on well-being (Cycle Two; 2021). METHODS Standardized measures of job satisfaction, burnout, secondary traumatic stress, and vulnerability to grief were used in an online national survey. Open-ended questions addressed resources and supports. HR partners across Canada validated the findings and contributed to alternative interpretations and implications. RESULTS 651 respondents in Cycle One and 1,360 in Cycle Two reported moderately high levels of job satisfaction; they reported finding great meaning in their work. Yet, mean levels of burnout and secondary traumatic stress were moderate, with the latter significantly increasing in Cycle Two. Reported vulnerability to grief was moderate but increased significantly during COVID. When available, supports lacked the quality necessary to respond to the complexities of HR workers' experiences, or an insufficient number of sessions were covered through benefits. Respondents shared that their professional quality of life was affected more by policy failures and gaps in the healthcare system than it was by the demands of their jobs. CONCLUSION Both the benefits and the strain of providing harm reduction services cannot be underestimated. For HR providers, these impacts are compounded by the drug toxicity emergency, making the service gaps experienced by them all the more critical to address. Implications highlight the need for integration of HR into the healthcare system, sustainable and reliable funding, sufficient counselling supports, and equitable staffing models. Support for this essential workforce is critical to ensuring the well-being of themselves, the individuals they serve, and the health of the broader healthcare system.
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Affiliation(s)
- Sheena Taha
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada.
| | - Samantha King
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada
| | - Sara Atif
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada
| | - Eliza Bate
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada
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Byregowda H, Tomko C, Schneider KE, Russell E, Johnson RM, Susukida R, Rouhani S, Parnham T, Park JN. Disruptions to naloxone training among lay and occupational responders in Maryland during the emergence of COVID-19: early impacts, recovery, and lessons learned. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023:100173. [PMID: 37362079 PMCID: PMC10271935 DOI: 10.1016/j.dadr.2023.100173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
Background : Opioid overdose death rates increased during the COVID-19 pandemic. Disruptions in community-based naloxone trainings could have reduced the likelihood of overdose reversal and increased the chances of a fatal overdose. We investigated changes in the number of people trained in naloxone administration and distribution in Maryland before, during, and after COVID-related stay-at-home orders. Methods : Data on naloxone training are from the Maryland Department of Health. We used interrupted time series models to estimate changes in average monthly number of people trained: [1] pre-interruption (4/2019-3/2020), [2] 1-month post-interruption (4/2020-5/2020), and [3] 12-months post-interruption (4/2020-3/2021). Trainees were classified as lay (e.g., people who use drugs) or occupational (e.g., law enforcement officers and harm reduction workers) responders. Results : There were 101,332 trainees; 54.1% lay, 21.5% occupational, and 23.4% unknown responder status. We observed a decrease in the average monthly number of trainees in the pre-interruption period (-235, p<0.001), a larger decrease of 93.2% during the 1-month post-interruption (-846, p=0.013), and an increase 12-months post-interruption (+217, p<0.001). There was a significant decrease among occupational responders 1-month post-interruption, and a significant increase among lay responders in the 12-month post-interruption period. Conclusions : Findings suggest a marked decrease in naloxone trainees immediately after stay-at-home order, followed by a moderate rebound in the 12-months after stay-at-home order. The decrease in occupational responders trained may have limited access to naloxone, but would likely have been offset by increases in number of lay responders trained. Strengthening lay and occupational responder connections could maintain naloxone distribution during public health crises.
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Affiliation(s)
- Himani Byregowda
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Erin Russell
- Center for Harm Reduction Services, Maryland Department of Health
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Saba Rouhani
- Department of Epidemiology, New York University School of Global Public Health
| | - Taylor Parnham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Ju Nyeong Park
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University
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Hermans SP, Samiec J, Golec A, Trimble C, Teater J, Hall OT. Years of Life Lost to Unintentional Drug Overdose Rapidly Rising in the Adolescent Population, 2016-2020. J Adolesc Health 2023; 72:397-403. [PMID: 36096899 DOI: 10.1016/j.jadohealth.2022.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/12/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Years of life lost (YLL) is an epidemiological estimate of premature death which provides increased weight to mortality at younger ages. This study aims to quantify the impact of overdose mortality in adolescents from 2016 to 2020 using YLL and document the role of illicitly manufactured fentanyl in rising overdose rates. METHODS Data were obtained from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research mortality file for years 2016-2020 to investigate unintentional overdose in adolescents aged 10-19. Unintentional overdose rates were investigated by year, gender, age, and substances involved. YLL was calculated using the Social Security Period of Life Table by age and year. YLL to unintentional overdoses was then compared to other leading causes of adolescent death. RESULTS The number of adolescent YLL to unintentional drug overdose in the United States more than doubled from 2019 to 2020 after remaining relatively stable between 2016 and 2019. In 2020, YLL to unintentional overdose accumulated to 84,179 YLL, surpassing that of cancer. Synthetic opioids including primarily illicitly manufactured fentanyl contributed to 81% of overdose deaths and 68,356 YLL, compared to 67% (26,628 YLL) in 2019. YLL to unintentional overdose during 2020 was higher for males (59,274) compared to females (24,905). DISCUSSION Mortality due to unintentional overdose in adolescents reached an all-time high in 2020. The majority of deaths (81%) involved fentanyl and other synthetic opioids. The trends depicted in this study signify the need for increased harm reduction approaches and treatment of opioid use disorder in adolescents.
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Affiliation(s)
- Sarah Perou Hermans
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jennifer Samiec
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Alexander Golec
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center Talbot Hall, Columbus, Ohio
| | | | - Julie Teater
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center Talbot Hall, Columbus, Ohio
| | - Orman Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center Talbot Hall, Columbus, Ohio.
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Parker DG, Zentner D, Burack JA, Wendt DC. The impact of the COVID-19 pandemic on medications for opioid use disorder services in the U.S. and Canada: a scoping review. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2181147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Daniel G. Parker
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Daysi Zentner
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Jacob A. Burack
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Dennis C. Wendt
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
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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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Simon KM, Levy SJ, Bukstein OG. Adolescent Substance Use Disorders. NEJM EVIDENCE 2022; 1:EVIDra2200051. [PMID: 38319247 PMCID: PMC11003516 DOI: 10.1056/evidra2200051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Adolescent Substance Use DisordersSubstance use disorders contribute to the leading causes of death among adolescents, including homicide and suicide. Here, Simon et al. review the most recent published data on adolescent substance use disorders and the implications for clinical practice.
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Affiliation(s)
- Kevin M Simon
- Adolescent Substance Use & Addiction Program (ASAP), Division of Developmental Medicine, Boston Children's Hospital, Boston, MA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Sharon J Levy
- Adolescent Substance Use & Addiction Program (ASAP), Division of Developmental Medicine, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Oscar G Bukstein
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Abstract
PURPOSE OF REVIEW To review the literature on the trends in substance use among youth during the coronavirus SARS-CoV-2 (COVID-19) pandemic. RECENT FINDINGS The pandemic has given rise to concerns about the mental health and social well-being of youth, including its potential to increase or exacerbate substance use behaviors. This systematic review identified and included 49 studies of use across alcohol, cannabis, tobacco, e-cigarettes/vaping, and other drugs, and unspecified substances. The majority of studies across all categories of youth substance use reported reductions in prevalence, except in the case of other drugs and unspecified drug and substance use, which included three studies that reported an increase in use and three studies that reported decrease in use. Overall, the results of this review suggest that the prevalence of youth substance use has largely declined during the pandemic. Youth substance use in the post-pandemic years will require monitoring and continued surveillance.
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de Vargas D, Pereira CF, Volpato RJ, Lima AVC, da Silva Ferreira R, de Oliveira SR, Aguilar TF. Strategies Adopted by Addiction Facilities during the Coronavirus Pandemic to Support Treatment for Individuals in Recovery or Struggling with a Substance Use Disorder: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212094. [PMID: 34831850 PMCID: PMC8624445 DOI: 10.3390/ijerph182212094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
This review aimed to identify and synthesize strategies and actions adopted by addiction facilities to support and maintain treatment during the coronavirus disease 2019 (COVID-19) pandemic. A scoping review was conducted using the following information sources: Virtual Health Library, SCOPUS, Web of Science, PubMed, CINAHL, and Latin American and Caribbean Health Science Literature. From a total of 971 articles, 28 studies were included. The strategies to maintain the care offer were telehealth/telemedicine, counselling/screening, 24-h telephone, webinars, conducting group therapy and support among users, adaptation for electronic health records, increased methadone/naloxone dispensing, restriction in the number of medication dispensing/day, and electronic prescription and home delivery medications. These strategies can be used to support health professionals in addressing the impact of the pandemic on the treatment of those in recovery or struggling with a substance use disorder when in-person treatment is not possible.
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Affiliation(s)
- Divane de Vargas
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
- Correspondence:
| | - Caroline Figueira Pereira
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Rosa Jacinto Volpato
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Ana Vitória Corrêa Lima
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Rogério da Silva Ferreira
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Sheila Ramos de Oliveira
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
| | - Thiago Faustino Aguilar
- School of Nursing, São Paulo University, São Paulo 05403-000, Brazil; (C.F.P.); (R.J.V.); (A.V.C.L.); (S.R.d.O.); (T.F.A.)
- Nucleon of Addiction Nursing Research, School of Nursing (NEPEEA), University of São Paulo, São Paulo 05403-000, Brazil;
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