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Brown L, Rishel Brakey H, Page K. Voices of the unhoused from Santa Fe, New Mexico: A mixed methods study of health status, substance use, and community harm reduction program perspectives. J Prev Interv Community 2024; 52:73-97. [PMID: 38757899 DOI: 10.1080/10852352.2024.2352266] [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] [Indexed: 05/18/2024]
Abstract
No published studies have examined the community service priorities and harm reduction perspectives of unhoused people in Santa Fe, New Mexico. We conducted a mixed methods pilot study of 56 unhoused people at community locations in Santa Fe to: (1) assess the current prevalence of chronic medical conditions and substance use; (2) highlight community service priorities; and (3) explore views of innovative community harm reduction programs. Our first hypothesis was there would be high prevalence of chronic medical conditions, for which we found high prevalence of post-traumatic stress disorder, major depression, substance use disorders, chronic pain, and hypertension. Our second hypothesis was that we would find top community service priorities of housing, food, and health care. We found long- and short-term housing and food, but not healthcare, top priorities. Our third hypothesis was that we would find mixed support for community harm reduction initiatives like managed alcohol programs and overdose prevention centers. We found positive, not mixed, support for these community harm reduction programs among Santa Fe's unhoused. Unhoused study participants ranged in age 27-77 years, with lifetime years unhoused from less than one year to 63 years. Study limitations included small sample size, convenience sampling, and descriptive results. Policies and program initiatives supporting additional Housing First options, managed alcohol programs, and overdose prevention centers in the Santa Fe community are clearly indicated to increase engagement with this vulnerable population. Future research should focus on inclusion of the perspectives of the unhoused in the design, conduct, evaluation, and dissemination of community programs to meet the needs of the unhoused, with re-defined outcomes to include changes in quality of life, program engagement, demarginalization, and future goals and plans, beyond currently utilized health and social service program outcome measures.
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Affiliation(s)
- Laura Brown
- Center for Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Heidi Rishel Brakey
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Carver H, Ciolompea T, Conway A, Kilian C, McDonald R, Meksi A, Wojnar M. Substance use disorders and COVID-19: reflections on international research and practice changes during the "poly-crisis". Front Public Health 2023; 11:1201967. [PMID: 37529435 PMCID: PMC10390069 DOI: 10.3389/fpubh.2023.1201967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Since March 2020, the COVID-19 pandemic has had a disproportionately high toll on vulnerable populations, coinciding with increased prevalence of alcohol-and drug-related deaths and pre-existing societal issues such as rising income inequality and homelessness. This poly-crisis has posed unique challenges to service delivery for people with substance use disorders, and innovative approaches have emerged. In this Perspectives paper we reflect on the poly-crisis and the changes to research and practice for those experiencing substance use disorders, following work undertaken as part of the InterGLAM project (part of the 2022. Lisbon Addictions conference). The authors, who were part of an InterGLAM working group, identified a range of creative and novel responses by gathering information from conference attendees about COVID-19-related changes to substance use disorder treatment in their countries. In this paper we describe these responses across a range of countries, focusing on changes to telehealth, provision of medications for opioid use disorder and alcohol harm reduction, as well as changes to how research was conducted. Implications include better equity in access to technology and secure data systems; increased prescribed safer supply in countries where this currently does not exist; flexible provision of medication for opioid use disorder; scale up of alcohol harm reduction for people with alcohol use disorders; greater involvement of people with lived/living experience in research; and additional support for research in low- and middle-income countries. The COVID-19 pandemic has changed the addictions field and there are lessons for ongoing and emerging crises.
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Affiliation(s)
- Hannah Carver
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Teodora Ciolompea
- Drug Addiction Evaluation and Treatment Center, Saint Stelian, Bucharest, Romania
| | - Anna Conway
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Carolin Kilian
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Rebecca McDonald
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Andia Meksi
- National Institute of Public Health, Tirana, Albania
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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Novotna G, Nielsen E, Berenyi R. Harm Reduction Strategies for Severe Alcohol Use Disorder in the Context of Homelessness: A Rapid Review. Subst Abuse 2023; 17:11782218231185214. [PMID: 37448810 PMCID: PMC10336757 DOI: 10.1177/11782218231185214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/13/2023] [Indexed: 07/15/2023]
Abstract
Severe alcohol use disorder (AUD) in the context of housing instability remains one of the most complex health and social issues. Homelessness is related to increased vulnerability to stigma, marginalization and harmful ways of alcohol consumption, including non-beverage alcohol use (NBA). As a result, severe intoxication, alcohol poisoning, injury and death are common occurrences. Although harm minimization strategies have been readily proposed and examined in the context of drug use, applying the same principles to severe AUD remains controversial within the research and treatment community. This article summarizes the emerging research on managed alcohol programs to increase awareness about alcohol-related strategies that address severe AUD and provide other wrap-around supports such as housing, health and social services to mitigate various harms, including COVID-19.
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Affiliation(s)
- Gabriela Novotna
- Faculty of Social Work, University of Regina, Regina, SK, Canada
| | - Erin Nielsen
- Faculty of Social Work, University of Regina, Regina, SK, Canada
| | - Rochelle Berenyi
- Carmichael Outreach Inc., University of Regina, Regina, SK, Canada
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Azevedo FO, Neto A, Gama A, Subtil A, Fuertes R, Pereira C, Tavares J, Medinas RL, Silva AV, Dias S. Problemas ligados ao álcool em centros de emergência (PLACE)-People experiencing homelessness with alcohol-related problems in Lisbon's emergency shelters during the COVID-19 pandemic: a description and analysis of a harm reduction intervention. Front Psychol 2023; 14:1165322. [PMID: 37275696 PMCID: PMC10236796 DOI: 10.3389/fpsyg.2023.1165322] [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: 02/13/2023] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Alcohol-related problems disproportionally affect people experiencing homelessness. As the first wave of the COVID-2019 pandemic spread in 2020, a number of emergency shelters were opened in Lisbon. Increased difficulties in obtaining alcohol could have led to an increased incidence of alcohol withdrawal. Therefore, a low-threshold harm reduction intervention was introduced to these emergency shelters. This consisted of a fixed medication treatment, made available immediately for those with specific conditions, without the need for a medical evaluation or abstinence from alcohol, together with an offer of subsequent access to specialized addiction centers. The Problemas Ligados ao Álcool em Centros de Emergência (PLACE) study (alcohol-related problems in emergency shelters) is a retrospective mixed-methods observational study. It describes the demographic, health, and social characteristics of shelter users participating in the program and aims to evaluate the intervention as well as the experience of the patients, professionals, and decision-makers involved. Results A total of 69 people using shelters self-reported alcohol-related problems. Among them, 36.2% of the people accepted a pharmacological intervention, and 23.2% selected an addiction appointment. The take-up of the intervention was associated with better housing outcomes. A description of an individual's trajectory after leaving the shelter is provided. Discussion This study suggests that non-abstinence-focused interventions can be useful and well-tolerated in treating addiction in this population.
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Affiliation(s)
- Filipe Oliveira Azevedo
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Neto
- Unidade de Alcoologia de Lisboa, Divisão para a Intervenção em Comportamentos Aditivos e Dependências, Associação Regional de Saúde, Instituto Público, Lisbon, Portugal
| | - Ana Gama
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Subtil
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | | - Raquel Luis Medinas
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana V. Silva
- Unidade de Alcoologia de Lisboa, Divisão para a Intervenção em Comportamentos Aditivos e Dependências, Associação Regional de Saúde, Instituto Público, Lisbon, Portugal
| | - Sónia Dias
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
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Brothers TD, Walley AY, Rivers-Bowerman H, McLeod M, Genge L. Grayken lessons: between a rock and a hard place? A 37-year-old man with acute liver injury while enrolled in a managed alcohol program for severe alcohol use disorder. Addict Sci Clin Pract 2023; 18:14. [PMID: 36879279 PMCID: PMC9988200 DOI: 10.1186/s13722-023-00370-5] [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: 11/09/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Managed alcohol programs aim to reduce health and social harms associated with severe alcohol use disorder. Here, we describe a young man with severe alcohol use disorder enrolled in a managed alcohol program, who was admitted to hospital with acute liver injury. Fearing that alcohol was contributing, the inpatient care team discontinued the managed alcohol dose in hospital. He was ultimately diagnosed with cephalexin-induced liver injury. After consideration of risks, benefits, and alternative options, the patient and care team jointly decided to restart managed alcohol after hospital discharge. With this case, we describe managed alcohol programs and summarize the emerging evidence-base, including eligibility criteria and outcome measures; we explore clinical and ethical dilemmas in caring for patients with liver disease within managed alcohol programs; and we emphasize principles of harm reduction and patient-centered care when establishing treatment plans for patients with severe alcohol use disorder and unstable housing.
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Affiliation(s)
- Thomas D Brothers
- Department of Medicine, Dalhousie University, Halifax, NS, Canada. .,Institute of Epidemiology and Health Care, UCL Collaborative Centre for Inclusion Health, University College London, London, UK.
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Helen Rivers-Bowerman
- Mobile Outreach Street Health (MOSH), North End Community Health Centre, Halifax, NS, Canada
| | - Magnus McLeod
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leah Genge
- Mobile Outreach Street Health (MOSH), North End Community Health Centre, Halifax, NS, Canada.,Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
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Lessons from the COVID-19 pandemic for substance misuse services: findings from a peer-led study. Harm Reduct J 2022; 19:140. [PMID: 36503439 PMCID: PMC9742020 DOI: 10.1186/s12954-022-00713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The measures implemented to contain the spread of the COVID-19 virus disrupted the provision of substance misuse treatment and support. However, little is known about the impact of this disruption on individuals seeking treatment for drug- and/or alcohol-related problems (henceforth service users). This study aimed to help substance misuse services learn lessons and identify ways of optimising delivery and minimising harm in the event of any future lockdowns or global crises. METHODS The study was co-produced by a team of peer researchers, practitioners, policymakers and academics. Telephone interviews were conducted with 202 substance misuse service users over a 6-month period commencing June 2020. The interviews were conducted by a small group of seven peer researchers each with lived experience of substance use problems. The interview data were recorded by the peers in an anonymous online questionnaire survey and analysed using standard quantitative and qualitative methods. RESULTS Service users responded to the COVID-19 pandemic in a variety of ways. Diverse responses were noted in relation to their substance use patterns, their personal lives and their substance misuse treatment experiences. For some, the pandemic acted as a new risk environment factor that increased their vulnerability to substance-related harm. For others, it facilitated aspects of the enabling environment, thereby reducing the risk of harm. CONCLUSIONS Service users are not a homogenous group, and an individualised approach to treatment that recognises the potential for varied responses to the same stimuli is needed. The findings suggest that service users would benefit from having a choice in how they access treatment and from greater access to outreach programmes that take treatments and harm reduction tools such as naloxone into the community. The research also supports the involvement of people with lived experience in substance use research, policy and practice.
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Carver H, Parkes T, Masterton W, Booth H, Ball L, Murdoch H, Falzon D, Pauly BM. The Potential for Managed Alcohol Programmes in Scotland during the COVID-19 Pandemic: A Qualitative Exploration of Key Areas for Implementation Using the Consolidated Framework for Implementation Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15207. [PMID: 36429926 PMCID: PMC9690644 DOI: 10.3390/ijerph192215207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
People experiencing homelessness and alcohol dependence are at increased risk of a range of harms, including from COVID-19. Managed Alcohol Programmes (MAPs) are an alcohol harm reduction intervention specifically for this group. In this paper we report on qualitative findings of a mixed methods study investigating the potential utility of MAPs during the COVID-19 pandemic in Scotland. Interviews, conducted with 40 participants, explored potential views of implementing MAPs during the pandemic. Theoretically, we drew on the Consolidated Framework for Implementation Research (CFIR) to inform data collection and analysis. Six themes were identified which mapped onto three CFIR domains: perceptions of MAPs and the evidence base; necessary components of MAPs; changing culture of alcohol harm reduction; MAPs as a moral and ethical grey area; addressing a service gap; and securing buy-in and partnership working. Participants were generally positive about MAPs and viewed them as a key intervention to address a service gap. Several necessary components were identified for successful implementation of MAPs. Securing buy-in from a range of stakeholders and partnership working were deemed important. Finally, MAPs require careful, long-term planning before implementation. We conclude that MAPs are needed in Scotland and require long-term funding and appropriate resources to ensure they are successful.
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Affiliation(s)
- Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Wendy Masterton
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Hazel Booth
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Lee Ball
- Homelessness Services Unit, The Salvation Army, London SE1 6BN, UK
| | - Helen Murdoch
- Homelessness Services Unit, The Salvation Army, London SE1 6BN, UK
| | - Danilo Falzon
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Bernie M. Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada
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Nash E, Walker E, Watt J, Sannikova A, Dawson A, Anderson T, Sheather M, Jewitt J, Linnegar P, Hutchings O, Haber PS. Management of alcohol and other drug issues in Special Health Accommodation during the COVID-19 Delta variant outbreak in Sydney, 2021. Drug Alcohol Rev 2022; 41:1319-1321. [PMID: 35730108 PMCID: PMC9350242 DOI: 10.1111/dar.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Emily Nash
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Emily Walker
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Joshua Watt
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alena Sannikova
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andrew Dawson
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Merryn Sheather
- Special Health Accommodation, Sydney Local Health District, Sydney, Australia
| | - Joseph Jewitt
- Special Health Accommodation, Sydney Local Health District, Sydney, Australia
| | - Peter Linnegar
- Special Health Accommodation, Sydney Local Health District, Sydney, Australia
| | | | - Paul S Haber
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
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