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Khazaee-Pool M, Naghibi SA, Pashaei T, Ponnet K. Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol. Addict Sci Clin Pract 2024; 19:40. [PMID: 38755676 PMCID: PMC11097512 DOI: 10.1186/s13722-024-00472-8] [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: 08/08/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND People with substance use disorders (SUDs) have restricted engagement with health-care facilities and describe repeated experiences of stigma, discrimination, and mistreatment when receiving care at health-care and public addiction treatment centers (PATCs). The purpose of the current study is to design practical cultural-based strategies to reduce addiction-related stigma and discrimination at PATCs. METHODS/DESIGN The present study will use a mixed-methods design with an explanatory sequential approach. Phase 1 of the study will combine a cluster sampling technique combined with a cross-sectional survey of Patients with Substance Use Disorders (SUDs) in Mazandaran, Iran. A total of three hundred and sixty individuals with SUDs will be selected to assess their experiences of stigma and factors predicting stigma. Phase 2 will involve qualitative study aimed at exploring participants' perceptions regarding the aspects and determinants of their stigma experience. The participants will include two groups: people with SUDs and staff/health-care providers at PATCs. Participants for Phase 2 will be purposively sampled from those involved in Phase 1.Qualitative data will be collected using in-depth semi-structured interviews and focus group discussions and analyzed using content analysis with a conventional approach. Phase 3 will focus on the development of new strategies to reduce the experiences of stigma among people with SUDs at PATCs. These strategies will be formulated based on the findings derived from the qualitative and quantitative data obtained in Phases 1 and 2, a comprehensive review of the literature, and expert opinions gathered using the nominal group technique. DISCUSSION This is one of the few studies conducted within the domain of stigma pertaining to individuals who use drugs within the context of Iranian culture employing a mixed-methods approach, this study aims to develop culturally sensitive strategies to reduce such problems from the perspective of Iranian people who use drugs. It is anticipated that the study will yield evidence-based insights and provide practical strategies to reduce the stigma and discrimination experienced by people who use drugs at PATCs. Such outcomes are important for informing policymaking and designing healthcare interventions tailored to the needs of individuals grappling with substance dependency.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Seyed Abolhassan Naghibi
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Pashaei
- Department of Health Promotion and Education, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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Karimi SE, Amadi S, Rampisheh Z, Tayefi B, Soleimanvandiazar N, Higgs P, Tehrani-Banihashemi A, Hajebi A, Nojomi M, Karimijavan G. Predictors of COVID-19 vaccine uptake among people who use substances: a case study in Tehran. Subst Abuse Treat Prev Policy 2024; 19:15. [PMID: 38409120 PMCID: PMC10895917 DOI: 10.1186/s13011-024-00596-9] [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] [Received: 12/05/2023] [Accepted: 02/07/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Vaccination is one of the most effective ways to manage infectious disease epidemics such as Covid-19. However, the low rates of vaccination in populations at risk including people using illicit substances, hinders the effectiveness of preventive vaccines in reducing transmission. The aim of this study was to investigate the rate of Covid-19 vaccination and its related factors among people who use substances in Tehran, Iran. METHODS Between July and December 2022, 386 people who use substances aged ≥ 18 years old were recruited by convenience street-based sampling in Tehran. The outcome variable in this study was self-reported completion of at least two doses of the Covid-19 vaccine. Logistic regression was used to investigate the factors related to Covid-19 vaccination. Data were analyzed using SPSS software version 20 at the 0.05 level of significance. As a measure of risk, 95% Confidence interval (CI) was used. The level of significance was considered at 0.05. RESULTS Almost three-quarters (n = 286) of the participants reported receiving at least two doses of the Covid-19 vaccine (95% CI, 70.2-79.3). Those participants with high school diplomas were 1.17 times more likely than less educated participants to report having had 2 vaccinations (OR of 1.17, CI 95%: 1.03-1.81). Participants with a higher mean score of having a positive attitude towards Covid-19 vaccination were more likely to have received a vaccination (OR of 1.12, CI 95%: 1.08-1.17). Ethnicity was also an influential variable, people with non-Fars ethnicity were less likely to be vaccinated than those of Fars ethnicity (OR of 0.33, CI 95%: 0.13-0.81). People with higher-than-average monthly income were more likely to report vaccination than those with low monthly incomes (OR of 1.27, CI 95%: 1.09-1.8). Also, participants reporting less access to vaccination centers had a lower chance of reporting having been vaccinated than those who reported high access to vaccination centers (OR of .17, CI 95%: .08-.36). CONCLUSIONS Covid-19 vaccine uptake was found to be relatively high among people using illicit substances in this study. Higher levels of education, Fars ethnicity, higher income levels, having a positive attitude towards vaccination and access to vaccination centers were the most important predictors of Covid-19 vaccination in this study.
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Affiliation(s)
- Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Amadi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Rampisheh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Batool Tayefi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Soleimanvandiazar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, P.O Box: 14665-354, Tehran, 1449614535, Iran.
| | - Peter Higgs
- Department of Public Health, La Trobe University, Victoria, Australia
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Public Health, La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora, Melbourne, VIC, 3086, Australia
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Hajebi
- Research Center for Addiction and Risky Behaviors (ReCARB), Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Sociology and Anthropology, Nipissing University, North Bay, ON, Canada
| | - Gelavizh Karimijavan
- Department of Speech Therapy, Rehabilitation Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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Hedayatyaghoobi M, Azizmohammad Looha M, Shafiee A, Jafarabady K, Safari O, Alirezaei A, Bakhtiyari M. Association between opioid abuse and COVID-19 susceptibility: a propensity score matched study. BMC Infect Dis 2023; 23:851. [PMID: 38053042 DOI: 10.1186/s12879-023-08842-4] [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: 08/01/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) has been associated with adverse health outcomes, and its potential impact on COVID-19 outcomes is of significant concern. This study aimed to assess the susceptibility and clinical outcomes of hospitalized COVID-19 patients with OUD using a propensity score-matched design. METHODS A historical cohort study was conducted in Alborz province, Iran, during the early months of the COVID-19 pandemic. Patients aged 18 years and above with confirmed COVID-19 were included in the study. OUD was defined as a compulsive urge to use opioids or opioid-derivative drugs. Non-opioid abusers with COVID-19 were selected as the control group. Data on demographics, clinical characteristics, laboratory factors, comorbidities, and vital signs were collected. Propensity score matching (PSM) was used to balance the groups and assess the impact of OUD on ICU admission, mortality, the need for intubation, and the severity of pulmonary involvement on CT scans. RESULTS A total of 442 patients were included in the study, with 351 discharged and 34 deceased. The PSM analysis showed that OUD was not significantly associated with ICU admission (OR: 1.87, 95% CI: 0.22-2.91, p = 0.631). However, opium users had an increased risk of mortality (OR: 2.38, 95% CI: 1.30-4.35, p = 0.005) and a higher likelihood of requiring intubation (OR: 3.57, 95% CI: 1.38-9.39, p = 0.009) compared to non-opioid abusers. The severity of pulmonary involvement on CT scans did not show a significant association with OUD. CONCLUSION OUD among hospitalized COVID-19 patients was associated with an increased risk of mortality and the need for intubation. These findings highlight the importance of addressing OUD as a potential risk factor in the management and treatment of COVID-19 patients. Further research is warranted to explore the underlying mechanisms and develop appropriate interventions to mitigate the impact of OUD on COVID-19 outcomes.
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Affiliation(s)
| | - Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Shafiee
- Department of Psychiatry and Mental Health, Alborz University of Medical Sciences, Karaj, Iran
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Kyana Jafarabady
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Omid Safari
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Amirhesam Alirezaei
- Department of Nephrology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahmood Bakhtiyari
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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Leonhardt M, Bramness JG, Lien L. Incidence of SARS-CoV-2 and all-cause mortality in persons with co-occurring substance use disorder and mental illness during the pandemic: a Norwegian cohort study. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02599-6. [PMID: 38015236 DOI: 10.1007/s00127-023-02599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Most people were affected by the COVID-19 pandemic. Persons with co-occurring substance use disorder (SUD) and mental illness (MI) are already a marginalized group, with above average mortality. Thus, the study aim was to investigate SARS-CoV-2 incidence and mortality among persons with SUD/MI during the first two years of the pandemic. METHODS This historical cohort study merged data from the Norwegian Patient Register, the Norwegian Surveillance System for Communicable Diseases and census data from Statistics Norway. We calculated crude mortality rates for persons with SUD and mild/moderate vs. severe MI and compared them to persons with physical illnesses or healthy controls. The incidence rate ratios for SARS-CoV-2 infection and mortality were estimated using Poisson regression models. RESULTS Compared to healthy controls, the SARS-Cov-2-infection rate was marginally lower in persons with SUD and mild/moderate MI (IRR,1.19 [95%CI,1.09-1.30]) as in persons with physical illness (IRR,1.35 [95%CI, 1.23-1.47]), whereas persons with SUD and severe MI showed a lower rate compared to healthy controls. Crude mortality rates for persons with SUD/MI were substantially higher and increased much more during the pandemic than for persons with physical illnesses or healthy controls. The IRR for mortality in persons with SUD and mild/moderate MI was 10.61 (95%CI,7.19-15.67) and 11.44 (95%CI,7.50-17.45) for SUD and severe MI, compared to 5.03 (3.34-7.57]) for persons with physical illnesses only. CONCLUSION The analysis showed excess mortality during COVID-19-pandemic for SUD/MI, but without higher SARS-CoV-2 infection rates in this group. Consequently, excess mortality among persons with SUD/MI was not due to SARS-CoV-2 infection.
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Affiliation(s)
- Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway.
- Faculty of Health Studies, VID Specialized University, Oslo, Norway.
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Hassman H, Strafford S, Shinde SN, Heath A, Boyett B, Dobbins RL. Open-label, rapid initiation pilot study for extended-release buprenorphine subcutaneous injection. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:43-52. [PMID: 36001871 DOI: 10.1080/00952990.2022.2106574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Background: For patients with opioid use disorder, buprenorphine extended-release injection (BUP-XR) achieves sustained therapeutic plasma concentrations, controls craving and withdrawal symptoms, and improves patient outcomes. Given retention challenges during transmucosal buprenorphine (BUP-TM) induction, assessing methods to quickly achieve sustained buprenorphine concentrations is important.Objectives: This open-label, single-group, single-center pilot study (NCT03993392) evaluated safety and tolerability of initiating BUP-XR following a single BUP-TM 4 mg dose.Methods: Eligible participants abstained from short and long-acting opioids for 6 and 24 hours, respectively. If the Clinical Opiate Withdrawal Scale (COWS) was ≥8, BUP-TM 4 mg was administered. Participants not exhibiting hypersensitivity, precipitated opioid withdrawal (POW), or sedation symptoms within 1 hour received BUP-XR 300 mg (assessed as inpatients for 48 hours and outpatients to Day 29). Endpoints were COWS score increase ≥6, independent adjudication of POW, and opioid use.Results: Twenty-six participants (14 male) received BUP-TM, 24 received BUP-XR, and 20 completed the study. After injection, COWS scores decreased from pre-BUP-TM baseline of 14.6 ± 4.1 to 6.9 ± 4.1 at 6 hours and 4.2 ± 3.2 at 24 hours. Most participants (62.5%) experienced maximum COWS scores pre-BUP-XR; 2 experienced a COWS score increase ≥6, occurring at 1 and 2 hours post-BUP-XR. By adjudication, 2/24 participants experienced POW. Irritability, anxiety, nausea, and pain were the most frequent adverse events (AEs) with no serious AEs.Conclusions: Results support increased flexibility for initiating BUP-XR. Initiating BUP-XR 300 mg following a single BUP-TM 4 mg dose was well tolerated. Although some participants initially experienced withdrawal symptoms after injection, significant symptomatic improvement was observed in all participants within 24 hours.
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Bonnet U, Specka M, Roser P, Scherbaum N. Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review. J Neural Transm (Vienna) 2023; 130:7-18. [PMID: 36346483 PMCID: PMC9641691 DOI: 10.1007/s00702-022-02564-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
The interaction between cannabis use or addiction and SARS-COV-2 infection rates and COVID-19 outcomes is obscure. As of 08/01/2022 among 57 evaluated epidemiological/clinical studies found in Pubmed-database, most evidence for how cannabis use patterns were influenced by the pandemic was given by two systematic reviews and 17 prospective studies, mostly involving adolescents. In this age group, cannabis use patterns have not changed markedly. For adults, several cross-sectional studies reported mixed results with cannabis use having increased, decreased or remained unchanged. Two cross-sectional studies demonstrated that the severity of adults´ cannabis dependence was either increased as a consequence of increasing cannabis use during the pandemic or not changed. Regarding the effect of cannabis use on COVID-19 outcomes, we found only five retrospective/cross-sectional studies. Accordingly, (i) cannabis use did not impact mild COVID-19 symptoms; (ii) cannabis using individuals experienced more COVID-19-related hospitalizations; (iii) cannabis using veterans were associated with reduced SARS-COV-2 infection rates; (iv) frequent cannabis use was significantly associated with COVID-19 mortality, and (v) cannabis dependents were at higher risk of COVID-19 breakthrough after vaccination. It should be outlined that the validity of these retrospective/cross-sectional studies (all self-reports or register/e-health-records) is rather low. Future prospective studies on the effects of cannabis use on SARS-COV-2 infection rates and COVID-19 outcomes are clearly required for conclusive risk-benefit assessments of the role of cannabis on users' health during the pandemic. Moreover, substance dependence (including cannabis) is associated with (often untreated) somatic comorbidity, which severity is a proven key risk factor for worse COVID-19 outcomes.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital, University of Duisburg-Essen, Grutholzallee 21, 44577 Castrop-Rauxel, Germany ,Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Specka
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Patrik Roser
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
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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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Patel SR, Margolies PJ, Covell NH, Hinds M, Lopez LO, Jean-Noel P, Dixon LB. Behavioral Health Workforce Development in the era of COVID-19: Examples From a State-Funded Intermediary Organization. Community Ment Health J 2022; 58:1563-1570. [PMID: 35471752 PMCID: PMC9038991 DOI: 10.1007/s10597-022-00972-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 04/03/2022] [Indexed: 01/27/2023]
Abstract
Intermediary and purveyor organizations (IPOs) play a key role in disseminating and implementing behavioral health evidence-based practices. The COVID-19 pandemic created a time of crisis and disruption to behavioral health care delivery. Using the conceptual framework of basic, targeted, and intensive technical assistance (TA) from the Training and Technology Transfer Centers, case studies are used to describe how programs at The Center for Practice Innovations a state funded-intermediary organization, adapted its training and technical assistance to be delivered entirely remotely, to include content related to COVID-19 and to provide guidance on telehealth-based behavioral health care.
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Affiliation(s)
- Sapana R Patel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. .,Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA. .,Associate Professor of Clinical Medical Psychology (In Psychiatry), Director of Strategic Planning and Curriculum Development, Center for Practice Innovations, Division of Behavioral Health Services and Policy Research, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA.
| | - Paul J Margolies
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Nancy H Covell
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Melissa Hinds
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Luis O Lopez
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Pascale Jean-Noel
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
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A COVID-19 Survey among People Who Use Drugs in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127002. [PMID: 35742252 PMCID: PMC9222643 DOI: 10.3390/ijerph19127002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
Background: to combat the COVID-19 pandemic, adherence to COVID-19 recommendations and vaccination against COVID-19 have been important. Among people who use drugs (PWUD), little is known regarding compliance towards COVID-19 recommendations, COVID-19 testing, or attitudes towards COVID-19 vaccination. We aimed to examine these issues in a sample of PWUD. Methods: a cross-sectional study was conducted between January and March 2021. Through users’ organizations and different low-threshold services for substance users, we recruited former drug users and professionals to include participants and perform the interviews. Participants completed an interviewer-administered questionnaire. Any person above 16 years of age who used substances were recruited. Results: 477 Norwegian PWUD participated in the study. The mean age was 43.8 (SD 12.8) years and 77% were males. Thirty-four percent had injected drugs the past four weeks. Alcohol (41%) and cannabis (41%) were the most common drugs used the past four weeks, followed by tranquilizers (37%), central stimulants (35%) and opioids (30%). The majority (90%) had washed their hands frequently, used alcohol sanitizer during the past two weeks, had used face masks, kept one-meter distance to other people and stayed at home if feeling unwell. Fifty-four percent had been COVID-19 tested. More than half the sample (58%) had positive attitudes to COVID-19 vaccination, while 26% were fairly or very unlikely to accept vaccination. Those older (OR = 0.96, 95% CI 0.94; 0.98) and using face masks (OR = 0.49, 95% CI 0.30; 0.79) were more likely to have positive attitudes towards vaccination, while those reporting low life-satisfaction (OR = 3.86, 95% CI 1.43; 10.40), using opioids (OR = 2.97, 95% CI 1.43; 6.18) or almost never staying at home when feeling unwell (OR = 2.76, 95% 1.39; 5.45) expressed more negative attitudes towards vaccination. Conclusion: there was generally a high compliance towards COVID-19 recommendations, but one quarter of the sample was sceptical towards COVID-19 vaccination. This indicates a need for targeted and tailored information and well-designed vaccination roll-out programs to reach all PWUD.
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COVID-19 Impact on Australian Patients with Substance Use Disorders: Emergency Department Admissions in Western Sydney before Vaccine Roll Out. Vaccines (Basel) 2022; 10:vaccines10060889. [PMID: 35746497 PMCID: PMC9230773 DOI: 10.3390/vaccines10060889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background: In this study, we determined the impact of the COVID-19 pandemic on Western Sydney patients with substance use disorders (SUD) by comparing emergency department (ED) admission rates before and after the onset of the COVID-19 pandemic and before the rollout of COVID-19 vaccination. Methods: ED admission data for patients with SUD were retrieved from the local electronic medical record (eMR) on the hospital central database. ED data collected from 25 January to 25 July 2019 (before the COVID-19 pandemic) were compared with data from 25 January to 25 July 2020 (early pandemic). ED admission reasons were categorised based on the presenting complaints and ED diagnoses. Results: Despite an overall reduction in ED admissions during the early pandemic, compared to the pre-pandemic period, admissions for patients with SUD increased significantly (1.7% to 3.4%, p < 0.01). ED admission rates related to infection (0.05% to 0.12%, p < 0.01), local infection (0.02% to 0.05%, p < 0.01), trauma (0.06% to 0.12%, p < 0.01), alcohol (0.01% to 0.03%, p < 0.05), and other issues (0.06% to 0.10%, p < 0.05) increased significantly among Indigenous patients with SUD. ED admission rates related to drugs (0.12% to 0.39%, p < 0.01), infection (0.21% to 0.34%, p < 0.01), local infection (0.07% to 0.18%, p < 0.01), gastrointestinal (0.15% to 0.23%, p < 0.05), trauma (0.14% to 0.25%, p < 0.01), alcohol (0.36% to 0.74%, p < 0.01), and ‘other’ issues (0.47% to 0.91%, p < 0.01) increased significantly among non-Indigenous patients with SUD. Four cases of COVID-19 were reported among these patients. Conclusions: There was an increase in ED admissions for patients with SUD in the initial six months of the COVID-19 pandemic (before vaccine rollout), mainly for drugs, systemic infection, local infection, trauma, and alcohol-related reasons. Now that most people in New South Wales have been vaccinated against COVID-19, a further study is needed to quantify the effect of the pandemic on patients with SUD in the post-vaccine era.
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Rosato V, Nevola R, Conturso V, Perillo P, Mastrocinque D, Pappalardo A, Le Pera T, Del Vecchio F, Claar E. Telemedicine Improves HCV Elimination among Italian People Who Use Drugs: An Innovative Therapeutic Model to Increase the Adherence to Treatment into Addiction Care Centers Evaluated before and during the COVID-19 Pandemic. BIOLOGY 2022; 11:800. [PMID: 35741321 PMCID: PMC9219716 DOI: 10.3390/biology11060800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
People who use drugs (PWUDs) are generally considered "hard-to-treat" patients, due to adherence to HCV antiviral therapy or re-infection concerns. Linkage-to-care still remains a significant gap for HCV elimination, worsened by the COVID-19 pandemic. To reduce time-to-treat and improve treatment adherence, we have developed a patient-tailored model-of-care, decentralized within the addiction center and supervised remotely by hepatologists. From January 2017 to December 2020, patients were enrolled in one addiction care center in Southern Italy, where a complete hepatologic assessment, including blood chemistry, ultrasound, and transient elastography examination, was provided. DAAs treatment has been adapted on clinical features, also performing a daily administration during an outpatient visit, and monitored remotely by specialists via telemedicine interactions. Adherence was evaluated on the accomplishment of therapy or on the percentage of attended visits. From a total of 690 PWUDs, 135 had an active HCV infection and were enrolled in the study. All patients started the treatment within 3 weeks after HCV diagnosis. Six drop-outs were recorded, obtaining a sustained virological response at week 12 (SVR12) in 98.5% of PWUDs. There were only two cases of treatment failure, one of which is re-infection. No differences were found between the SVR12 rates before and during the COVID-19 pandemic. We obtained a high SVR12 rate, providing a comprehensive assessment within the addiction care center, tailoring the drug administration with a hepatologic remote stewardship. Our therapeutic model should improve the time-to-treat and treatment adherence in PWUDs.
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Affiliation(s)
- Valerio Rosato
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (R.N.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Riccardo Nevola
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (R.N.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Vincenza Conturso
- DS32 (Distretto Sanitario N. 32), Ser.D. Unit, ASL Napoli 1 Centro, 80147 Naples, Italy; (V.C.); (T.L.P.); (F.D.V.)
| | - Pasquale Perillo
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (R.N.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Davide Mastrocinque
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (R.N.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Annalisa Pappalardo
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (R.N.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Teresa Le Pera
- DS32 (Distretto Sanitario N. 32), Ser.D. Unit, ASL Napoli 1 Centro, 80147 Naples, Italy; (V.C.); (T.L.P.); (F.D.V.)
| | - Ferdinando Del Vecchio
- DS32 (Distretto Sanitario N. 32), Ser.D. Unit, ASL Napoli 1 Centro, 80147 Naples, Italy; (V.C.); (T.L.P.); (F.D.V.)
| | - Ernesto Claar
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (R.N.); (P.P.); (D.M.); (A.P.); (E.C.)
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Zeverdegani SK. Influence of COVID-19 Pandemic on the Psychological Condition and Mental Health of Different Types of Population: A Narrative Review. Int J Prev Med 2022; 13:71. [PMID: 35706876 PMCID: PMC9188900 DOI: 10.4103/ijpvm.ijpvm_301_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
One of the most important occupational and environmental pollutants are biological agents such as various types of viruses. Recently the 2019-nCoV causes lower respiratory tract disease, called novel coronavirus pneumonia that in addition to causes physical disorders, can lead to mental health problems. This study looks at some of the articles that deal with psychological problems caused by the coronavirus pandemic in different groups of people. For this purpose, a review of the published literature was performed in some databases (PubMed, Google Scholar, Elsevier) and related references were used.
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Affiliation(s)
- Sara Karimi Zeverdegani
- Department of Occupational Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Sara Karimi Zeverdegani, Department of Occupational Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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13
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Behnoush AH, Bazmi E, Forouzesh M, Behnoush B. Risk of COVID-19 infection and the associated hospitalization, ICU admission and mortality in opioid use disorder: a systematic review and meta-analysis. Addict Sci Clin Pract 2022; 17:68. [PMID: 36451181 PMCID: PMC9709364 DOI: 10.1186/s13722-022-00349-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Opioid use disorder (OUD) as a common drug use disorder can affect public health issues, including the COVID-19 pandemic, in which patients with OUD may have higher risk of infection and severe disease. This systematic review and meta-analysis was conducted to investigate the risk of COVID-19 and the associated hospitalization, intensive care unit (ICU) admission, and mortality in patients with OUD. MATERIALS AND METHODS A comprehensive systematic search was performed on PubMed, Scopus, Embase, and Web of Science to find studies which compared the infection rate and outcomes of COVID-19 in OUD patients in comparison with the normal population. A random effects meta-analysis model was developed to estimate odd ratios (OR) and 95% confidence interval (CI) between the outcomes of COVID-19 and OUD. RESULTS Out of 2647 articles identified through the systematic search, eight were included in the systematic review and five in the meta-analysis. Among 73,345,758 participants with a mean age of 57.90 ± 13.4 years, 45.67% were male. The findings suggested no significant statistical relationship between COVID-19 infection and OUD (OR (95% CI): 1.18 (0.47-2.96), p-value: 0.73). Additionally, patients with OUD had higher rate of hospitalization (OR (95% CI) 5.98 (5.02-7.13), p-value<0.01), ICU admission (OR (95% CI): 3.47 (2.24-5.39), p-value<0.01), and mortality by COVID-19) OR (95% CI): 1.52(1.27-1.82), pvalue< 0.01). CONCLUSION The present findings suggested that OUD is a major risk factor for mortality and the need for hospitalization and ICU admission in patients with COVID-19. It is recommended that policymakers and healthcare providers adopt targeted methods to prevent and manage clinical outcomes and decrease the burden of COVID-19, especially in specific populations such as OUD patients.
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Affiliation(s)
- Amir Hossein Behnoush
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Bazmi
- grid.508126.80000 0004 9128 0270Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Mehdi Forouzesh
- grid.508126.80000 0004 9128 0270Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Behnam Behnoush
- grid.411705.60000 0001 0166 0922Department of Forensic Medicine and Toxicology, Tehran University of Medical Sciences, Tehran, Iran
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14
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Nyamathi AM, Gelberg L, Lee D, Arce N, Patten-Jones A, Yadav K, Goodwine M, Alikhani M, Yao M, Chang AH, Salem BE. Perceptions of Homeless Adults and Their Providers on Coping With the Impact of COVID-19 Pandemic on Mental Health, Substance Use, and Harm Reduction Services. Glob Qual Nurs Res 2022; 9:23333936221108712. [PMID: 35912133 PMCID: PMC9335488 DOI: 10.1177/23333936221108712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Adults experiencing homelessness experience a disproportionate burden of health disparities which has further exacerbated mental health, substance use, and coping during the COVID-19 pandemic. As limited data is available to understand the experience of adults experiencing homelessness and their health during this time, the purpose of this study was to explore how COVID-19 may have impacted their mental health, substance use, and ways of coping in this population. Using community-based participatory research, a community advisory board was established and remote individual interviews with 21 adults experiencing homelessness and 10 providers were conducted in Skid Row, Los Angeles. Using a qualitative, data analytic approach, the following major themes emerged: (1) Negative Impact of COVID-19 on Mental Health; (2) Negative Impact of COVID-19 on Limitation of Harm Reduction Services; and (3) Coping Strategies Utilized During the COVID-19 Pandemic. More research is needed to understand the impact of this pandemic on underserved communities.
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Affiliation(s)
| | - Lillian Gelberg
- David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Darlene Lee
- University of California, Irvine, California, USA
| | | | | | - Kartik Yadav
- University of California, Irvine, California, USA
| | | | | | - Maritas Yao
- University of California, Los Angeles, California, USA
| | - Alicia H Chang
- Los Angeles County Department of Public Health, California, USA
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15
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Jamali Z, Emamian MH, Hashemi H, Fotouhi A. The Association of Opioid Use Disorder and COVID-19, a Longitudinal Study. Int J Prev Med 2022; 13:157. [PMID: 36910999 PMCID: PMC9999101 DOI: 10.4103/ijpvm.ijpvm_68_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/15/2022] [Indexed: 03/14/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) quickly spread to the world, causing a pandemic. While some studies have found no link between opioid use disorder (OUD) and COVID-19, the role of opioid on COVID-19 is challenging. The present study aimed to determine the relationship between OUD and COVID-19. Methods This was a prospective cohort study. We used data from the third phase of the Shahroud Eye Cohort Study on 4394 participants which started in September 2019 and ended before the COVID-19 epidemic in Shahroud in February 2020. The participants were followed for about 13 months till March 26, 2021. COVID-19 was detected by RT-PCR on swap samples from the oropharynx and nasopharynx. The incidence of COVID-19 compared in OUD and non-OUD participants, and relative risk was calculated in log-binomial regression models. Results Among the 4394 participants with a mean age of 61.1 years, 120 people had OUD. The incidence of COVID-19 in participants with OUD and non-OUD was 4.17% and 6.22%, respectively (P-value: 0356). The relative risk of OUD for COVID-19 was 0.60 (95% confidence intervals: 0.25-1.44; P value: 0.251). Conclusions OUD was not associated with COVID-19. The claim that people with OUD are less likely to develop COVID-19 is not supported by these data.
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Affiliation(s)
- Zhaleh Jamali
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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16
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Arshonsky J, Krawczyk N, Bunting AM, Frank D, Friedman SR, Bragg MA. Informal coping strategies among people who use opioids during COVID-19: A thematic analysis of Reddit forums. JMIR Form Res 2021; 6:e32871. [PMID: 35084345 PMCID: PMC8896559 DOI: 10.2196/32871] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/18/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use. OBJECTIVE This qualitative study aimed to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic. METHODS We extracted data from two major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5, 2020 to May 13, 2020 that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed. RESULTS Of the 300 subreddit posts, 100 discussed at least one type of informal coping strategy. Those strategies included: psychological and behavioral coping skills, adopting healthy habits, and using substances to manage withdrawal symptoms. Twelve subreddit posts explicitly mentioned using social distancing as an opportunity for cessation or reduction of opioid use. CONCLUSIONS Reddit discussion forums provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance related harms.
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Affiliation(s)
- Josh Arshonsky
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave., New York, US
| | - Noa Krawczyk
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave., New York, US
| | - Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave., New York, US
| | - David Frank
- Behavioral Science Training Program in Drug Abuse Research, New York University, New York City, US
| | - Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave., New York, US
| | - Marie A Bragg
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave., New York, US
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17
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Exploring the Potential of Implementing Managed Alcohol Programmes to Reduce Risk of COVID-19 Infection and Transmission, and Wider Harms, for People Experiencing Alcohol Dependency and Homelessness in Scotland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312523. [PMID: 34886249 PMCID: PMC8657286 DOI: 10.3390/ijerph182312523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023]
Abstract
People who experience homelessness and alcohol dependency are more vulnerable than the general population to risks/harms relating to COVID-19. This mixed methods study explored stakeholder perspectives concerning the impact of COVID-19 and the potential utility of introducing managed alcohol programmes (MAPs) in Scotland as part of a wider health/social care response for this group. Data sources included: 12 case record reviews; 40 semi-structured qualitative interviews; and meeting notes from a practitioner-researcher group exploring implementation of MAPs within a third sector/not-for-profit organisation. A series of paintings were curated as a novel part of the research process to support knowledge translation. The case note review highlighted the complexity of health problems experienced, in addition to alcohol dependency, including polysubstance use, challenges related to alcohol access/use during lockdown, and complying with stay-at-home rules. Qualitative analysis generated five subthemes under the theme of ‘MAPs as a response to COVID-19′: changes to alcohol supply/use including polysubstance use; COVID-19-related changes to substance use/homelessness services; negative changes to services for people with alcohol problems; the potential for MAPs in the context of COVID-19; and fears and concerns about providing MAPs as a COVID-19 response. We conclude that MAPs have the potential to reduce a range of harms for this group, including COVID-19-related harms.
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18
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Mohammadi Z, Eghtesad S, Hashemi-Shahri SM, Tabatabaei SM, Sharafkhah M, Poustchi H. The Seroprevalence of COVID-19 in Intravenous Drug Users in Comparison to Non-drug Users. Middle East J Dig Dis 2021; 13:67-70. [PMID: 34712441 PMCID: PMC8531943 DOI: 10.34172/mejdd.2021.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND COVID-19 infection has led to a worldwide pandemic, and new cases are on the rise. Intravenous drug users (IVDU) are presumably at a higher risk of being infected since they have poor personal hygiene, live in groups, and have risky behaviors. The current study aimed to evaluate the seroprevalence of COVID-19 in IVDU in comparison with non-drug users (N-DU). METHODS This cross-sectional study was conducted on 167 IVDU and 134 N-DU. A questionnaire gathering data on demographics, comorbidities, and use of personal protective equipment was administered to all participants. In addition, 5 cc of blood was taken from each individual to test for SARS-CoV-2 specific antibodies (Pishtaz Teb SARS-Cov-2 ELISA kits). RESULTS The mean age of N-DU and IVDU were 38.9 ± 12.9 and 40.38 ± 10.24 years, respectively. COVID-19 seroprevalence in IVDU was 9.7%, and 4.8% in N-DU, but this finding was not statistically significant (p = 0.096). CONCLUSION While the seroprevalence of COVID-19 was not significantly different among the two groups, IVDU should still be considered by policymakers as a high-risk group due to their lifestyle and risky behaviors. Providing personal protective equipment and other means of protection and treatment to this population can help mitigate the spread of and mortality from COVID-19.
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Affiliation(s)
- Zahra Mohammadi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Eghtesad
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Maryam Sharafkhah
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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19
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Martin A, Raber JP, Shayer D, Lai D, Goodcoff A, Kannikal J, Raja AS, He S. Get waivered remote: Nationwide, remote DEA-x waiver course in response to COVID-19. Digit Health 2021; 7:20552076211048985. [PMID: 34691756 PMCID: PMC8529309 DOI: 10.1177/20552076211048985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Problem As of 2020, less than 5% of physicians in the United States have a drug
enforcement administration-X waiver to prescribe buprenorphine. The
coronavirus-2019 pandemic restricted in-person gatherings, including
traditional drug enforcement administration-X waiver courses. As a result,
in-person conferences have needed to adopt remote formats. Many programs
identified a gap between educational delivery and the faculty skills
required to deliver content remotely. Approach To address the need for high-quality remote learning, Get Waivered designed
and implemented a novel experience for clinicians, called Get Waivered
Remote. An educational session was live-streamed via Zoom™. To foster
interactivity, like in-person didactic conferences, participants were polled
to facilitate discussion among presenters, learners, and facilitators during
the broadcast Outcomes The RE-AIM framework was used for evaluation. Our program had a
Reach encompassing 814 users that participated during
the live-streamed event; Effectiveness with 73.79%
reporting being somewhat familiar or very familiar with the practice of
opioid dependency treatment with approved buprenorphine medications;
Adoption with 95.15% reporting a favorable experience
and 92.23% reporting it was similar or more enjoyable than their usual
teaching; Implementation with 450 messages sent by 281
users to engage with presenters and other learners via Zoom chat in real
time. Next steps Get Waivered Remote provides a proof-of-concept that a broadcast with a
concurrent, interactive remote learning platform is feasible, low cost, and
simple to execute. Further study is required to assess the ability of our
group to maintain this innovation and also to measure its impact on the
treatment of opioid use disorder.
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Affiliation(s)
- Alister Martin
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua P Raber
- Dr Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | - Deborah Lai
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Adam Goodcoff
- Department of Emergency Medicine, University of Illinois - Chicago, Chicago, IL, USA
| | | | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Shuhan He
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.,Digital Growth Strategy, Strategic Alliance Initiative, Center for Innovation in Digital HealthCare, Massachusetts General Hospital, Boston, MA, USA
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Sowmya AV, Javadekar A, Menon P, Saldanha D. Impact of COVID-19 pandemic on persons with psychiatric disorders. Ind Psychiatry J 2021; 30:S288-S290. [PMID: 34908712 PMCID: PMC8611553 DOI: 10.4103/0972-6748.328832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/28/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
From the beginning of COVID-19 pandemic, concerns have been raised about its effect on mental health and on patients with psychiatric illnesses. A few reports suggest that patients with COVID-19 have increased symptoms of anxiety disorders, post-traumatic stress disorder, depression, increased substance use, and insomnia. There is an increased trend seen in flare-up of psychotic symptoms and new emergence of psychotic symptoms in previously healthy adults. There is extensive research available on the impact of COVID-19 on physical health, but there is a paucity of studies on the effects of COVID-19 on psychiatric illness.
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Affiliation(s)
- A V Sowmya
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Archana Javadekar
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Preethi Menon
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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Galarneau LR, Hilburt J, O’Neill ZR, Buxton JA, Scheuermeyer FX, Dong K, Kaczorowski J, Orkin AM, Barbic SP, Bath M, Moe J, Miles I, Tobin D, Grier S, Garrod E, Kestler A. Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study. PLoS One 2021; 16:e0255396. [PMID: 34324589 PMCID: PMC8320992 DOI: 10.1371/journal.pone.0255396] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022] Open
Abstract
AIM To capture pandemic experiences of people with opioid use disorder (OUD) to better inform the programs that serve them. DESIGN We designed, conducted, and analyzed semi-structured qualitative interviews using grounded theory. We conducted interviews until theme saturation was reached and we iteratively developed a codebook of emerging themes. Individuals with lived experience of substance use provided feedback at all steps of the study. SETTING We conducted phone or in-person interviews in compliance with physical distancing and public health regulations in outdoor Vancouver parks or well-ventilated indoor spaces between June to September 2020. PARTICIPANTS Using purposive sampling, we recruited participants (n = 19) who were individuals with OUD enrolled in an intensive community outreach program, had visited one of two emergency departments, were over 18, lived within catchment, and were not already receiving opioid agonist therapy. MEASUREMENTS We audio-recorded interviews, which were later transcribed verbatim and checked for accuracy while removing all identifiers. Interviews explored participants' knowledge of COVID-19 and related safety measures, changes to drug use and healthcare services, and community impacts of COVID-19. RESULTS One third of participants were women, approximately two thirds had stable housing, and ages ranged between 23 and 59 years old. Participants were knowledgeable on COVID-19 public health measures. Some participants noted that fear decreased social connection and reluctance to help reverse overdoses; others expressed pride in community cohesion during crisis. Several participants mentioned decreased access to housing, harm reduction, and medical care services. Several participants reported using drugs alone more frequently, consuming different or fewer drugs because of supply shortages, or using more drugs to replace lost activities. CONCLUSION COVID-19 had profound effects on the social lives, access to services, and risk-taking behaviour of people with opioid use disorder. Pandemic public health measures must include risk mitigation strategies to maintain access to critical opioid-related services.
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Affiliation(s)
- Lexis R. Galarneau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail: (LG); (AK)
| | - Jesse Hilburt
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Zoe R. O’Neill
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Jane A. Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Frank X. Scheuermeyer
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montréal, and Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Aaron M. Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Skye Pamela Barbic
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Misty Bath
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Jessica Moe
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columba, Canada
| | - Isabelle Miles
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Dianne Tobin
- Vancouver Area Network of Drug Users, Vancouver, British Columbia, Canada
| | - Sherry Grier
- Portland Hotel Society Community Services Society, Vancouver, British Columbia, Canada
| | - Emma Garrod
- Providence Health Care, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- * E-mail: (LG); (AK)
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Van Hout MC, Haddad P, Aaraj E. The Impact of COVID-19 on Drug Use and Harm Reduction Programming in the Middle East and North Africa (MENA) Region: a Regional Consultation of Stakeholders and People Who Use Drugs. Int J Ment Health Addict 2021; 20:2072-2085. [PMID: 34276260 PMCID: PMC8276543 DOI: 10.1007/s11469-021-00500-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/24/2022] Open
Abstract
The Middle East and North Africa (MENA) region has witnessed a slow but steady increase in the harm reduction response since 2016. It is likely that such gains are threatened by the impact of COVID-19. Very little is known about the health response and situation of people who use drugs (PWUD) during the pandemic in the region. A mixed method study was conducted by the MENA Harm Reduction Association (MENAHRA) to assess the situation of PWUD and impacts on harm reduction services during COVID-19. Twelve countries and two regional viewpoints responded to the survey. A virtual focus group was held with the MENA Network of People who Use Drugs (MENANPUD) focal points (n = 11). The study highlights how COVID-19 aggravated existing marginalization and stigmatization of PWUD and other key populations in the MENA region, with government level resourcing severely impacted by COVID-19. It further illustrates the commitment by harm reduction non-governmental organizations (NGOs) in diversifying their response, particularly through mobile outreach to drug hot spots, and the reliance of technology to support awareness raising, telemedicine, and medicine supplies. Positive shifts are observed in harm reduction policy by governments in some MENA countries and the continued commitment to support PWUD communities by existing harm reduction NGOs. Continued advocacy for and implementation of harm reduction responses at the domestic and regional levels should be underpinned by inclusion in state health emergency planning and disease control efforts, awareness raising around innovation and telemedicine to support health and NGO support systems and medicine supply chains, resourcing of NGOs, and provision of economic support for PWUD, disease surveillance, and research.
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Affiliation(s)
| | - Patricia Haddad
- Middle East and North African Harm Reduction Association (MENAHRA), Beirut, Lebanon
| | - Elie Aaraj
- Middle East and North African Harm Reduction Association (MENAHRA), Beirut, Lebanon
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Abstract
PURPOSE OF REVIEW Opioid use is prevalent in the United Kingdom and prior to the COVID-19 pandemic it had been recognized that the safety of opioids was an important issue to be monitored by the UK medicines regulatory agency. With the emergence of COVID-19, this requirement has been even greater. This review was undertaken to determine the impact of the pandemic on safety and surveillance of opioids in the United Kingdom. RECENT FINDINGS During the COVID-19 pandemic, the surveillance of opioids in the United Kingdom continued, although primary research was often conducted with data prior to the pandemic. Of those studies that were conducted while the pandemic was ongoing, access to opioids (or opioid substitution therapy) and the subsequent effect on patient safety was the main theme. SUMMARY In the United Kingdom, changes in accessibility to the healthcare system and how healthcare providers operated during the COVID-19 pandemic may have had unintended consequences on use and safety of opioids, due to the shift in focus to preventing COVID-19 from overwhelming the healthcare system. The findings from this review support the need to continue surveillance in the United Kingdom, including the impact of the COVID-19 pandemic on opioid utilization and safety.
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Affiliation(s)
- Vicki Osborne
- Drug Safety Research Unit, Southampton
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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McDowell MJ, Fry CE, Nisavic M, Grossman M, Masaki C, Sorg E, Bird S, Smith F, Beach SR. Evaluating the association between COVID-19 and psychiatric presentations, suicidal ideation in an emergency department. PLoS One 2021; 16:e0253805. [PMID: 34191850 PMCID: PMC8244888 DOI: 10.1371/journal.pone.0253805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/13/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To estimate the association between COVID-19 and Emergency Department (ED) psychiatric presentations, including suicidal ideation. METHODS Using an interrupted time series design, we analyzed psychiatric presentations using electronic health record data in an academic medical center ED between 2018 and 2020. We used regression models to assess the association between the onset of the COVID-19 outbreak and certain psychiatric presentations. The period February 26-March 6, 2020 was used to define patterns in psychiatric presentations before and after the coronavirus outbreak. RESULTS We found a 36.2% decrease (unadjusted) in ED psychiatric consults following the coronavirus outbreak, as compared to the previous year. After accounting for underlying trends, our results estimate significant differential change associated with suicidal ideation and substance use disorder (SUD) presentations following the outbreak. Specifically, we noted a significant differential increase in presentations with suicidal ideation six weeks after the outbreak (36.4 percentage points change; 95% CI: 5.3, 67.6). For presentations with SUD, we found a differential increase in the COVID-19 time series relative to the comparison time series at all post-outbreak time points and this differential increase was significant three weeks (32.8 percentage points; 95% CI: 4.0, 61.6) following the outbreak. Our results estimate no differential changes significant at the P value < 0.05 level associated with affective disorder or psychotic disorder presentations in the COVID-19 time series relative to the comparator time series. CONCLUSIONS The COVID-19 outbreak in Boston was associated with significant differential increases in ED presentations with suicidal ideation and SUD.
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Affiliation(s)
- Michal J. McDowell
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- McLean Hospital, Belmont, MA, United States of America
| | - Carrie E. Fry
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Mladen Nisavic
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Mila Grossman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- McLean Hospital, Belmont, MA, United States of America
| | - Charles Masaki
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- McLean Hospital, Belmont, MA, United States of America
| | - Emily Sorg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Suzanne Bird
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Felicia Smith
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Scott R. Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
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Is the Right to Abortion at Risk in Times of COVID-19? The Italian State of Affairs within the European Context. Medicina (B Aires) 2021; 57:medicina57060615. [PMID: 34204759 PMCID: PMC8231552 DOI: 10.3390/medicina57060615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 01/07/2023] Open
Abstract
The COVID-19 health emergency has thrown the health systems of most European countries into a deep crisis, forcing them to call off and postpone all interventions deemed not essential or life-saving in order to focus most resources on the treatment of COVID-19 patients. To facilitate women who are experiencing difficulties in terminating their pregnancies in Italy, the Ministry of Health has adapted to the regulations in force in most European countries and issued new guidelines that allow medical abortion up to 63 days, i.e., 9 weeks of gestational age, without mandatory hospitalization. This decision was met with some controversy, based on the assumption that the abortion pill could "incentivize" women to resort to abortion more easily. In fact, statistical data show that in countries that have been using medical abortion for some time, the number of abortions has not increased. The authors expect that even in Italy, as is the case in other European countries, the use of telemedicine is likely to gradually increase as a safe and valuable option in the third phase of the health emergency. The authors argue that there is a need to favor pharmacological abortion by setting up adequately equipped counseling centers, as is the case in other European countries, limiting hospitalization to only a few particularly complex cases.
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Parkes T, Carver H, Masterton W, Falzon D, Dumbrell J, Grant S, Wilson I. "You know, we can change the services to suit the circumstances of what is happening in the world": a rapid case study of the COVID-19 response across city centre homelessness and health services in Edinburgh, Scotland. Harm Reduct J 2021; 18:64. [PMID: 34118942 PMCID: PMC8197599 DOI: 10.1186/s12954-021-00508-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/01/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated unprecedented changes in the way that health, social, and housing services are delivered to individuals experiencing homelessness and problem substance use. Protecting those at high risk of infection/transmission, whilst addressing the multiple health and social needs of this group, is of utmost importance. This study aimed to document the impact of the COVID-19 pandemic on individuals who were experiencing homelessness in one city centre in Scotland, and how services adapted in response. METHODS Semi-structured interviews were conducted with individuals with lived/living experience of homelessness (n = 10), staff within onethird sector service (n = 5), and external professionals (n = 5), during April-August 2020, using a rapid case study design. These were audio-recorded, fully transcribed, and analysed using Framework. Analysis was informed by inclusion health and equity-orientated approaches to meeting the needs of people with multiple and complex needs, and emerging literature on providing harm reduction in the context of COVID-19. RESULTS Those with lived/living experience of homelessness and problem substance use faced a range of additional challenges during the pandemic. Mental health and use of substances were affected, influenced by social isolation and access to services. A range of supports were provided which flexed over the lockdown period, including housing, health and social care, substance use treatment, and harm reduction. As well as documenting the additional risks encountered, findings describe COVID-19 as a 'path-breaking' event that created opportunities to get evidence into action, increase partnership working and communication, to proactively address risks. CONCLUSIONS This rapid case study has described the significant impact of the COVID-19 pandemic on a group of people experiencing homelessness and problem substance use within one city centre in Scotland and provides a unique lens on service/professional responses. It concludes with lessons that can inform the international and ongoing response to this pandemic. It is vital to recognise the vision and leadership that has adapted organisational responses in order to reduce harms. We must learn from such successes that were motivated both by compassion and care for those vulnerable to harms and the desire to provide high-quality, evidence-based, harm reduction services.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK.
| | - Hannah Carver
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Wendy Masterton
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Danilo Falzon
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Joshua Dumbrell
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK.,The Salvation Army, Homelessness Services Unit, Edinburgh, Scotland, UK
| | - Susan Grant
- The Salvation Army, Homelessness Services Unit, Edinburgh, Scotland, UK
| | - Iain Wilson
- The Salvation Army, Homelessness Services Unit, Edinburgh, Scotland, UK
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Kelly JD, Bravata DM, Bent S, Wray CM, Leonard SJ, Boscardin WJ, Myers LJ, Keyhani S. Association of Social and Behavioral Risk Factors With Mortality Among US Veterans With COVID-19. JAMA Netw Open 2021; 4:e2113031. [PMID: 34106264 PMCID: PMC8190626 DOI: 10.1001/jamanetworkopen.2021.13031] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE The US Department of Veterans Affairs (VA) offers programs that reduce barriers to care for veterans and those with housing instability, poverty, and substance use disorder. In this setting, however, the role that social and behavioral risk factors play in COVID-19 outcomes is unclear. OBJECTIVE To examine whether social and behavioral risk factors were associated with mortality among US veterans with COVID-19 and whether this association might be modified by race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained data from the VA Corporate Data Warehouse to form a cohort of veterans who received a positive COVID-19 test result between March 2 and September 30, 2020, in a VA health care facility. All veterans who met the inclusion criteria were eligible to participate in the study, and participants were followed up for 30 days after the first SARS-CoV-2 or COVID-19 diagnosis. The final follow-up date was October 31, 2020. EXPOSURES Social risk factors included housing problems and financial hardship. Behavioral risk factors included current tobacco use, alcohol use, and substance use. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality in the 30-day period after the SARS-CoV-2 or COVID-19 diagnosis date. Multivariable logistic regression was used to estimate odds ratios, clustering for health care facilities and adjusting for age, sex, race, ethnicity, marital status, clinical factors, and month of COVID-19 diagnosis. RESULTS Among 27 640 veterans with COVID-19 who were included in the analysis, 24 496 were men (88.6%) and the mean (SD) age was 57.2 (16.6) years. A total of 3090 veterans (11.2%) had housing problems, 4450 (16.1%) had financial hardship, 5358 (19.4%) used alcohol, and 3569 (12.9%) reported substance use. Hospitalization occurred in 7663 veterans (27.7%), and 1230 veterans (4.5%) died. Housing problems (adjusted odds ratio [AOR], 0.96; 95% CI, 0.77-1.19; P = .70), financial hardship (AOR, 1.13; 95% CI, 0.97-1.31; P = .11), alcohol use (AOR, 0.82; 95% CI, 0.68-1.01; P = .06), current tobacco use (AOR, 0.85; 95% CI, 0.68-1.06; P = .14), and substance use (AOR, 0.90; 95% CI, 0.71-1.15; P = .41) were not associated with higher mortality. Interaction analyses by race/ethnicity did not find associations between mortality and social and behavioral risk factors. CONCLUSIONS AND RELEVANCE Results of this study showed that, in an integrated health system such as the VA, social and behavioral risk factors were not associated with mortality from COVID-19. Further research is needed to substantiate the potential of an integrated health system to be a model of support services for households with COVID-19 and populations who are at risk for the disease.
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Affiliation(s)
- J. Daniel Kelly
- San Francisco VA Medical Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Dawn M. Bravata
- US Department of Veterans Affairs, Health Services and Development, Center for Health Information and Communication, Indianapolis, Indiana
- Department of Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
- Veterans Affairs Medical Center, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis
- Regenstrief Institute, Indianapolis, Indiana
| | - Stephen Bent
- San Francisco VA Medical Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Charlie M. Wray
- San Francisco VA Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Samuel J. Leonard
- Department of Medicine, University of California, San Francisco, San Francisco
| | - W. John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Laura J. Myers
- US Department of Veterans Affairs, Health Services and Development, Center for Health Information and Communication, Indianapolis, Indiana
| | - Salomeh Keyhani
- San Francisco VA Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco
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28
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Radfar SR, De Jong CAJ, Farhoudian A, Ebrahimi M, Rafei P, Vahidi M, Yunesian M, Kouimtsidis C, Arunogiri S, Massah O, Deylamizadeh A, Brady KT, Busse A, Potenza MN, Ekhtiari H, Baldacchino AM. Reorganization of Substance Use Treatment and Harm Reduction Services During the COVID-19 Pandemic: A Global Survey. Front Psychiatry 2021; 12:639393. [PMID: 34025471 PMCID: PMC8135096 DOI: 10.3389/fpsyt.2021.639393] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/27/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health responses were categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups. Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. Fifty-seven percent of overdose prevention interventions and 81% of outreach services were also negatively impacted. Conclusions: Participants reported that SUD treatment and harm-reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we highlight several issues and complications resulting from the pandemic concerning people with SUDs that should be tackled more efficiently during the future waves or similar pandemics. The issues and potential strategies comprise the following: (1) helping policymakers to generate business continuity plans, (2) maintaining the use of evidence-based interventions for people with SUDs, (3) being prepared for adequate medication supplies, (4) integrating harm reduction programs with other treatment modalities, and (5) having specific considerations for vulnerable groups such as immigrants and refugees.
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Affiliation(s)
- Seyed Ramin Radfar
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
- Integrated Substance Abuse Programs Department, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ebrahimi
- Materials and Energy Research Center, Tehran, Iran
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Rafei
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Mehrnoosh Vahidi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Christos Kouimtsidis
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | | | - Omid Massah
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | | | - Anja Busse
- Staff Member of Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, Division for Operations, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Marc N. Potenza
- Connecticut Council on Problem Gambling and Connecticut Mental Health Center, Yale School of Medicine, New Haven, CT, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, OK, United States
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Spechler PA, Stewart JL, Kuplicki R, Paulus MP. COVID-19 vaccine willingness and cannabis use histories. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.26.21256109. [PMID: 33948603 PMCID: PMC8095213 DOI: 10.1101/2021.04.26.21256109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Cannabis use is associated with problematic health-behaviors such as excessive alcohol and tobacco use, and sedentary behavior. Here, we examined the association between cannabis use history and an especially topical health-behavior, willingness to receive a COVID-19 vaccine. Methods COVID-19 vaccine willingness was surveyed in a subset of participants from the Tulsa 1000 Study, which is a longitudinal study of psychiatric treatment-seeking and healthy control participants. We identified 45 participants who completed a COVID-19 vaccine questionnaire and reported more than 10 lifetime cannabis uses. Those participants were compared to a group of 45 individuals with very light (<10) cannabis use histories who were propensity score-matched on age, sex, income, and race. Two-group t-tests and Bayes factor analysis on vaccine willingness were conducted between groups. Exploratory correlation analyses were conducted on vaccine willingness and lifetime cannabis use levels within the cannabis group only. Results Vaccine willingness did not differ between the two groups (t88=0.33, p=.74; BF01=4.3). However, a negative correlation was identified within the cannabis group, such that higher lifetime cannabis use histories correlated with less willingness to receive a vaccine (rho43= -.33, p=.03). Conclusions Although vaccine willingness did not differ between the two matched groups, preliminary evidence suggests that heavy lifetime cannabis use might indicate a reluctance to engage in health-promoting behaviors like receiving a COVID-19 vaccine.
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Affiliation(s)
- Philip A. Spechler
- Laureate Institute for Brain Research. 6655 S Yale Ave. Tulsa, Oklahoma, 74136. United States
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research. 6655 S Yale Ave. Tulsa, Oklahoma, 74136. United States
- University of Tulsa. Tulsa, Oklahoma. United States
| | - Rayus Kuplicki
- Laureate Institute for Brain Research. 6655 S Yale Ave. Tulsa, Oklahoma, 74136. United States
| | | | - Martin P. Paulus
- Laureate Institute for Brain Research. 6655 S Yale Ave. Tulsa, Oklahoma, 74136. United States
- University of Tulsa. Tulsa, Oklahoma. United States
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Kim HK, Carvalho AF, Gratzer D, Wong AHC, Gutzin S, Husain MI, Mulsant BH, Stergiopoulos V, Daskalakis ZJ. The Impact of COVID-19 on Psychiatric Emergency and Inpatient Services in the First Month of the Pandemic in a Large Urban Mental Health Hospital in Ontario, Canada. Front Psychiatry 2021; 12:563906. [PMID: 33967842 PMCID: PMC8102788 DOI: 10.3389/fpsyt.2021.563906] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/30/2021] [Indexed: 12/24/2022] Open
Abstract
The World Health Organization characterized COVID-19 (coronavirus disease 2019) as a pandemic on March 11, 2020 (WHO). Within a couple of days, all Canadian provinces announced the implementation of social distancing measures. We evaluated the immediate effect of COVID-19 on psychiatric emergency and inpatient services in Canada's largest psychiatric hospital in the first month of the pandemic. We extracted data from the electronic medical records of the Center for Addiction and Mental Health in Toronto, Canada. We compared emergency department visits, inpatient occupancy rates, and length of stay in March 2019 and March 2020, and during the first and second half of March 2020. There was a decrease in the number of emergency department visits and inpatient occupancy rates in March 2020 compared to March 2019. There was also a significant decrease in the number of emergency department visits and inpatient occupancy rates in the second half of March 2020 compared to the first half. Our findings suggest that the pandemic was followed by a rapid decrease in the usage of psychiatric emergency and inpatient services in a large mental health hospital. Future studies will need to assess whether this decrease will be followed by a return to baseline or an increase in need for these services.
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Affiliation(s)
- Helena K. Kim
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andre F. Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - David Gratzer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Albert H. C. Wong
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Shayla Gutzin
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - M. Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Zafiris J. Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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31
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Tay Wee Teck J, Baldacchino A, Gibson L, Lafferty C. Using Microdosing to Induct Patients Into a Long-Acting Injectable Buprenorphine Depot Medication in Low Threshold Community Settings: A Case Study. Front Pharmacol 2021; 12:631784. [PMID: 33833682 PMCID: PMC8021866 DOI: 10.3389/fphar.2021.631784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/02/2021] [Indexed: 12/24/2022] Open
Abstract
Healthcare innovation has never been more important as it is now when the world is facing up to the unprecedented challenges brought by the COVID-19 pandemic. Within addictions services in Scotland, the priority has been to tackle our rising drug related death rate by maintaining and improving access to treatment while protecting frontline workers and managing operational challenges as a result of the pandemic. We present here a case study of five patients with opioid use disorder whose treatment represents a confluence of three important Medication Assisted Treatment (MAT) service innovations. The first was a low threshold drop in and outreach MAT service to rapidly and safely initiate opiate replacement therapy (ORT). The second was the provision of a microdosing regimen to enable same day induction to oral buprenorphine while minimizing the risk of precipitated opioid withdrawals and/or treatment disengagement. The third was rapid transitioning to an injectable long-acting buprenorphine depot which reduced unnecessary face to face patient contact and treatment non-adherence. This case study of five patients highlights the valuable role that buprenorphine microdosing can play in making induction to long-acting buprenorphine depot feasible to a broader range of patients, including those on a high dose methadone treatment regime.
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Affiliation(s)
- Joseph Tay Wee Teck
- School of Medicine, Population and Behavioural Science Division, University of St Andrews, St Andrews, United Kingdom
- Harm Reduction Team, NHS Lothian, Edinburgh, United Kingdom
| | - Alexander Baldacchino
- School of Medicine, Population and Behavioural Science Division, University of St Andrews, St Andrews, United Kingdom
- NHS Fife Addiction Services, Cameron Hospital, Fife, United Kingdom
| | - Lauren Gibson
- NHS Fife Addiction Services, Cameron Hospital, Fife, United Kingdom
| | - Con Lafferty
- NHS Fife Addiction Services, Cameron Hospital, Fife, United Kingdom
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32
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Parkes T, Carver H, Masterton W, Falzon D, Dumbrell J, Grant S, Wilson I. 'They already operated like it was a crisis, because it always has been a crisis': a qualitative exploration of the response of one homeless service in Scotland to the COVID-19 pandemic. Harm Reduct J 2021; 18:26. [PMID: 33658042 PMCID: PMC7927775 DOI: 10.1186/s12954-021-00472-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/11/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated unprecedented changes in the way that services are delivered to individuals experiencing homelessness and problem substance use. Protecting those at high risk of infection/transmission, whilst addressing the multiple health and social needs of this group, is of utmost importance. The aim of this novel qualitative study was to document how one service in Scotland, the Wellbeing Centre run by The Salvation Army, adapted in response. METHODS Care was taken to identify methods that did not create additional stress at this pressured time. Semi-structured interviews were conducted with Centre clients (n = 10, in-person and telephone) and staff (n = 5, telephone), and external professionals (n = 5, telephone), during April-August 2020. These were audio-recorded, fully transcribed, and analysed using Framework. Service documents were used to enhance contextual understanding. Analysis was informed by theories of psychologically informed environments and enabling environments. RESULTS The start of the pandemic was a time of confusion, disruption, and isolation. Centre staff rapidly adapted methods of engagement to provide a range of comprehensive physical and emotional supports, to both existing and new clients, through telephone and online communication and, eventually, socially distanced in-person support. This involved balancing the risks of COVID-19 infection/transmission with the benefits of continuity of support to those highly vulnerable to a range of harms. Whilst the pandemic created many challenges, it also facilitated removal of barriers, particularly concerning provision of harm reduction services which had previously been severely constrained. Clients described the Centre as a 'lifeline', providing stability and safety during a period of profound disruption when other services closed their doors. Strong leadership, intensive team working, support/training for staff, a focus on relationships, and active use of client feedback, enabled responsive adaptation to fast-changing demands and the creation of a 'culture of care'. CONCLUSION This study provides a unique insight into the pandemic by analysing the response of one homeless service during the height of the pandemic. We present a range of implications that have international relevance for those designing policies, and adapting front-line services, to proactively respond to COVID-19 and the continued public health crises of homelessness and drug-related deaths.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Hannah Carver
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Wendy Masterton
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Danilo Falzon
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Josh Dumbrell
- Salvation Army Centre for Addictions Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland
- The Salvation Army, Homelessness Services Unit, Edinburgh, Scotland
| | - Susan Grant
- The Salvation Army, Homelessness Services Unit, Edinburgh, Scotland
| | - Iain Wilson
- The Salvation Army, Homelessness Services Unit, Edinburgh, Scotland
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Bhatia G, Chatterjee B, Dhawan A. Adolescents, Drugs, and COVID-19: Special Challenges During the Pandemic. Indian J Psychol Med 2021; 43:95-99. [PMID: 34376882 PMCID: PMC8313445 DOI: 10.1177/0253717621988998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Gayatri Bhatia
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Biswadip Chatterjee
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Anju Dhawan
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Margolies PJ, Covell NH, Patel SR. Applying Implementation Drivers to Scale-up Evidence-Based Practices in New York State. ACTA ACUST UNITED AC 2021; 1:53-64. [PMID: 34622210 PMCID: PMC7775828 DOI: 10.1007/s43477-020-00002-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
Abstract
Mental health authorities in several states, often working with academic partners, have played important roles in disseminating evidence-based practices (EBPs) for adults diagnosed with serious mental illness. This work has been facilitated by intermediary organizations that work directly with providers to implement EBPs. This report uses two case studies to describe how the Center for Practice Innovations (CPI), an intermediary organization, has used the Active Implementation Research Network’s nine implementation drivers to successfully implement EBPs across the large state of New York. One case study focuses on supported employment and the second on integrated treatment for co-occurring mental health and substance use conditions. We provide these case studies to illustrate how intermediary organizations can use implementation science to organize and select effective support strategies to disseminate and implement a range of EBPs within a state system.
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Affiliation(s)
- Paul J Margolies
- Columbia University Vagelos College of Physicians and Surgeons, Center for Practice Innovations, New York State Psychiatric Institute, New York, NY USA
| | - Nancy H Covell
- Columbia University Vagelos College of Physicians and Surgeons, Center for Practice Innovations, New York State Psychiatric Institute, New York, NY USA
| | - Sapana R Patel
- Columbia University Vagelos College of Physicians and Surgeons, Center for Practice Innovations, New York State Psychiatric Institute, New York, NY USA
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Scherbaum N, Bonnet U, Hafermann H, Schifano F, Bender S, Grigoleit T, Kuhn J, Nyhuis P, Preuss UW, Reymann G, Schneider U, Shibata J, Specka M. Availability of Illegal Drugs During the COVID-19 Pandemic in Western Germany. Front Psychiatry 2021; 12:648273. [PMID: 33967857 PMCID: PMC8102785 DOI: 10.3389/fpsyt.2021.648273] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/04/2021] [Indexed: 12/11/2022] Open
Abstract
Background: In response to the COVID-19-pandemic, a lockdown was established in the middle of March 2020 by the German Federal Government resulting in drastic reduction of private and professional traveling in and out of Germany with a reduction of social contacts in public areas. Research Questions: We seek evidence on whether the lockdown has led to a reduced availability of illegal drugs and whether subjects with substance-related problems tried to cope with possible drug availability issues by increasingly obtaining drugs via the internet, replacing their preferred illegal drug with novel psychoactive substances, including new synthetic opioids (NSO), and/or by seeking drug treatment. Methods: A questionnaire was anonymously filled in by subjects with substance-related disorders, typically attending low-threshold settings, drug consumption facilities, and inpatient detoxification wards from a range of locations in the Western part of Germany. Participants had to both identify their main drug of abuse and to answer questions regarding its availability, price, quality, and routes of acquisition. Results: Data were obtained from 362 participants. The most frequent main substances of abuse were cannabis (n = 109), heroin (n = 103), and cocaine (n = 75). A minority of participants reported decreased availability (8.4%), increased price (14.4%), or decreased quality (28.3%) of their main drug. About 81% reported no change in their drug consumption due to the COVID-19 pandemic and the lockdown. A shift to the use of novel psychoactive substances including NSO were reported only by single subjects. Only 1-2% of the participants obtained their main drug via the web. Discussion: Present findings may suggest that recent pandemic-related imposed restrictions may have not been able to substantially influence either acquisition or consumption of drugs within the context of polydrug users (including opiates) attending a range of addiction services in Germany.
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Affiliation(s)
- Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Udo Bonnet
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Evangelisches Krankenhaus Castrop-Rauxel, Castrop-Rauxel, Germany
| | - Henning Hafermann
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabrizio Schifano
- Psychopharmacology, Substance Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, United Kingdom
| | - Stefan Bender
- Klinik für Psychiatrie und Psychotherapie, LWL-Klinik Marsberg, Marsberg, Germany
| | - Torsten Grigoleit
- Abteilung für Abhängigkeitserkrankungen, LVR-Klinik Langenfeld, Langenfeld, Germany
| | - Jens Kuhn
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Johanniter Krankenhaus Oberhausen, Oberhausen, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Peter Nyhuis
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, St. Marien Hospital Eickel, Herne, Germany
| | - Ulrich W Preuss
- Vitos-Klinik für Psychiatrie und Psychotherapie, Herborn, Germany
| | | | - Udo Schneider
- Medizinisches Zentrum für Seelische Gesundheit, Krankenhaus Lübbecke-Rahden, Lübbecke, Germany
| | - Jo Shibata
- Substitution Outpatient Clinic, Health Department of the City of Cologne, Cologne, Germany
| | - Michael Specka
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
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36
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Kyaw Hla Z, Ramalho R, Teunissen L, Cuykx I, Decorte P, Pabian S, Van Royen K, De Backer C, Gerritsen S. Socioeconomic and Environmental Factors Associated With Increased Alcohol Purchase and Consumption in 38 Countries During the Covid-19 Pandemic. Front Psychiatry 2021; 12:802037. [PMID: 35095616 PMCID: PMC8795628 DOI: 10.3389/fpsyt.2021.802037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS To explore changes in alcohol purchase and consumption during the first few months of the Covid-19 pandemic, and assess associations between increased alcohol purchase/use and socioeconomic and environmental factors. DESIGN Secondary data from a cross-sectional online survey conducted from 17 April to 25 June 2020. SETTING Thirty-eight countries from all continents of the world. PARTICIPANTS A total of 37,206 adults (mean age:36.7, SD:14.8, 77% female) reporting alcohol purchasing and drinking habit before and during the pandemic. MEASUREMENTS Changes in alcohol stock-up and frequency of alcohol use during the pandemic and increased alcohol stock-up and use were stratified by gender, age, education, household structure, working status, income loss, psychological distress, and country based on alcohol consumption per capita. The associations between increased alcohol stock-up/use and living with children, working from home, income loss and distress were examined using multivariate logistic regression, controlling for demographic factors. FINDINGS The majority of respondents reported no change in their alcohol purchasing and drinking habits during the early pandemic period. Increased drinking was reported by 20.2% of respondents, while 17.6% reported decreased alcohol use. More than half (53.3%) of respondents experienced psychological distress, with one in five (20.7%) having severe distress. Female gender, being aged under 50, higher educational attainment, living with children, working from home, and psychological distress were all independently associated with increased alcohol drinking during lockdown. Limitations of the study were the non-representative sample, the data collection early in the pandemic, and the non-standard measurement of alcohol consumption. CONCLUSION Increased psychological distress among people during the early pandemic period, resulted in increased alcohol consumption, especially among women with children working from home during lockdown.
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Affiliation(s)
- Zaheer Kyaw Hla
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rodrigo Ramalho
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Lauranna Teunissen
- Department of Communication Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Isabelle Cuykx
- Department of Communication Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Paulien Decorte
- Department of Communication Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Sara Pabian
- Department of Communication Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium.,Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Kathleen Van Royen
- Department of Communication Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium.,Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Charlotte De Backer
- Department of Communication Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Sarah Gerritsen
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
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Farhoudian A, Radfar SR, Mohaddes Ardabili H, Rafei P, Ebrahimi M, Khojasteh Zonoozi A, De Jong CAJ, Vahidi M, Yunesian M, Kouimtsidis C, Arunogiri S, Hansen H, Brady KT, Potenza MN, Baldacchino AM, Ekhtiari H. A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic. Front Psychiatry 2021; 12:646206. [PMID: 34421664 PMCID: PMC8377291 DOI: 10.3389/fpsyt.2021.646206] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background and Aims: COVID-19 has infected more than 77 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing, and "lockdown" measures have affected drug and alcohol supply chains and subsequently their availability, price, and use patterns, with possible downstream effects on presentations of SUDs and demand for treatment. Given the lack of multicentric epidemiologic studies, we conducted a rapid global survey within the International Society of Addiction Medicine (ISAM) network in order to understand the status of substance-use patterns during the current pandemic. Design: Cross-sectional survey. Setting: Worldwide. Participants: Starting on April 4, 2020 during a 5-week period, the survey received 185 responses from 77 countries. Measurements: To assess addiction medicine professionals' perceived changes in drug and alcohol supply, price, use pattern, and related complications during the COVID-19 pandemic. Findings: Participants reported (among who answered "decreased" or "increased") a decrease in drug supply (69.0%) and at the same time an increase in price (95.3%) globally. With respect to changes in use patterns, an increase in alcohol (71.7%), cannabis (63.0%), prescription opioids (70.9%), and sedative/hypnotics (84.6%) use was reported, while the use of amphetamines (59.7%), cocaine (67.5%), and opiates (58.2%) was reported to decrease overall. Conclusions: The global report on changes in the availability, use patterns, and complications of alcohol and drugs during the COVID-19 pandemic should be considered in making new policies and in developing mitigating measures and guidelines during the current pandemic (and probable future ones) in order to minimize risks to people with SUD.
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Affiliation(s)
- Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ramin Radfar
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran.,Integrated Substance Abuse Programs Department, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hossein Mohaddes Ardabili
- Psychiatry and Behavioral Sciences Research Center, Faculty of Medicine, Ibn-e-Sina Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parnian Rafei
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ebrahimi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Khojasteh Zonoozi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehrnoosh Vahidi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Christos Kouimtsidis
- Surrey and Borders Partnership National Health Service Foundation Trust, Leatherhead, United Kingdom
| | | | - Helena Hansen
- Departments of Anthropology and Psychiatry, New York University, New York, NY, United States
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | | | - Marc N Potenza
- Yale School of Medicine, Connecticut Council on Problem Gambling and Connecticut Mental Health Center, New Haven, CT, United States
| | - Alexander Mario Baldacchino
- Division of Population and Behavior Sciences, Medical School, University of St Andrews, St Andrews, United Kingdom
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, OK, United States
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Althobaiti YS, Alzahrani MA, Alsharif NA, Alrobaie NS, Alsaab HO, Uddin MN. The Possible Relationship between the Abuse of Tobacco, Opioid, or Alcohol with COVID-19. Healthcare (Basel) 2020; 9:healthcare9010002. [PMID: 33375144 PMCID: PMC7822153 DOI: 10.3390/healthcare9010002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction: Substance use disorder has been frequently reported to increase the risk of infectious diseases, which might be owing to the sharing of contaminated inhalation, smoking, vaping, or injection equipment. Aim: This review analyzes the recent literature with the aim to put in light the possible relationship between the abuse of different substances (Tobacco, opioid, and Alcohol) with coronavirus disease (COVID-19). Tobacco: Multiple studies confirmed that cigarette smoking affects the respiratory system by increasing the expression of angiotensin-converting enzyme-2 (ACE2) receptors, which have a significant association with COVID-19 infection rate and disease severity. Opioid: Studies conducted regarding the association of opioid use disorder (OUD) and COVID-19 infection severity are limited; however, opioids can lead to both respiratory depression and kidney injuries, causing poor prognosis for those with COVID-19 infections. Alcohol: People with alcohol use disorders are at risk of developing acute lung injury and severe COVID-19 infection. Alcohol consumption during the COVID-19 pandemic has two possible scenarios: either increased or decreased based on situations. Conclusion: SUD has been frequently reported to have a positive relationship with COVID-19 severity Further studies are needed to understand the effects of opioids and alcohol abuse on COVID-19.
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Affiliation(s)
- Yusuf S. Althobaiti
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
- Department of Pharmacology and Toxicology, Health Science Campus, College of Pharmacy, Taif University, Taif 21974, Saudi Arabia
- General Directorate of Narcotics Control, General Administration for Precursors and Laboratories, Ministry of Interior, Riyadh 11134, Saudi Arabia
- Correspondence: ; Tel.: +966-545-736-200
| | - Maram A. Alzahrani
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
| | - Norah A. Alsharif
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
| | - Nawal S. Alrobaie
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
| | - Hashem O. Alsaab
- Department of Pharmaceutics and Pharmaceutical Technology, Taif University, Taif 21944, Saudi Arabia;
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Yazdi K, Fuchs-Leitner I, Rosenleitner J, Gerstgrasser NW. Impact of the COVID-19 Pandemic on Patients With Alcohol Use Disorder and Associated Risk Factors for Relapse. Front Psychiatry 2020; 11:620612. [PMID: 33391060 PMCID: PMC7772314 DOI: 10.3389/fpsyt.2020.620612] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background: The impact of the ongoing COVID-19 pandemic on vulnerable groups like patients suffering from substance use disorders is expected to be tremendous, and corresponding concerns were raised early on by many experts around the world. Psychosocial distress, financial insecurities and physiological problems associated with the COVID-19 crisis could be especially challenging for this group of patients. Methods: In the current study data was collected from a clinical sample of patients with alcohol use disorder (AUD; N = 127) during the initial stage of the pandemic. The impact of various COVID-19 related factors (physiological, psychosocial, economic and others) on patients' personal life was evaluated. Alcohol consumption, craving, and potential posttraumatic stress disorder (PTSD) symptoms were assessed using different scales and their associations were analyzed. Furthermore, differences regarding these variables between comparably sized groups of patients who remained abstinent (N = 37), relapsed (N = 41), or reported unaltered drinking behavior (consuming subgroup, N = 49) were investigated. The impact of sociodemographic and COVID-19 factors on relapse (in comparison to abstinence) was evaluated using binary logistic regression analysis. Results: Our results confirmed the expected positive associations between alcohol consumption, craving, and PTSD symptoms, respectively, among patients with AUD. Furthermore, group differences indicate significantly lower levels on all three scales for abstinent patients. Although generally low PTSD scores were observed, 8% of our participants were found to be at risk of PTSD. Results of a binary logistic regression analysis indicated the presence of psychosocial COVID-19 factors (e.g., isolation, anxiety, and depression) as well as living alone as two major risk factors for relapse. Discussion: Our findings based on actual patient data support the anticipated negative consequences of the pandemic on persons with AUD. Crucially, our results regarding relapse emphasized psychosocial COVID-19 factors and isolation as especially challenging circumstances for persons with AUD, whereas economic and physiological health aspects seemed of minor impact on relapse. Our results reflect the initial stage of the pandemic, whereas long-term developments should be closely monitored.
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Affiliation(s)
- Kurosch Yazdi
- Department of Psychiatry - Specialization Addiction Medicine, Kepler University Hospital, Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Isabella Fuchs-Leitner
- Department of Psychiatry - Specialization Addiction Medicine, Kepler University Hospital, Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Jan Rosenleitner
- Department of Psychiatry - Specialization Addiction Medicine, Kepler University Hospital, Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Nikolas W. Gerstgrasser
- Department of Psychiatry - Specialization Addiction Medicine, Kepler University Hospital, Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
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40
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Wilkinson R, Hines L, Holland A, Mandal S, Phipps E. Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID-19 response. Harm Reduct J 2020; 17:95. [PMID: 33261636 PMCID: PMC7705852 DOI: 10.1186/s12954-020-00445-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND People who inject drugs are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. METHODS A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic-type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. RESULTS In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly; for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. CONCLUSIONS This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.
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Affiliation(s)
- Rebecca Wilkinson
- Rebecca Wilkinson, Public Health Registrar, School of Primary Care, Population Sciences and Medical Education, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - Lindsey Hines
- Lindsey Hines, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Holland
- Adam Holland Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sema Mandal
- Sema Mandal Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
| | - Emily Phipps
- Emily Phipps Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
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41
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Haghighi-Morad M, Alavi Darazam I, Bahrami-Moltagh H, Amerifar M, Zamani N, Hassanian-Moghaddam H. Atypical presentation of COVID-19; an observational retrospective study. BMC Infect Dis 2020; 20:870. [PMID: 33225911 PMCID: PMC7681183 DOI: 10.1186/s12879-020-05617-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND COVID-19 infection may present with atypical signs and symptoms and false negative polymerase chain reaction (PCR) tests predisposing healthy people and health care workers to infection. The aim of the current study is to evaluate the features of atypical presentations in COVID-19 infection in a referral center in Tehran, Iran. METHODS Hospital database of inpatients admitted to Loghman Hakim hospital between February 20th and May 11th, 2020 was reviewed and all patients with final diagnosis of COVID-19 infection were evaluated for their presenting symptoms. Patients with chief complaints of "fever", "dyspnea", and/or "cough" as typical presentations of COVID-19 were excluded and those with other clinical presentations were included. RESULTS Nineteen patients were included with a mean age of 51 ± 19 years, of whom, 17 were males (89%). Median [IQR] Glasgow coma scale (GCS) was 14 [13, 15]. Almost 10 had referred with chief complaint of methanol poisoning and overdose on substances of abuse. Only 8 cases (42%) had positive COVID-19 test. Nine (47%) needed invasive mechanical ventilation, of whom, two had positive COVID-19 test results (p = ns). Eight patients (42%) died with three of them having positive PCRs. CONCLUSIONS In patients referring to emergency departments with chief complaint of poisoning (especially poisonings that can result in dyspnea including substances of abuse and toxic alcohols), gastrointestinal, and constitutional respiratory symptoms, attention should be given not to miss possible cases of COVID-19.
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Affiliation(s)
- Maryam Haghighi-Morad
- Department of Radiology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Department of Infectious Disease and Tropical Medicine, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hooman Bahrami-Moltagh
- Department of Radiology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Amerifar
- Department of Radiology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Avenue, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Avenue, Tehran, Iran.
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42
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Coughlin LN, Bonar EE, Bickel WK. Considerations for remote delivery of behavioral economic interventions for substance use disorder during COVID-19 and beyond. J Subst Abuse Treat 2020; 120:108150. [PMID: 33298296 PMCID: PMC7532990 DOI: 10.1016/j.jsat.2020.108150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/10/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
The response to the COVID-19 crisis has created direct pressure on health care providers to deliver virtual care, and has created the opportunity to develop innovations in remote treatment for people with substance use disorders. Remote treatments provide an intervention delivery framework that capitalizes on technological innovations in remote monitoring of behaviors and can efficiently use information collected from people and their environment to provide personalized treatments as needed. Interventions informed by behavioral economic theories can help to harness the largely untapped potential of virtual care in substance use treatment. Behavioral economic treatments, such as contingency management, the substance-free activity session, and episodic future thinking, are positioned to leverage remote monitoring of substance use and to use personalized medicine frameworks to deliver remote interventions in the COVID-19 era and beyond. With increased remote care, there is an opportunity for virtual treatment development. Treatments can capitalize on remote technology to increase effectiveness. Behavioral economic interventions are well positioned to fill this need. Remote behavioral economic interventions can add to current treatments.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, United States of America.
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, United States of America; Injury Prevention Center, University of Michigan, United States of America
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech, United States of America
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43
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Afifi RA, Novak N, Gilbert PA, Pauly B, Abdulrahim S, Rashid SF, Ortega F, Ferrand RA. 'Most at risk' for COVID19? The imperative to expand the definition from biological to social factors for equity. Prev Med 2020; 139:106229. [PMID: 32763263 PMCID: PMC7831462 DOI: 10.1016/j.ypmed.2020.106229] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/10/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022]
Abstract
First recognized in December 2019, the Coronavirus Disease 2019 (COVID19) was declared a global pandemic by the World Health Organization on March 11, 2020. To date, the most utilized definition of 'most at risk' for COVID19 morbidity and mortality has focused on biological susceptibility to the virus. This paper argues that this dominant biomedical definition has neglected the 'fundamental social causes' of disease, constraining the effectiveness of prevention and mitigation measures; and exacerbating COVID19 morbidity and mortality for population groups living in marginalizing circumstances. It is clear - even at this early stage of the pandemic - that inequitable social conditions lead to both more infections and worse outcomes. Expanding the definition of 'most at risk' to include social factors is critical to implementing equitable interventions and saving lives. Prioritizing populations with social conditions is necessary for more effective control of the epidemic in its next phase; and should become standard in the planning for, and prevention and mitigation of all health conditions. Reversing disparities and health inequities is only possible through an expansion of our 'most-at-risk' definition to also include social factors.
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Affiliation(s)
- Rima A Afifi
- University of Iowa College of Public Health, Department of Community and Behavioral Health, 145 N Riverside Drive, Iowa City, IA 52242, USA.
| | - Nicole Novak
- University of Iowa College of Public Health, Department of Community and Behavioral Health, 145 N Riverside Drive, Iowa City, IA 52242, USA.
| | - Paul A Gilbert
- University of Iowa College of Public Health, Department of Community and Behavioral Health, 145 N Riverside Drive, Iowa City, IA 52242, USA.
| | - Bernadette Pauly
- University of Victoria School of Nursing, Victoria, British Columbia, Canada.
| | - Sawsan Abdulrahim
- American University of Beirut, Faculty of Health Sciences, Department of Health Promotion and Community Health, Beirut, Lebanon.
| | - Sabina Faiz Rashid
- BRAC University, James P Grant School of Public Health, Dhaka, Bangladesh.
| | - Fernando Ortega
- Universidad San Francisco de Quito, College of Health Sciences, Quito, Ecuador.
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44
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COVID-19 and Children with Special Healthcare Needs: Recommendations for Helping Parents and Caregivers of Young Children. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2020. [DOI: 10.5812/pedinfect.107357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Alavi M, Moghanibashi-Mansourieh A, Radfar SR, Alizadeh S, Bahramabadian F, Esmizade S, Dore GJ, Sedeh FB, Deilamizade A. Coordination, cooperation, and creativity within harm reduction networks in Iran: COVID-19 prevention and control among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 93:102908. [PMID: 32819776 PMCID: PMC7430297 DOI: 10.1016/j.drugpo.2020.102908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
Abstract
An unprecedented public health crisis confronts the world. Iran is among the hardest-hit countries, where effects of the COVID-19 pandemic are stretched across society and felt by the most marginalised people. Among people who use drugs, a comprehensive response to the crisis calls for broad collaboration, coordination, and creativity involving multiple government and non-government organisations. This commentary provides early insights into an unfolding experience, demonstrating the operational and policy impact of an initiative, bringing together a diverse array of harm reduction stakeholders to address the pandemic. In the context of lived experiences of social and economic marginalization, this initiative intends to lead efforts in developing an equitable response to the COVID-19 pandemic.
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Affiliation(s)
- Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Moghanibashi-Mansourieh
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Kodakyar Ave., Daneshjo Blvd., Evin, Tehran 19857-13834, Iran.
| | - Seyed Ramin Radfar
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | | | - Sara Esmizade
- Faculty of Social Sciences, University of Tehran, Tehran, Iran
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Farid Barati Sedeh
- Center for Prevention and Treatment of Addiction, State Welfare Organization, Tehran, Iran
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46
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Zastepa E, Sun JC, Clune J, Mathew N. Adaptation of contingency management for stimulant use disorder during the COVID-19 pandemic. J Subst Abuse Treat 2020; 118:108102. [PMID: 32854983 PMCID: PMC7417964 DOI: 10.1016/j.jsat.2020.108102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 12/24/2022]
Abstract
The current coronavirus disease (COVID-19) pandemic has rapidly spread across the world. Individuals with stimulant use disorder are a vulnerable population, who are particularly at risk of negative outcomes during this pandemic due to several risk factors, including mental and physical comorbidities, weakened immune responses, high-risk behaviors, and barriers to healthcare access. Engaging patients with stimulant use disorder in regular treatment has become even more difficult during this pandemic, which has resulted in many cuts to addiction treatment programs. The most effective treatment options for stimulant use disorder are psychosocial interventions, which rely heavily on in-person interactions, posing an added challenge during physical distancing. In particular, contingency management (CM) is a behavioral therapy that utilizes tangible reinforcements to incentivize targeted behavior changes, and is an effective treatment intervention used for stimulant use disorder. This paper highlights the treatment challenges for individuals with stimulant use disorder and the importance of adapting CM programs during COVID-19. We present strategies for how CM can be adapted and its role expanded in a safe way during the COVID-19 pandemic to help prevent infection spread, stimulant use relapse, and worsened psychosocial consequences. Stimulant users face increased risk of relapse and infection during a pandemic. Contingency management is an effective treatment for stimulant use disorder. Contingency management can be adapted to mitigate negative outcomes of COVID-19.
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Affiliation(s)
- Evelyn Zastepa
- Faculty of Medicine, University of British Columbia, Department of Psychiatry, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada.
| | - Jane C Sun
- Provincial Health Services Authority, British Columbia Mental Health and Substance Use Services, 4949 Heather St, Vancouver, BC V5Z 3L7, Canada.
| | - Jennifer Clune
- Faculty of Medicine, University of British Columbia, Department of Psychiatry, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada.
| | - Nickie Mathew
- Faculty of Medicine, University of British Columbia, Department of Psychiatry, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada; Burnaby Centre for Mental Health and Addiction, 3405 Willingdon Ave, Burnaby, BC V5G 3H4, Canada.
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47
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Jemberie WB, Stewart Williams J, Eriksson M, Grönlund AS, Ng N, Blom Nilsson M, Padyab M, Priest KC, Sandlund M, Snellman F, McCarty D, Lundgren LM. Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions. Front Psychiatry 2020; 11:714. [PMID: 32848907 PMCID: PMC7396653 DOI: 10.3389/fpsyt.2020.00714] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022] Open
Abstract
COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.
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Affiliation(s)
- Wossenseged Birhane Jemberie
- Department of Social Work, Umeå University, Umeå, Sweden
- Centre for Demography and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
- The Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH), Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jennifer Stewart Williams
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Malin Eriksson
- Department of Social Work, Umeå University, Umeå, Sweden
| | | | - Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Mojgan Padyab
- Department of Social Work, Umeå University, Umeå, Sweden
- Centre for Demography and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
| | - Kelsey Caroline Priest
- MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Mikael Sandlund
- Psychiatry Unit, Department of Clinical Science, Umeå University, Umeå, Sweden
| | | | - Dennis McCarty
- Oregon Health & Science University- Portland State University, School of Public Health, Portland, OR, United States
| | - Lena M. Lundgren
- Department of Social Work, Umeå University, Umeå, Sweden
- Cross-National Behavioral Health Laboratory, Graduate School of Social Work, University of Denver, Denver, CO, United States
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48
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Wei Y, Shah R. Substance Use Disorder in the COVID-19 Pandemic: A Systematic Review of Vulnerabilities and Complications. Pharmaceuticals (Basel) 2020; 13:E155. [PMID: 32708495 PMCID: PMC7407364 DOI: 10.3390/ph13070155] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/18/2023] Open
Abstract
As the world endures the coronavirus disease 2019 (COVID-19) pandemic, the conditions of 35 million vulnerable individuals struggling with substance use disorders (SUDs) worldwide have not received sufficient attention for their special health and medical needs. Many of these individuals are complicated by underlying health conditions, such as cardiovascular and lung diseases and undermined immune systems. During the pandemic, access to the healthcare systems and support groups is greatly diminished. Current research on COVID-19 has not addressed the unique challenges facing individuals with SUDs, including the heightened vulnerability and susceptibility to the disease. In this systematic review, we will discuss the pathogenesis and pathology of COVID-19, and highlight potential risk factors and complications to these individuals. We will also provide insights and considerations for COVID-19 treatment and prevention in patients with SUDs.
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Affiliation(s)
- Yufeng Wei
- Department of Chemistry, New Jersey City University, Jersey City, NJ 07305, USA;
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49
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Chang J, Agliata J, Guarinieri M. COVID-19 - Enacting a 'new normal' for people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102832. [PMID: 32654930 PMCID: PMC7332951 DOI: 10.1016/j.drugpo.2020.102832] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022]
Abstract
The COVID-19 crisis has magnified existing social, economic and political inequities. People who use drugs are particularly vulnerable due to criminalisation and stigma and often experience underlying health conditions, higher rates of poverty, unemployment and homelessness, as well as a lack of access to vital resources – putting them at greater risk of infection. On the other hand, COVID-19 presents an opportunity to confront the mistakes of the past and re-negotiate a new social contract. The International Network of People who use Drugs (INPUD) believe that this crisis must be an occasion to rethink the function of punishment, to reform the system and to work towards ending the war on drugs. This commentary presents a set of recommendations to UN agencies, governments, donor agencies, academics, researchers and civil society, challenging these actors to work alongside people who use drugs to enact a new reality based on solidarity and cooperation, protection of health, restoration of rights and dignity and most importantly to mobilise to win the peace.
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Affiliation(s)
- Judy Chang
- International Network of People who use Drugs, London, UK.
| | - Jake Agliata
- International Network of People who use Drugs, London, UK
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50
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Conway B, Truong D, Wuerth K. COVID-19 in homeless populations: unique challenges and opportunities. Future Virol 2020. [PMCID: PMC7319497 DOI: 10.2217/fvl-2020-0156] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Brian Conway
- Vancouver Infectious Diseases Centre, 201-1200 Burrard St, Vancouver, BC V6Z 2C7, Canada
| | - David Truong
- Vancouver Infectious Diseases Centre, 201-1200 Burrard St, Vancouver, BC V6Z 2C7, Canada
| | - Kelli Wuerth
- Vancouver Infectious Diseases Centre, 201-1200 Burrard St, Vancouver, BC V6Z 2C7, Canada
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