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Heidari O, Shah H, Bhagwat A, Ahmad NJ, Whaley S, Sherman SG, Morris M, Saloner B. Changes in opioid treatment programs and harm reduction provider services during the COVID-19 pandemic: Findings from 10 states. Psychol Serv 2024; 21:658-664. [PMID: 37824245 PMCID: PMC11009379 DOI: 10.1037/ser0000805] [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] [Indexed: 10/14/2023]
Abstract
Harm reduction and opioid treatment programs (OTPs) modified service delivery based on rapid changes to state and federal regulations during the COVID-19 pandemic. There is little evidence on how these regulations changed the delivery of medication for opioid use disorder and harm reduction services and whether certain regulations should be made permanent. This study explores how harm reduction OTPs across the United States leveraged changes in regulations and responded to impacts of COVID-19 to continue providing services and perspectives on future legislation that regulates their practice and practice sites. The COVID Harm Reduction and Treatment programs Survey study administered a survey that included closed-ended and free-response questions to 22 sites between August 2020 and January 2021. Program demographics and responses to survey items pertaining to site and service modifications were tabulated and proportions reported. A qualitative descriptive method was used to analyze free-response questions. All (100%) surveyed providers reported the need to modify their services. The majority (68%) reported an increase or no change in client volume; 68% reported increases in naloxone services and 77% reported increases in syringe services programs. Qualitative themes included (a) flexibility in reaching clients due to regulatory changes, (b) benefits and drawbacks of telehealth, and (c) increased vulnerabilities of their clients during the pandemic. Despite difficulties during the COVID-19 pandemic, harm reduction and OTP sites found that regulatory changes provided flexibility in service delivery and that they were better able to serve their clients. Future policies should bolster these sites to continue to provide low-barrier and high-quality services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Omeid Heidari
- University of Washington, School of Nursing, Department of Child, Family, and Population Health
| | - Hridika Shah
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - Atharva Bhagwat
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - N. Jia Ahmad
- Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital and Brigham and Women’s Hospital
| | - Sara Whaley
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins University, Bloomberg School of Public Health
| | - Miles Morris
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - Brendan Saloner
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
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Rahmani A, Janatolmakan M, Rezaei E, Allahqoli L, Fallahi A, Ebrahimi E, Motamedi M, Yousefi F, Apay SE. Challenges of the COVID-19 pandemic on women's HIV harm reduction centers: a mixed-methods study. Harm Reduct J 2024; 21:139. [PMID: 39049029 PMCID: PMC11267809 DOI: 10.1186/s12954-024-01060-4] [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: 12/03/2023] [Accepted: 07/14/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed significant challenges to nations worldwide, affecting various sectors of society. Women's HIV harm reduction centers, which provide critical services, have also been affected by these difficulties. This study aimed to examine the challenges of the COVID-19 pandemic on the services offered by women's HIV harm reduction centers from the perspective of clients. METHODS A convergent mixed-method design was utilized to gain in-depth insights into the challenges of COVID-19 on the services provided by women's HIV harm reduction centers, counseling centers, and night shelters that cater to women at risk, such as drug users, sex workers, and the homeless population, in three provinces (Tehran, Khuzestan, and Kermanshah) in Iran. The study was conducted from January to May 2023. The quantitative aspect of the study employed a cross-sectional method with a sample size of 430 individuals. A researcher-developed questionnaire was used to assess a range of services. The qualitative part of the study involved traditional content analysis and included 32 individual interviews. The integration of qualitative and quantitative results was performed during the interpretation phase to provide a comprehensive understanding of the challenges of COVID-19 on women's HIV harm reduction centers. RESULTS In the quantitative phase, the mean age of women was 39.0 ± 10.2 years. 165 women reported a history of COVID-19, which accounts for 38.4% of the total. More than half of them (n = 102, 61.8%) recovering at home. The majority of women (n = 365, 84.9%) mentioned receiving the COVID-19 vaccine. COVID-19 diagnostic tests were conducted for 74.2% (n = 319) of women. Women expressed higher satisfaction with the services (HIV prevention services, and accommodation services) before the COVID-19 pandemic compared to the satisfaction during the pandemic. The qualitative analysis identified emerging challenges related to the COVID-19 pandemic in two categories: personal challenges and mismanagement of services, comprising nineteen subcategories. CONCLUSION The findings of this study highlight the adverse impact of the COVID-19 pandemic on the services provided by women's HIV harm reduction centers, in contrast to the pre-pandemic period. To mitigate these negative effects, it is crucial to implement preventive measures and practical solutions. This may involve addressing the personal and management challenges of the centers.
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Affiliation(s)
- Azam Rahmani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elham Rezaei
- Midwifery department, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Arezoo Fallahi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Elham Ebrahimi
- Department of Reproductive Health Midwifery, School of Nursing & Midwifery Nursing and Midwifery Care Research Center, Tehran, Iran
| | - Mahnaz Motamedi
- HIV/STIs Department, Communicable Disease Control Center, Ministry of Health and Medical Education of Iran, Tehran, Iran
| | - Fatemeh Yousefi
- Department of midwifery, reproductive health promotion research center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Serap Ejdar Apay
- Faculty of Health Sciences, Atatürk University & Atateknokent Company, Erzurum, Turkey
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Dauria EF, Lapinski J, Hawk M, Egan JE, Venkat D, Robertson T. RIvER Clinic: Rethinking Incarceration and Empowering Recovery-An Innovative Postincarceration Care Delivery Model Implemented During the COVID-19 Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:420-423. [PMID: 38603749 DOI: 10.1097/phh.0000000000001877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The Rethinking Incarceration and Empowering Recovery (RIvER) Clinic was launched in June 2021 to address the health disparities experienced during and after incarceration. The RIvER Clinic's multidisciplinary, community-centered team engages patients during jail detention and after release via telehealth, collocated in community locations, on a mobile van, and in clinic. The clinic serves as a bridge between incarceration and the establishment of permanent health care and social services in the community. In 2022, a total of 479 visits were completed. The clinic provided multidisciplinary substance use support to all eligible patients, paying for 104 medication for opioid use disorder (MOUD) prescriptions for uninsured patients. Twenty-five percent of patients were transitioned to community-based care, and less than 5% of patients were reincarcerated. Despite some limitations, results demonstrate that the RIvER Clinic is successfully reintegrating a marginalized population into its community. The purpose of this article is to describe the implementation and preliminary outcomes of this postincarceration clinic.
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Affiliation(s)
- Emily F Dauria
- Author Affiliations: Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Dauria, Hawk, and Egan and Ms Lapinski); and Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania (Drs Venkat and Robertson)
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Ekhtiari H, Khojasteh Zonoozi A, Rafei P, Abolghasemi FS, Pemstein D, Abdelgawad T, Achab S, Ghafri HA, Al’Absi M, Bisch M, Conti AA, Ambekar A, Arunogiri S, Bhad R, Bilici R, Brady K, Bunt G, Busse A, Butner JL, Danesh A, El-Khoury J, Omari FE, Jokūbonis D, de Jong C, Dom G, Ebrahimi M, Fathi Jouzdani A, Ferri M, Galea-Singer S, Parker DG, Higuchi S, Kathiresan P, Khelifa E, Kouimtsidis C, Krupitsky EM, Long J, Maremmani I, McGovern G, Mohaddes Ardabili H, Rahimi-Movaghar A, Rataemane ST, Sangchooli A, Sibeko G, Vella AM, Vista SBD, Zare-Bidoky M, Zhao M, Javed A, Potenza MN, Baldacchino AM. World addiction medicine reports: formation of the International Society of Addiction Medicine Global Expert Network (ISAM-GEN) and its global surveys. Front Psychiatry 2024; 15:1230318. [PMID: 38528974 PMCID: PMC10961370 DOI: 10.3389/fpsyt.2024.1230318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and professionals globally. The dynamic nature of drug addiction at the global level has resulted in a crucial need for developing an international collaborative network of addiction societies, treatment programs and experts to monitor emerging national, regional, and global concerns. This protocol paper presents methodological details of running longitudinal surveys at national, regional, and global levels through the Global Expert Network of the International Society of Addiction Medicine (ISAM-GEN). The initial formation of the network with a recruitment phase and a round of snowball sampling provided 354 experts from 78 countries across the globe. In addition, 43 national/regional addiction societies/associations are also included in the database. The surveys will be developed by global experts in addiction medicine on treatment services, service coverage, co-occurring disorders, treatment standards and barriers, emerging addictions and/or dynamic changes in treatment needs worldwide. Survey participants in categories of (1) addiction societies/associations, (2) addiction treatment programs, (3) addiction experts/clinicians and (4) related stakeholders will respond to these global longitudinal surveys. The results will be analyzed and cross-examined with available data and peer-reviewed for publication.
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Affiliation(s)
- Hamed Ekhtiari
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Arash Khojasteh Zonoozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parnian Rafei
- Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland
| | - Fateme Sadat Abolghasemi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dan Pemstein
- Political Science and Public Policy & Challey Institute, North Dakota State University, Fargo, ND, United States
| | | | - Sophia Achab
- Faculty of Medicine, Sociological and Psychological Research Unit, Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Hamad Al Ghafri
- National Rehabilitation Center, Abu Dhabi, United Arab Emirates
| | - Mustafa Al’Absi
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Michaël Bisch
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | - Aldo Alberto Conti
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Melbourne, VIC, Australia
| | - Roshan Bhad
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rabia Bilici
- Faculty of Medicine, Department of Psychology, Istanbul Ticaret University, Istanbul, Türkiye
| | - Kathleen Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Gregory Bunt
- School of Medicine, New York University, New York City, NY, United States
| | - Anja Busse
- Prevention, Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime (UNODC), Vienna, Austria
| | - Jenna L. Butner
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Ahmad Danesh
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
| | | | - Fatima El Omari
- Faculty of Medicine, University Mohammed Vth of Rabat, Rabat, Morocco
| | - Darius Jokūbonis
- Republican Center for Addictive Disorders, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Cor de Jong
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Mohsen Ebrahimi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Fathi Jouzdani
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Susanna Galea-Singer
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
- National Health Service (NHS) Fife Addiction Services, Cameron Hospital, Windygates, United Kingdom
| | | | - Susumu Higuchi
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Preethy Kathiresan
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Emira Khelifa
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Christos Kouimtsidis
- National Office for Addressing Drugs, Athens, Greece
- Surrey and Borders Partnership, National Health Service (NHS) Foundation Trust, Leatherhead, United Kingdom
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Evgeny M. Krupitsky
- Department of Addictions, Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Jiang Long
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Icro Maremmani
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- UniCamillus, International Medical University in Rome, Rome, Italy
| | - Garrett McGovern
- Irish Chapter of International Society of Addiction Medicine (IRE-ISAM), Dublin, Ireland
| | - Hossein Mohaddes Ardabili
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arshiya Sangchooli
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Goodman Sibeko
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Anna Maria Vella
- Foundation for Social Welfare Services (FSWS), Sedqa, Santa Venera, Malta
| | - Salvador Benjamin D. Vista
- Department of Psychiatry and Behavioral Medicine, College of Medicine and Philippines General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Marc N. Potenza
- Department of Psychiatry and Child Center, Yale School of Medicine, New Haven, CT, United States
- Connecticut Mental Health Center, New Haven, CT, United States
- Connecticut Council on Problem Gambling, Wethersfield, CT, United States
- Wu Tsai Institute and Department of Neuroscience, Yale University, New Haven, CT, United States
| | - Alexander Mario Baldacchino
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
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Allen B, Schell RC, Jent VA, Krieger M, Pratty C, Hallowell BD, Goedel WC, Basta M, Yedinak JL, Li Y, Cartus AR, Marshall BDL, Cerdá M, Ahern J, Neill DB. PROVIDENT: Development and Validation of a Machine Learning Model to Predict Neighborhood-level Overdose Risk in Rhode Island. Epidemiology 2024; 35:232-240. [PMID: 38180881 PMCID: PMC10842082 DOI: 10.1097/ede.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Drug overdose persists as a leading cause of death in the United States, but resources to address it remain limited. As a result, health authorities must consider where to allocate scarce resources within their jurisdictions. Machine learning offers a strategy to identify areas with increased future overdose risk to proactively allocate overdose prevention resources. This modeling study is embedded in a randomized trial to measure the effect of proactive resource allocation on statewide overdose rates in Rhode Island (RI). METHODS We used statewide data from RI from 2016 to 2020 to develop an ensemble machine learning model predicting neighborhood-level fatal overdose risk. Our ensemble model integrated gradient boosting machine and super learner base models in a moving window framework to make predictions in 6-month intervals. Our performance target, developed a priori with the RI Department of Health, was to identify the 20% of RI neighborhoods containing at least 40% of statewide overdose deaths, including at least one neighborhood per municipality. The model was validated after trial launch. RESULTS Our model selected priority neighborhoods capturing 40.2% of statewide overdose deaths during the test periods and 44.1% of statewide overdose deaths during validation periods. Our ensemble outperformed the base models during the test periods and performed comparably to the best-performing base model during the validation periods. CONCLUSIONS We demonstrated the capacity for machine learning models to predict neighborhood-level fatal overdose risk to a degree of accuracy suitable for practitioners. Jurisdictions may consider predictive modeling as a tool to guide allocation of scarce resources.
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Affiliation(s)
- Bennett Allen
- From the Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Robert C Schell
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Victoria A Jent
- From the Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Maxwell Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Claire Pratty
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Benjamin D Hallowell
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence, RI, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Melissa Basta
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence, RI, USA
| | - Jesse L Yedinak
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Yu Li
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Abigail R Cartus
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Magdalena Cerdá
- From the Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Daniel B Neill
- Center for Urban Science and Progress, New York University, New York, NY, USA
- Department of Computer Science, Courant Institute for Mathematical Sciences, New York University, New York, NY, USA
- Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA
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Roxburgh A, Livingston M, Dietze P, Nielsen S, Cogger S, Bartlett M, Day C, Latimer J, Jauncey M, Clark N. The impact of COVID-19 public health measures on attendance and overdose at supervised injecting facilities in Australia. Public Health 2023; 224:90-97. [PMID: 37742585 DOI: 10.1016/j.puhe.2023.08.019] [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: 04/28/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic disrupted service provision of harm reduction and drug treatment services for people who inject drugs in many countries. The two supervised injecting facilities (SIFs) in Sydney and Melbourne were differentially impacted by the pandemic, requiring local procedural changes in each service. We aimed to examine the impact of pandemic responses (including restrictions on movement, known as 'lockdowns') on service use and key parameters such as client reports of drug injected and recorded overdose rates. STUDY DESIGN Time series analysis of weekly client visits and monthly overdoses occurring at each service. METHODS Administrative client data from the two SIFs (Sydney data from 1 January 2018 to 30 April 2022; Melbourne data from 1 July 2018 to 30 April 2022) were examined using interrupted time series analyses with lockdown dates in each state entered as interruption terms. We analysed weekly SIF visits overall and by drug type, and monthly rates of opioid overdose at each service. RESULTS Lockdowns resulted in decreased visits to both services. The number of weekly client visits decreased during the first national lockdown for both the Sydney (trend change = -57.9; 95% CI [-109.4, -6.4]) and Melbourne SIF (near sig trend change = -54.8 [-110.8, 1.05]). Trends in visit numbers increased after lockdowns were lifted in each city; however, visits in Sydney have not returned to the numbers recorded prior to the pandemic. Visits to the Melbourne SIF related to heroin use declined at each lockdown (trend 1 = -42.7 [-81.5, -3.9]; trend 2 = -56.1 [-94.6, -17.7]; trend 3 = -33.8 [-67.4, -0.2]); heroin visits to the Sydney SIF declined during the first lockdown and remained low (trend = -55.6 [-82.8, -28.3]). Methamphetamine visits to the Sydney SIF fluctuated, surpassing heroin visits at several timepoints. Rates of monthly opioid overdoses at both services declined immediately following the start of the first lockdown (Sydney = -16.6 [-26.1, -6.8]; Melbourne = -6.4 [-8.7, -4.1]), with increasing trends recorded at the end of the final lockdown in each jurisdiction (Sydney = 2.8 [0.6, 5.0]; Melbourne = 1.3 [0.72, 3.2]). CONCLUSIONS Public health restrictions related to the COVID-19 pandemic were associated with reduced client visits to, and overdoses in, Australian SIFs. Variations were noted in the drugs injected, likely reflecting changes in local drug markets. Shifts to other drugs during these periods were evident: methamphetamine in Sydney; co-injection of heroin and diphenhydramine in Melbourne.
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Affiliation(s)
- A Roxburgh
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia.
| | - M Livingston
- National Drug Research Institute, Curtin University, Perth, Australia
| | - P Dietze
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - S Nielsen
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - S Cogger
- North Richmond Community Health Medically Supervised Injecting Room, Melbourne Australia
| | - M Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - C Day
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - J Latimer
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - M Jauncey
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - N Clark
- North Richmond Community Health Medically Supervised Injecting Room, Melbourne Australia; Addiction Medicine, Royal Melbourne Hospital, Melbourne, Australia
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7
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Moreheart S, Shannon K, Krüsi A, McDermid J, Ettinger E, Braschel M, Goldenberg SM. Negative changes in illicit drug supply during COVID-19: Associations with use of overdose prevention and health services among women sex workers who use drugs (2020-2021). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104212. [PMID: 37797570 PMCID: PMC10798550 DOI: 10.1016/j.drugpo.2023.104212] [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: 11/30/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Women sex workers are a highly criminalized population who are over-represented amongst people who use drugs (PWUD) and face gaps in overdose prevention and harm reduction services. British Columbia, Canada continues to face a pronounced drug poisoning crisis of the illicit drug supply, which has intensified during the COVID-19 pandemic. Our objective was to examine the prevalence and structural correlates of experiencing negative changes in illicit drug supply (e.g., availability, quality, cost, or access to drugs) amongst women sex workers who use drugs during the first year of the COVID-19 pandemic. METHODS Cross-sectional questionnaire data were drawn from a prospective, community-based cohort of women sex workers in Vancouver (AESHA) from April 2020 to 2021. Bivariate and multivariable logistic regression was used to investigate structural correlates of negative changes in drug supply during COVID-19 among sex workers who use drugs. RESULTS Among 179 sex workers who use drugs, 68.2% reported experiencing negative changes to drug supply during COVID-19, 54.2% recently accessed overdose prevention sites, and 44.7% reported experiencing recent healthcare barriers. In multivariable analysis adjusted for injection drug use, women who reported negative changes in illicit drug supply had higher odds of experiencing recent healthcare barriers (AOR 2.28, 95%CI 1.12-4.62); those recently accessing overdose prevention sites (AOR 1.75, 95%CI 0.86-3.54) faced marginally higher odds also. CONCLUSIONS Over two-thirds of participants experienced negative changes to illicit drug supply during the first year of the COVID-19 pandemic. The association between experiencing negative changes in the illicit drug supply and accessing overdose prevention services highlights the agency of women in taking measures to address overdose-related risks. Highly criminalized women who experience structural barriers to direct services are also vulnerable to fluctuations in the illicit drug supply. Attenuating health consequences requires interventions tailored to sex workers' needs.
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Affiliation(s)
- Sarah Moreheart
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Emma Ettinger
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Miriam Goldenberg
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, United States.
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Tay Wee Teck J, Butner JL, Baldacchino A. Understanding the use of telemedicine across different opioid use disorder treatment models: A scoping review. J Telemed Telecare 2023:1357633X231195607. [PMID: 37661829 DOI: 10.1177/1357633x231195607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. METHODS The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. RESULTS A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. CONCLUSIONS Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
- Forward Leeds and Humankind Charity, Durham, UK
| | - Jenna L Butner
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Alex Baldacchino
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
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9
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Haddad S, Shawa M, Kane JC, Bwalya B, Sienkiewicz M, Kilbane G, Chibemba V, Chiluba P, Mtongo N, Metz K, Chibwe M, Mushabati N, Zulu A, Paul R, Banda Z, Loongo H, Kamanga M, Greene MC. Alcohol and other drug use patterns and services in an integrated refugee settlement in Northern Zambia: a formative research study. Confl Health 2023; 17:40. [PMID: 37620915 PMCID: PMC10464007 DOI: 10.1186/s13031-023-00538-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Evidence on patterns of alcohol and other drug (AOD) use and how to effectively deliver services to address AOD use in humanitarian settings is limited. This study aimed to qualitatively explore the patterns of AOD use among Congolese refugees in Mantapala Refugee Settlement and members of the surrounding host community and identify potential appropriate intervention and implementation approaches to address AOD use disorders among conflict-affected populations. METHODS Fifty free listing interviews, 25 key informant interviews, and four focus group discussions were conducted among refugees, host community members, humanitarian implementing agency staff, and refugee incentive workers. These participants were selected based on their knowledge of AOD use and related problems in the settlement and the surrounding host community in northern Zambia. RESULTS Cannabis and home-brewed alcohol were the substances that were perceived to be most commonly used and have the greatest impact on the community. Participants reported that self-medication, boredom, and relief of daily stressors associated with lack of housing, safety, and employment were reasons that people used AODs. Participants recommended that programming include components to address the underlying causes of AOD use, such as livelihood activities. Stigma due to the criminalization of and societal ideals and religious beliefs regarding AOD use was identified as a substantial barrier to accessing and seeking treatment. CONCLUSIONS Our study's findings indicate the need for services to address AOD use in Mantapala Refugee Settlement. Interventions should consider the social and structural determinants of AOD use.
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Affiliation(s)
- Stephanie Haddad
- Columbia University Mailman School of Public Health, 60 Haven Avenue, New York, NY, 10032, USA
| | - Mbaita Shawa
- Women in Law and Development in Africa, PO Box 31456, Lusaka, Zambia
| | - Jeremy C Kane
- Columbia University Mailman School of Public Health, 60 Haven Avenue, New York, NY, 10032, USA
| | | | - Megan Sienkiewicz
- Columbia University Mailman School of Public Health, 60 Haven Avenue, New York, NY, 10032, USA
| | - Grace Kilbane
- Columbia University Mailman School of Public Health, 60 Haven Avenue, New York, NY, 10032, USA
| | - Veronica Chibemba
- Women in Law and Development in Africa, PO Box 31456, Lusaka, Zambia
| | - Princess Chiluba
- Women in Law and Development in Africa, PO Box 31456, Lusaka, Zambia
| | - Nkumbu Mtongo
- Women in Law and Development in Africa, PO Box 31456, Lusaka, Zambia
| | - Kristina Metz
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Mildred Chibwe
- Women in Law and Development in Africa, PO Box 31456, Lusaka, Zambia
| | | | - Allan Zulu
- CARE Zambia, PO Box 36238, Lusaka, Zambia
| | - Ravi Paul
- School of Medicine, University of Zambia, University Teaching Hospital, PO Box 50110, Lusaka, Zambia
| | - Zaliwe Banda
- Zambia Ministry of Health, PO Box 30205, Lusaka, Zambia
| | | | - Muzi Kamanga
- Women in Law and Development in Africa, PO Box 31456, Lusaka, Zambia
| | - M Claire Greene
- Columbia University Mailman School of Public Health, 60 Haven Avenue, New York, NY, 10032, USA.
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Janku C, De Sa L, Daniyan A. An Introduction to Harm Reduction for Medical Students: Addressing Stigma Through an Interactive Preclerkship Lecture. Cureus 2023; 15:e44076. [PMID: 37750156 PMCID: PMC10518041 DOI: 10.7759/cureus.44076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Harm reduction is a non-traditional approach to addressing substance use disorders and a tool to prevent the spread of transmissible blood-borne infections. We taught an interactive lecture on harm reduction for medical students at the California University of Science and Medicine. This lecture was unique in that it is the only one that was directly developed in collaboration with a harm reduction nonprofit organization for the purpose of educating future physicians. METHODS The class was encouraged to think critically about the topic of harm reduction, their biases toward persons who use injection drugs (PWID), and the role of physicians in improving health outcomes for this population. We sent pre- and post-surveys to the students to measure changes in their attitudes toward PWID and harm reduction. Results: Overall, we successfully changed medical students' perspectives of PWID. However, their perspectives on the topic of harm reduction did not change significantly from the already positive opinions students had on the topic before the session. After the session, students were less likely to enjoy giving extra time to these patients and were more likely to find that these patients were difficult to work with. Discussion: Harm reduction interventions can potentially prevent health complications associated with drug use, such as bacterial endocarditis, abscess formation, and transmitting diseases such as hepatitis and HIV, alleviating some of the burden placed on healthcare systems by PWID. This interactive session can serve as a model for other institutions that desire to educate their medical students on the topic of harm reduction and to address the stigma that is faced by PWID.
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Affiliation(s)
- Cynthia Janku
- Neurology, California University of Science and Medicine, Colton, USA
| | - Lauren De Sa
- Internal Medicine/Pediatrics, California University of Science and Medicine, Colton, USA
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Carver H, Ciolompea T, Conway A, Kilian C, McDonald R, Meksi A, Wojnar M. Substance use disorders and COVID-19: reflections on international research and practice changes during the "poly-crisis". Front Public Health 2023; 11:1201967. [PMID: 37529435 PMCID: PMC10390069 DOI: 10.3389/fpubh.2023.1201967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Since March 2020, the COVID-19 pandemic has had a disproportionately high toll on vulnerable populations, coinciding with increased prevalence of alcohol-and drug-related deaths and pre-existing societal issues such as rising income inequality and homelessness. This poly-crisis has posed unique challenges to service delivery for people with substance use disorders, and innovative approaches have emerged. In this Perspectives paper we reflect on the poly-crisis and the changes to research and practice for those experiencing substance use disorders, following work undertaken as part of the InterGLAM project (part of the 2022. Lisbon Addictions conference). The authors, who were part of an InterGLAM working group, identified a range of creative and novel responses by gathering information from conference attendees about COVID-19-related changes to substance use disorder treatment in their countries. In this paper we describe these responses across a range of countries, focusing on changes to telehealth, provision of medications for opioid use disorder and alcohol harm reduction, as well as changes to how research was conducted. Implications include better equity in access to technology and secure data systems; increased prescribed safer supply in countries where this currently does not exist; flexible provision of medication for opioid use disorder; scale up of alcohol harm reduction for people with alcohol use disorders; greater involvement of people with lived/living experience in research; and additional support for research in low- and middle-income countries. The COVID-19 pandemic has changed the addictions field and there are lessons for ongoing and emerging crises.
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Affiliation(s)
- Hannah Carver
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Teodora Ciolompea
- Drug Addiction Evaluation and Treatment Center, Saint Stelian, Bucharest, Romania
| | - Anna Conway
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Carolin Kilian
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Rebecca McDonald
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Andia Meksi
- National Institute of Public Health, Tirana, Albania
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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Li H, Su W, Cai J, Zhao L, Li Y. Effects of exercise of different intensities on withdrawal symptoms among people with substance use disorder: a systematic review and meta-analysis. Front Physiol 2023; 14:1126777. [PMID: 37234417 PMCID: PMC10208401 DOI: 10.3389/fphys.2023.1126777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/17/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Exercise can effectively attenuate withdrawal symptoms and reduce relapse, but it is unknown whether exercise of different intensities produces different results. This study aimed to systematically review the effects of different exercise intensities on withdrawal symptoms among people with substance use disorder (SUD). Methods: Systematic searches for randomized controlled trials (RCTs) on exercise, SUD, and abstinence symptoms were conducted via electronic databases, including PubMed, up to June 2022. Study quality was evaluated using the Cochrane Risk of Bias tool (RoB 2.0) for assessment of risk of bias in randomized trials. The meta-analysis was performed by calculating the standard mean difference (SMD) in outcomes of interventions involving light-, moderate-, and high-intensity exercise for each individual study using Review Manager version 5.3 (RevMan 5.3). Results: In total, 22 RCTs (n = 1,537) were included. Overall, exercise interventions had significant effects on withdrawal symptoms, but the effect size varied with exercise intensity and by outcome measure (i.e., for different negative emotions). Light-, moderate-, and high-intensity exercise reduced cravings after the intervention [SMD = -0.71, 95% CI = (-0.90, -0.52)], and there were no statistical differences between the subgroups (p > 0.05). Light-, moderate-, and high-intensity exercise reduced depression after the intervention [light, SMD = -0.33, 95% CI = (-0.57, -0.09); moderate, SMD = -0.64, 95% CI = (-0.85, -0.42); high, SMD = -0.25, 95% CI = (-0.44, -0.05)], with moderate-intensity exercise producing the best effect (p < 0.05). Only light- and moderate-intensity exercise relieved anxiety after the intervention [light, SMD = -0.48, 95% CI = (-0.71, -0.26); moderate, SMD = -0.58, 95% CI = (-0.85, -0.31)]. Only high-intensity exercise worked in alleviating stress [SMD = -1.13, 95% CI = (-2.22, -0.04)]. Both irritability and restlessness could be improved by light- and moderate-intensity exercise [irritability, SMD = -0.74, 95% CI = (-0.98, -0.50); restless, SMD = -0.72, 95% CI = (-0.98, -0.47)], and there were no statistical differences between the subgroups (p > 0.05). Moderate- and high-intensity exercise decreased withdrawal syndrome after the intervention [moderate, SMD = -0.30, 95% CI = (-0.55, -0.05); high, SMD = -1.33, 95% CI = (-1.90, -0.76)], with high-intensity exercise producing the best effects (p < 0.01). Conclusion: Overall, exercise leads to improvements in withdrawal symptoms in individuals with SUD, but these effects vary significantly between the exercise of different intensities and according to the type of withdrawal symptoms. Moderate-intensity exercise has the greatest benefits in improving depression and anxiety; high-intensity exercise has the greatest benefits in improving withdrawal syndrome. Systematic Review Registration: www.crd.york.ac.uk/PROSPERO/, identifier, CRD42022343791.
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Affiliation(s)
- Hao Li
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Wantang Su
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Jiajia Cai
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Li Zhao
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
| | - Yan Li
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
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13
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Adams A, Blawatt S, MacDonald S, Finnick R, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. Provider experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic: A qualitative systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104058. [PMID: 37182352 PMCID: PMC10165059 DOI: 10.1016/j.drugpo.2023.104058] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Historical restrictions on take-home medications for opioid use disorder have generated considerable debate. The COVID-19 pandemic shifted the perceived risks and benefits of daily clinic attendance and led to widespread policy reform, creating an unprecedented opportunity to explore the impact of more flexible prescribing. We conducted a qualitative systematic review to synthesize the evidence on providers' experiences with relaxing restrictions on take-home doses of medications prescribed for opioid use disorder during the COVID-19 pandemic. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42022360589; https://www.crd.york.ac.uk/prospero/). From Sept.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, the Cochrane Register of Controlled Trials, and the grey literature from 2020 onward. Studies were eligible for inclusion if they used qualitative methods to investigate providers' experiences with relaxed restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic. We appraised study quality using the CASP qualitative checklist and used thematic synthesis and GRADE-CERQual to synthesize the results. RESULTS We retrieved 13 articles representing 11 studies. Six were conducted in the United States and most focused on changes to methadone treatment. Providers' experiences with increased flexibilities around take-homes were broadly positive, despite widespread initial concern over client safety and the potential for medication misuse. For a small number of providers, concerns about diversion were a specific manifestation of more general unease with loss of control over clients and the treatment process. Most providers appreciated increased flexibilities and described them as enabling more individualized, person-centered care. CONCLUSION Our findings support the continuation of flexibilities around take-homes and demonstrate that regulations and policies that reduce flexibility around take-homes conflict with person-centered approaches to care. Stronger guidance and support from professional regulatory agencies may help increase uptake of flexibilities around take-homes.
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Affiliation(s)
- Alison Adams
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Sarin Blawatt
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Rhys Finnick
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC V6H 4C1, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
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14
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Pietrantoni D, Barroca C, Lynch S, Byrne J, Ortner M, Kotwani R, Limbrick K, Kaldas P, Moussa M, Fredrickson T, Schaefer J, Jacobs RJ. A Scoping Review on the Effects of COVID-19 on Syringe Service Programs in the United States. Cureus 2023; 15:e39023. [PMID: 37378253 PMCID: PMC10292154 DOI: 10.7759/cureus.39023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/14/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic has had worldwide impacts, including disrupting community services. One interrupted service was syringe service programs (SSPs), community-established initiatives that provide sterile supplies and aid in overcoming addiction in drug-using participants. In the United States (U.S.), SSPs have been key in combating the recent opioid use crisis and associated infections such as the human immunodeficiency virus (HIV) and hepatitis C. While some published reports on the pandemic's overall impacts on SSPs exist, certain aspects such as operational changes and repercussions on staff and participants may still be lacking. Information about the impact of interrupted SSP services due to the pandemic may provide insight into how to prepare to mitigate similar outcomes during possible future health outbreaks. The aim of this scoping review was thus to explore the effects of the COVID-19 pandemic on the operations, staff, and participants of SSPs in the U.S. The initial search of the databases PubMed, Embase, and Web of Science with selected keywords yielded 117 articles published in English between January 1, 2020, and August 31, 2022. After screening each article for study eligibility, 11 articles were included in the final review. Of the seven articles exploring SSP operational impacts from the pandemic, five acknowledged that mitigation strategies influenced functions, seven highlighted supply changes, and four emphasized the resulting staffing changes. Four studies inspected the pandemic's impacts on SSP participants, which included two articles highlighting participants' struggles with isolation and loneliness, one referencing the fear of exposure to the SARS-CoV-2 virus, and two examining the overall negative psychological effects experienced during this time. SSPs in various settings and regions across the U.S. experienced changes due to the COVID-19 pandemic. Many of these modifications negatively impacted operations, staffing, and participant relationships. Examining the issues that individual SSPs encountered highlights opportunities for structured solutions for the present and in the case of future infectious disease outbreaks. With the severity of the opioid use crisis in the U.S. and the dependence on SSPs for its mitigation, future work in this space should be prioritized.
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Affiliation(s)
- Dylan Pietrantoni
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Crystal Barroca
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sarah Lynch
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jonathan Byrne
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Miranda Ortner
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Roshni Kotwani
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Kolin Limbrick
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Paul Kaldas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Michael Moussa
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Tatem Fredrickson
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jeffrey Schaefer
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Silva-Aravena F, Núñez Delafuente H, Gutiérrez-Bahamondes JH, Morales J. A Hybrid Algorithm of ML and XAI to Prevent Breast Cancer: A Strategy to Support Decision Making. Cancers (Basel) 2023; 15:cancers15092443. [PMID: 37173910 PMCID: PMC10177162 DOI: 10.3390/cancers15092443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
Worldwide, the coronavirus has intensified the management problems of health services, significantly harming patients. Some of the most affected processes have been cancer patients' prevention, diagnosis, and treatment. Breast cancer is the most affected, with more than 20 million cases and at least 10 million deaths by 2020. Various studies have been carried out to support the management of this disease globally. This paper presents a decision support strategy for health teams based on machine learning (ML) tools and explainability algorithms (XAI). The main methodological contributions are: first, the evaluation of different ML algorithms that allow classifying patients with and without cancer from the available dataset; and second, an ML methodology mixed with an XAI algorithm, which makes it possible to predict the disease and interpret the variables and how they affect the health of patients. The results show that first, the XGBoost Algorithm has a better predictive capacity, with an accuracy of 0.813 for the train data and 0.81 for the test data; and second, with the SHAP algorithm, it is possible to know the relevant variables and their level of significance in the prediction, and to quantify the impact on the clinical condition of the patients, which will allow health teams to offer early and personalized alerts for each patient.
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Affiliation(s)
- Fabián Silva-Aravena
- Facultad de Ciencias Sociales y Económicas, Universidad Católica del Maule, Avenida San Miguel 3605, Talca 3460000, Chile
| | - Hugo Núñez Delafuente
- Doctorado en Sistemas de Ingeniería, Facultad de Ingeniería, Universidad de Talca, Camino Los Niches Km 1, Curicó 3340000, Chile
| | - Jimmy H Gutiérrez-Bahamondes
- Doctorado en Sistemas de Ingeniería, Facultad de Ingeniería, Universidad de Talca, Camino Los Niches Km 1, Curicó 3340000, Chile
| | - Jenny Morales
- Facultad de Ciencias Sociales y Económicas, Universidad Católica del Maule, Avenida San Miguel 3605, Talca 3460000, Chile
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Potenza MN, Baldacchino AM. Virtually there and back again: An overview of the 2021 and 2022 Scientific Annual Conferences of the International Society of Addiction Medicine. Drug Alcohol Depend 2023; 245:109805. [PMID: 36827932 DOI: 10.1016/j.drugalcdep.2023.109805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/21/2023]
Abstract
The International Society of Addiction Medicine (ISAM) has held annual conferences for over 20 years. Conference-related information, including main themes and selected abstracts, have been published regularly. This communication describes the events of the 2021 and 2022 conferences, the second virtual and first in-person/hybrid conference. These conferences were widely attended by addiction medicine professionals from around the world, and multiple topics, both pandemic-related and not, were covered. After a three-year period with two virtual meetings, the 2022 event in Valetta, Malta, provided an opportunity to reunite and discuss current information in person. Albeit with different formats, both meetings provided opportunities for sharing of recent, clinically relevant findings to assist in addressing addictions globally.
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Affiliation(s)
- Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale School of Medicine, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience and Wu Tsai Institute, Yale University, New Haven, CT, USA.
| | - Alex M Baldacchino
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
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Gainer DM, Wong C, Embree JA, Sardesh N, Amin A, Lester N. Effects of Telehealth on Dropout and Retention in Care among Treatment-Seeking Individuals with Substance Use Disorder: A Retrospective Cohort Study. Subst Use Misuse 2023; 58:481-490. [PMID: 36710568 DOI: 10.1080/10826084.2023.2167496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: During the COVID-19 pandemic, telehealth became a widely used method of delivering treatment for substance use disorders (SUD), but its impact upon treatment engagement and dropout remains unknown. Methods: We conducted a retrospective analysis of adult SUD patients (n = 544) between October 2020 and June 2022 among a cohort of treatment-seeking patients at a nonprofit community behavioral health center in Southwestern Ohio. We estimated the likelihood of treatment dropout using survival curves and Cox proportional hazard models, comparing patients who used telehealth with video, telephone, or solely in-person services within the first 14 days of diagnosis. We also compared the likelihood of early treatment engagement. Results: Patients who received services through telehealth with video in the initial 14 days of diagnosis had a lower hazard of dropout, compared to patients receiving solely in-person services (0.64, 95% CI [0.46, 0.90]), while there was no difference in hazards of dropout between patients who received telephone and in-person services. Early use of telehealth, both via video (5.40, 95% CI [1.92, 15.20]) and telephone (2.12, 95% CI [1.05, 4.28]), was associated with greater odds of treatment engagement compared to in-person care. Conclusion: This study adds to the existing literature related to telehealth utilization and engagement in care and supports the inclusion of telehealth in SUD treatment programs for treatment-seeking individuals.
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Affiliation(s)
- Danielle M Gainer
- Wright State University Boonshoft School of Medicine, Fairborn, Ohio, USA.,OneFifteen / Samaritan Behavioral Health, Inc., Dayton, Ohio, USA
| | - Celeste Wong
- Verily Life Sciences, South San Francisco, California, USA
| | - Jared A Embree
- Wright State University Boonshoft School of Medicine, Fairborn, Ohio, USA
| | - Nina Sardesh
- Verily Life Sciences, South San Francisco, California, USA
| | - Amna Amin
- OneFifteen / Samaritan Behavioral Health, Inc., Dayton, Ohio, USA
| | - Natalie Lester
- Wright State University Boonshoft School of Medicine, Fairborn, Ohio, USA.,Verily Life Sciences, South San Francisco, California, USA
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Teck JTW, Zlatkute G, Perez A, Dritschel H, Ghosh A, Potenza MN, Ambekar A, Ekhtiari H, Stein D, Khazaal Y, Arunogiri S, Torrens M, Ferri M, Galea-Singer S, Baldacchino A. Key implementation factors in telemedicine-delivered medications for opioid use disorder: a scoping review informed by normalisation process theory. Lancet Psychiatry 2023; 10:50-64. [PMID: 36526346 DOI: 10.1016/s2215-0366(22)00374-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
Telemedicine could improve access to medications for opioid use disorder (MOUD). Telemedicine-delivered MOUD (TMOUD) has expanded substantially in response to the restrictions imposed by the COVID-19 pandemic on in-person clinical contact, yet this expansion has not happened consistently across all health systems and countries. This Review aims to understand key factors in TMOUD implementation that might explain variations in uptake. We did a scoping review using three English language databases for articles reporting on the implementation of TMOUD services. 57 peer-reviewed articles were identified, subjected to open coding and thematic analysis, and further interpreted through normalisation process theory (NPT). NPT was originally used to evaluate telehealth innovations and has been applied extensively to describe, assess, and develop the implementation potential of a broad range of complex health-care interventions. By categorising our findings according to the four core NPT constructs of coherence, cognitive participation, collective action, and reflexive monitoring, we aim to rationalise the current evidence base to show the workability of TMOUD in practice. We find that variations in TMOUD models in practice depend on organisations' attitudes towards risk, clinicians' tensions around giving up control over standard practices, organisation-level support in overcoming operational and technological challenges, and evaluation methods that might neglect a potential widening of the digital divide.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK; Forward Leeds and Humankind Charity, Durham, UK.
| | - Giedre Zlatkute
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
| | - Alberto Perez
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
| | - Heidi Dritschel
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
| | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA; the Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dan Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Yasser Khazaal
- Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Research Center, Institute of Mental Health, Montréal University, Montréal, QC, Canada
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Melbourne, VIC, Australia
| | - Marta Torrens
- School of Medicine, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Susanna Galea-Singer
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK; NHS Fife Addiction Services, Leven, UK
| | - Alex Baldacchino
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
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Rijnink A, Blake D, Groot S, Brough C. Accessing needle exchange services in disasters for remote areas of Aotearoa New Zealand. Harm Reduct J 2022; 19:145. [PMID: 36544156 PMCID: PMC9771773 DOI: 10.1186/s12954-022-00709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Needle Exchange Programme (NEP) mobile outreach services in Aotearoa New Zealand distribute injecting equipment to people who inject drugs (PWID) living in remote regions. In disasters, continued access to such services is imperative for the health and wellbeing of PWID. Disasters can compound existing inequities, particularly in regions characterised by poor or limited infrastructure, smaller populations, and challenging socioeconomic conditions. To gain insight into the barriers that prevent access to NEP harm-reduction services and understand the needs of PWID prior to and during disasters, this study foregrounds the voices of PWID based on the West Coast of the South Island, Aotearoa New Zealand. METHODS This qualitative study applied an interpretive phenomenological analysis approach, where 14 PWID and one key NEP staff member took part in semi-structured interviews. The interviews provided the opportunity for participants to share their experiences and perspectives about accessing sterile drug-injecting equipment during disasters, including the four-week COVID-19 Level 4 lockdown in March 2020. In total five superordinate and 14 subordinate themes were identified from the interveiws. RESULTS This study focuses on four of the key themes that impacted accessibility to NEP services: infrastructural hazards and equipment costs; social capital and practical support from peers and key contact networks; social stigma in public locations, including NEP-based pharmacies and emergency centres; and potential solutions to NEP equipment accessibility as frequently suggested by participants. CONCLUSIONS Access to NEP services is essential during natural hazard and human-generated disasters, as such NEP mobile outreach services and disaster resilience efforts should focus on maintaining service continuity for PWID during adverse times. This study champions a needs-based, stigma free approach to inclusive harm-reduction and emergency management practices for groups with specific needs in a disaster context.
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Affiliation(s)
- Anne Rijnink
- grid.148374.d0000 0001 0696 9806School of Psychology, Massey University, Wellington, Aotearoa New Zealand
| | - Denise Blake
- grid.267827.e0000 0001 2292 3111School of Health, Te Herenga Waka-Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Shiloh Groot
- grid.9654.e0000 0004 0372 3343School of Psychology, University of Auckland, Auckland, Aotearoa New Zealand
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20
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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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21
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Harker N, Johnson K, Erasmus J, Myers B. COVID 19—impact on substance use treatment utilization and provision in South Africa. Subst Abuse Treat Prev Policy 2022; 17:15. [PMID: 35241095 PMCID: PMC8892117 DOI: 10.1186/s13011-022-00446-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide. The aim of this study was to explore, changes in the number of SUD treatment episodes provided during the height of the pandemic and, SUD treatment providers’ perceptions of the impact of COVID-19-related restrictions on people with SUDs and the delivery of SUD treatment services in South Africa. Methods We used administrative data collected as part of the South African Community Epidemiology Network on Drug Use (SACENDU) project to assess whether the number of treatment episodes changed during the height of COVID-19 restrictions. We used data from an online survey of SUD treatment providers to assess providers’ perceptions of the impact of COVID-19 on SUD treatment delivery. Eight seven SUD facilities were recruited to participate in the online survey. Results Sixty-three organisations (out of a total of 86) participated in the survey, yielding a 73.2% response rate. About half (n = 30; 47.6%) of the sample thought the need for SUD treatment had remained the same or had increased during the COVID-19 lockdown. Half the sample (n = 32; 50.7%) reported decreased availability of SUD services during COVID-19 lockdowns. Participants believed that the lack of services during COVID-19 lockdown impacted negatively on patients that were enrolled in their programmes and on individuals who wished to access the service. Furthermore, changes in service provision seemed to increase patients’ anxiety, exacerbate pre-existing mental health problems and in some cases were thought to precipitate relapse. In addition, patient disengagement and attrition from treatment were thought to have increased during this period. Whilst 47.6% (n = 30) of providers agreed with the value of the alcohol ban, 23.8% (n = 15) of providers thought it had unintended negative consequences. Conclusion Based on the findings it is evident that SUD treatment services in South Africa have been significantly affected during the COVID-19 pandemic and more severely during the onset of the pandemic. Together with service providers, more effective ways should be sought on how to feasibly expand access to SUD treatment for all South Africans and enhance the country’s preparedness for future health emergencies.
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22
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Rains A, York M, Bolinski R, Ezell J, Ouellet LJ, Jenkins WD, Pho MT. Attitudes toward harm reduction and low-threshold healthcare during the COVID-19 pandemic: qualitative interviews with people who use drugs in rural southern Illinois. Harm Reduct J 2022; 19:128. [PMID: 36403075 PMCID: PMC9675127 DOI: 10.1186/s12954-022-00710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Chronic health conditions associated with long-term drug use may pose additional risks to people who use drugs (PWUD) when coupled with COVID-19 infection. Despite this, PWUD, especially those living in rural areas, may be less likely to seek out health services. Previous research has highlighted the increased disease burden of COVID-19 among PWUD. Our manuscript supplements this literature by exploring unique attitudes of PWUD living in rural areas toward the pandemic, COVID-19 vaccination, and the role of harm reduction (HR) organizations in raising health awareness among PWUD. METHODS Semi-structured interviews were conducted with 20 PWUD living in rural southern Illinois. Audio recordings were professionally transcribed. A preliminary codebook was created based on interview domains. Two trained coders conducted iterative coding of the transcripts, and new codes were added through line-by-line coding and thematic grouping. RESULTS Twenty participants (45% female, mean age of 38) completed interviews between June and November 2021. Participants reported negative impacts of the pandemic on mental health, financial wellbeing, and drug quality. However, the health impacts of COVID-19 were often described as less concerning than its impacts on these other aspects of life. Many expressed doubt in the severity of COVID-19 infection. Among the 16 unvaccinated participants who reported receiving most of their information from the internet or word of mouth, uncertainty about vaccine contents and distrust of healthcare and government institutions engendered wariness of the vaccination. Distrust of healthcare providers was related to past stigmatization and judgement, but did not extend to the local HR organization, which was unanimously endorsed as a positive institution. Among participants who did not access services directly from the HR organization, secondary distribution of HR supplies by other PWUD was a universally cited form of health maintenance. Participants expressed interest in low-threshold healthcare, including COVID-19 vaccination, should it be offered in the local HR organization's office and mobile units. CONCLUSION COVID-19 and related public health measures have affected this community in numerous ways. Integrating healthcare services into harm reduction infrastructures and mobilizing secondary distributors of supplies may promote greater engagement with vaccination programs and other healthcare services. TRIAL NUMBER NCT04427202.
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Affiliation(s)
- Alex Rains
- Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - Mary York
- Department of Sociology, Southern Illinois University, Carbondale, IL, USA
| | - Rebecca Bolinski
- Department of Sociology, Southern Illinois University, Carbondale, IL, USA
| | - Jerel Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, USA
- Center for Cultural Humility, Cornell University, Ithaca, NY, USA
| | - Lawrence J Ouellet
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Wiley D Jenkins
- Department of Epidemiology and Biostatistics, SIU School of Medicine, Springfield, IL, USA
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, USA
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23
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Struggling With Recovery From Opioids: Who Is at Risk During COVID-19? J Addict Med 2022:01271255-990000000-00100. [PMID: 36255118 DOI: 10.1097/adm.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Individuals in recovery from opioid use disorder (OUD) are vulnerable to the impacts of the COVID-19 pandemic. Recent findings suggest increased relapse risk and overdose linked to COVID-19-related stressors. We aimed to identify individual-level factors associated with COVID-19-related impacts on recovery. METHODS This observational study (NCT04577144) enrolled 216 participants who previously partook in long-acting buprenorphine subcutaneous injection clinical trials (2015-2017) for OUD. Participants indicated how COVID-19 affected their recovery from substance use. A machine learning approach Classification and Regression Tree analysis examined the association of 28 variables with the impact of COVID-19 on recovery, including demographics, substance use, and psychosocial factors. Tenfold cross-validation was used to minimize overfitting. RESULTS Twenty-six percent of the sample reported that COVID-19 had made recovery somewhat or much harder. Past-month opioid use was higher among those who reported that recovery was harder compared with those who did not (51% vs 24%, respectively; P < 0.001). The final classification tree (overall accuracy, 80%) identified the Beck Depression Inventory (BDI-II) as the strongest independent risk factor associated with reporting COVID-19 impact. Individuals with a BDI-II score ≥10 had 6.45 times greater odds of negative impact (95% confidence interval, 3.29-13.30) relative to those who scored <10. Among individuals with higher BDI-II scores, less progress in managing substance use and treatment of OUD within the past 2 to 3 years were also associated with negative impacts. CONCLUSIONS These findings underscore the importance of monitoring depressive symptoms and perceived progress in managing substance use among those in recovery from OUD, particularly during large-magnitude crises.
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24
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Mauro PM, Gutkind S, Rivera-Aguirre A, Gary D, Cerda M, Santos EC, Castillo-Carniglia A, Martins SS. Trends in cannabis or cocaine-related dependence and alcohol/drug treatment in Argentina, Chile, and Uruguay. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103810. [PMID: 35939947 PMCID: PMC9912990 DOI: 10.1016/j.drugpo.2022.103810] [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: 10/07/2021] [Revised: 07/09/2022] [Accepted: 07/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND In the context of changing cannabis and other drug policy and regulation, concerns may arise regarding drug treatment access and use. We assessed cannabis/cocaine-related dependence and treatment in Argentina, Chile, and Uruguay. METHODS Nationally representative cross-sectional household surveys of people ages 15-64 in Argentina (4 surveys, 2006-2017), Chile (7 surveys, 2006-2018), and Uruguay (4 surveys, 2006-2018) were harmonized. We estimated weighted prevalences of cannabis or cocaine-related (cocaine or cocaine paste) dependence, based on meeting 3+ past-year ICD-10 dependence criteria. We estimated weighted prevalences of past-year alcohol/drug treatment use (Argentina, Chile) or use/seeking (Uruguay) among people with past-year cannabis/cocaine-related dependence. We tested model-based prevalence trends over time and described individual-level treatment correlates by country. RESULTS Cannabis/cocaine dependence prevalence increased in the region starting in 2010-2011, driven by cannabis dependence. Adjusted cannabis dependence prevalence increased from 0.7% in 2010 to 1.5% in 2017 in Argentina (aPD=0.8, 95% CI= 0.3, 1.2), from 0.8% in 2010 to 2.8% in 2018 in Chile (aPD=2.0, 95% CI= 1.4, 2.6), and from 1.4% in 2011 to 2.4% in 2018 in Uruguay (aPD=0.9, 95% CI= 0.2, 1.6). Cocaine-related dependence increased in Uruguay, decreased in Argentina, and remained stable in Chile. Among people with past-year cannabis/cocaine dependence, average alcohol/drug treatment use prevalence was 15.3% in Argentina and 6.0% in Chile, while treatment use/seeking was 14.7% in Uruguay. Alcohol/drug treatment prevalence was lower among people with cannabis dependence than cocaine-related dependence. Treatment correlates included older ages in all countries and male sex in Argentina only. CONCLUSION Alcohol/drug treatment use among people with cannabis/cocaine-related dependence remained low, signaling an ongoing treatment gap in the context of growing cannabis dependence prevalence in the region. Additional resources may be needed to increase treatment access and uptake. Future studies should assess contributors of low treatment use, including perceived need, stigma, and service availability.
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Affiliation(s)
- Pia M Mauro
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA.
| | - Sarah Gutkind
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
| | - Ariadne Rivera-Aguirre
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA; Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
| | - Dahsan Gary
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
| | - Magdalena Cerda
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA
| | - Erica Chavez Santos
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA; University of Washington School of Public Health, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Alvaro Castillo-Carniglia
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA; Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile; Society and Health Research Center, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Badajoz 130, Room 1306, Las Condes, Santiago, Chile; Millennium Nucleus on Sociomedicine (SocioMed), Chile
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
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Online dialectical behavioral therapy for adults with internet addiction: A quasi-experimental trial during the COVID-19 pandemic. Psychiatry Res 2022; 315:114698. [PMID: 35792416 DOI: 10.1016/j.psychres.2022.114698] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 11/20/2022]
Abstract
The pathological use of the Internet has surged during the pandemic, even though service provisions were negatively impacted. Telepsychiatry can be used as a solution to maintain psychiatric addiction services. This study examined the efficacy of online group dialectical behavioral therapy (DBT) for Internet addiction (IA), compared to cognitive behavioral therapy (CBT). Participants were divided into two arms for 8 weeks: the experimental arm received eight sessions of online DBT skill group training (n = 20), and the control arm received four sessions of online individual CBT (n = 20). All participants were required to complete a sociodemographic and Internet use survey, the Internet Addiction Test (IAT), and the University of Rhode Island Change Assessment (URICA). All participants completed the therapy. Of the 40 participants, six (15%) perceived the need for therapy and one (2.5%) participant had a history of seeking IA therapy. In the pre-post comparison, significant improvements were noted in the IAT and URICA scores as well as Internet use duration for both arms. No significant differences were observed across the arms and in the time-by-arm interaction. Online group DBT is a viable alternative to online CBT in an acute constrained setting, although further studies are required to scrutinize its long-term efficacy. Trial Registration: ISRCTN17273762.
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26
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Shircliff K, Liu M, Prestigiacomo C, Fry M, Ladd K, Gilbert MK, Rattermann MJ, Cyders MA. Mixed methods prospective findings of the initial effects of the U.S. COVID-19 pandemic on individuals in recovery from substance use disorder. PLoS One 2022; 17:e0270582. [PMID: 35776699 PMCID: PMC9249176 DOI: 10.1371/journal.pone.0270582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
The beginning of the U.S. COVID-19 pandemic interrupted integral services and supports for those in recovery from substance use disorders. The current study used qualitative and quantitative data to identify 1) pandemic-related barriers/stressors, 2) coping strategies employed, and 3) how the stressors and strategies predicted subsequent substance use frequency. Participants were 48 adults (40.5% female; 90.2% White) between 26 and 60 years old (M = 42.66, SD = 8.44) who were part of a larger, multi-year longitudinal study of individuals in recovery from substance use disorders. Individuals completed two interviews, one during the six weeks of initial stay-at-home orders in the state in which data were collected and the second within six to twelve months of their initial interview. Common barriers to recovery included cancelled support meetings, changes in job format (i.e., being fired or furloughed), and lack of social support. Common coping strategies included self-care, leisure activities/hobbies, taking caution against exposure, and strengthening personal relationships. The relationship between cravings at baseline and substance use at follow up was stronger for those who experienced worsening of their mental health (B = 21.80, p < .01) than for those who did not (B = 5.45, p = 0.09), and for those who were taking caution against exposure (B = 24.57, p < .01) than for those who were not (B = 1.87, p = 0.53). Those who engaged in self-care (B = 0.00, p>.99) had lower rates of substance use at follow-up than those who did not employ self-care as a coping mechanism (B = 16.10, p < .01). These findings inform research priorities regarding prospective effects of the pandemic on treatment endeavors, particularly emphasizing treating mental health and encouraging self-care strategies.
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Affiliation(s)
- Katherine Shircliff
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Melissa Liu
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Christiana Prestigiacomo
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Melissa Fry
- Department of Sociology, Indiana University Southeast, Indianapolis, Indiana, United States of America
| | - Kevin Ladd
- Department of Psychology, Indiana University South Bend, Indianapolis, Indiana, United States of America
| | | | - Mary Jo Rattermann
- Research & Evaluation Resources LLC, Indianapolis, Indiana, United States of America
- Community Fairbanks Recovery Center, Indianapolis, Indiana, United States of America
| | - Melissa A. Cyders
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
- * E-mail:
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Leslie K, Bartram M, Atanackovic J, Chamberland-Rowe C, Tulk C, Bourgeault IL. Enhancing the capacity of the mental health and substance use health workforce to meet population needs: insights from a facilitated virtual policy dialogue. Health Res Policy Syst 2022; 20:51. [PMID: 35525981 PMCID: PMC9077339 DOI: 10.1186/s12961-022-00857-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Timely knowledge mobilization has become increasingly critical during the COVID-19 pandemic and complicated by the need to establish or maintain lines of communication between researchers and decision-makers virtually. Our recent pan-Canadian research study on the mental health and substance use health (MHSUH) workforce during the pandemic identified key policy barriers impacting this essential workforce. To bridge the evidence-policy gap in addressing these barriers, we held a facilitated virtual policy dialogue. This paper discusses the insights generated at this virtual policy dialogue and highlights how this integrated knowledge mobilization strategy can help drive evidence-based policy in an increasingly digital world. METHODS We held a 3-hour virtual policy dialogue with 46 stakeholders and policy decision-makers as the final phase in our year-long mixed-methods research study. The event was part of our integrated knowledge mobilization strategy and was designed to generate stakeholder-driven policy implications and priority actions based on our research findings. The data collected from the virtual policy dialogue included transcripts from the small-group breakout rooms and main sessions, reflective field notes and the final report from the external facilitator. Coded data were thematically analysed to inform our understanding of the prioritization of the policy implications and action items. RESULTS Facilitated virtual policy dialogues generate rich qualitative insights that guide community-informed knowledge mobilization strategies and promote evidence-informed policy. Our policy dialogue identified actionable policy recommendations with equity as a cross-cutting theme. Adapting policy dialogues to virtual formats and including technology-assisted facilitation can offer advantages for equitable stakeholder participation, allow for deeper analysis and help build consensus regarding evidence-based policy priorities. CONCLUSIONS Our facilitated virtual policy dialogue was a key knowledge mobilization strategy for our research on the capacity of the Canadian MHSUH workforce to respond to the COVID-19 pandemic. Our policy dialogue allowed us to engage a diverse group of MHSUH workforce stakeholders in a meaningful action-oriented way, provided an avenue to get feedback on our research findings, and generated prioritized action items that incorporated the knowledge and experience of these MHSUH workforce stakeholders.
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Affiliation(s)
- Kathleen Leslie
- Faculty of Health Disciplines, Athabasca University, 1 University Drive Athabasca, Athabasca, AB, T9S 3A3, Canada.
| | - Mary Bartram
- Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON, K1R 1A4, Canada
| | - Jelena Atanackovic
- School of Sociological and Anthropological Studies, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Caroline Chamberland-Rowe
- Telfer School of Management, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Christine Tulk
- Faculty of Arts and Social Sciences, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Ivy Lynn Bourgeault
- School of Sociological and Anthropological Studies, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
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Kumar N, Janmohamed K, Nyhan K, Martins SS, Cerda M, Hasin D, Scott J, Sarpong Frimpong A, Pates R, Ghandour LA, Wazaify M, Khoshnood K. Substance, use in relation to COVID-19: A scoping review. Addict Behav 2022; 127:107213. [PMID: 34959077 PMCID: PMC8684053 DOI: 10.1016/j.addbeh.2021.107213] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/24/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023]
Abstract
Background We conducted a scoping review focused on various forms of substance use amid the pandemic, looking at both the impact of substance use on COVID-19 infection, severity, and vaccine uptake, as well as the impact that COVID-19 has had on substance use treatment and rates. Methods A scoping review, compiling both peer-reviewed and grey literature, focusing on substance use and COVID-19 was conducted on September 15, 2020 and again in April 15, 2021 to capture any new studies. Three bibliographic databases (Web of Science Core Collection, Embase, PubMed) and several preprint servers (EuropePMC, bioRxiv, medRxiv, F1000, PeerJ Preprints, PsyArXiv, Research Square) were searched. We included English language original studies only. Results Of 1564 articles screened in the abstract and title screening phase, we included 111 research studies (peer-reviewed: 98, grey literature: 13) that met inclusion criteria. There was limited research on substance use other than those involving tobacco or alcohol. We noted that individuals engaging in substance use had increased risk for COVID-19 severity, and Black Americans with COVID-19 and who engaged in substance use had worse outcomes than white Americans. There were issues with treatment provision earlier in the pandemic, but increased use of telehealth as the pandemic progressed. COVID-19 anxiety was associated with increased substance use. Conclusions Our scoping review of studies to date during COVID-19 uncovered notable research gaps namely the need for research efforts on vaccines, COVID-19 concerns such as anxiety and worry, and low- to middle-income countries (LMICs) and under-researched topics within substance use, and to explore the use of qualitative techniques and interventions where appropriate. We also noted that clinicians can screen and treat individuals exhibiting substance use to mitigate effects of the pandemic. Funding Study was funded by the Institution for Social and Policy Studies, Yale University and The Horowitz Foundation for Social Policy. DH was funded by a NIDA grant (R01DA048860). The funding body had no role in the design, analysis, or interpretation of the data in the study.
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Farhoudian A, Radfar SR. How Substance Use Treatment Services in Iran Survived Despite a Dual Catastrophic Situation. Am J Public Health 2022; 112:S133-S135. [PMID: 35349327 PMCID: PMC8965175 DOI: 10.2105/ajph.2022.306794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Ali Farhoudian
- Ali Farhoudian is with the Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ramin Radfar is with the School of Advanced Technologies in Medicine, Tehran University of Medical Sciences
| | - Seyed Ramin Radfar
- Ali Farhoudian is with the Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ramin Radfar is with the School of Advanced Technologies in Medicine, Tehran University of Medical Sciences
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Corey J, Lyons J, O’Carroll A, Stafford R, Ivers JH. A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063219. [PMID: 35328907 PMCID: PMC8954292 DOI: 10.3390/ijerph19063219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.
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Affiliation(s)
- Julia Corey
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | - James Lyons
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | | | - Richie Stafford
- HSE Community Healthcare Organisation Dublin North City & County, D09C8P5 Dublin, Ireland;
| | - Jo-Hanna Ivers
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
- Correspondence:
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Vallecillo G, Fonseca F, Oviedo L, Durán X, Martinez I, García-Guix A, Castillo C, Torrens M, Llana S, Roquer A, Martinez MDLC, Aguelo S, Canosa I. Similar COVID-19 incidence to the general population in people with opioid use disorder receiving integrated outpatient clinical care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100027. [PMID: 35156106 PMCID: PMC8760741 DOI: 10.1016/j.dadr.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022]
Abstract
Introduction During the COVID-19 pandemic, limited access to health care augmented COVID-19 risk in subjects with opioid use disorder (OUD). The aim of the study was to compare COVID-19 incidence in individuals with OUD receiving continuous clinical care with that of the general population. Methods A prospective cohort study was carried out from March 2020 to March 2021 comparing COVID-19 cumulative incidence of individuals presenting an OUD receiving integrated clinical care with that of an age-reference general population, in three public outpatient treatment centers for addiction in Barcelona, Spain. Results Over the study period, 366 individuals received clinical care. Mean age: 48.2±8.9 years, 280 (76.5%) were men and 283 (77.3%) native Spanish. All subjects were on opioid agonist therapy. Prevalence of communicable diseases were: HIV infection in 109 (29.8%) and hepatitis C in 46 (12.6%). Psychiatric comorbidity was present in 207 (56.6%), and 119 (32.5%) had >1 chronic medical disease. COVID-19 was diagnosed in 10 patients a cumulative incidence of 2,732 casesx100,000 people/year (C.I.95%: 1,318–4,967). There were no differences compared to the age-general population: 2,856 casesx100,000 people/year (C.I.95%: 2,830–2,880) (p=0.81). In the bivariate analysis, hypertension (5[50.0%] vs. 53[14.9%], p=0.01) and cardiovascular chronic diseases (2 [20.0%] vs. 8 [2.2%], p=0.03) were more prevalent in patients with OUD and COVID-19. Conclusions Individuals with OUD who received integrated clinical care had a COVID-19 incidence comparable to the general population. Ensuring comprehensive healthcare is essential to prevent the clinical impact of COVID-19 on individuals with OUD.
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Narasimha VL, Butner J, Hanafi E, Farokhnia M, Bhad R, Chalabianloo F, Kouimtsidis C, Baldacchino A, Arunogiri S. Harm reduction and abstinence-based models for treatment of substance use disorders during the COVID-19 pandemic: a global perspective. BJPsych Int 2022; 19:66-69. [PMID: 36287782 PMCID: PMC9540565 DOI: 10.1192/bji.2022.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 01/14/2023] Open
Abstract
The COVID-19 pandemic has significantly affected treatment services for people with substance use disorders (SUDs). Based on the perspectives of service providers from eight countries, we discuss the impact of the pandemic on SUD treatment services. Although many countries quickly adapted in provision of harm reduction services by changes in policy and service delivery, some went into a forced abstinence-based strategy. Similarly, disruption of abstinence-based approaches such as therapeutic communities has been reported. Global awareness is crucial for responsible management of SUDs during the pandemic, and the development of international health policy guidelines is an urgent need in this area.
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The impact of COVID-19 pandemic on the 2020 hepatitis C cascade of care in the country of Georgia. Public Health 2022; 205:182-186. [PMID: 35305459 PMCID: PMC9004234 DOI: 10.1016/j.puhe.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In 2015, the Republic of Georgia initiated a National Hepatitis C Elimination Program, with a goal of 90% reduction in prevalence of chronic hepatitis C virus (HCV) infections by 2020. In this article, we explore the impact of the COVID-19 pandemic on the 2020 hepatitis C cascade of care in Georgia. STUDY DESIGN Retrospective analytic study. METHODS We used a national screening registry that includes hospitals, blood banks, antenatal clinics, harm reduction sites, and other programs and services to collect data on hepatitis C screening. A separate national treatment database was used to collect data on viremia and diagnostic testing, treatment initiation, and outcome including testing for and achieving sustained virologic response (SVR). We used these databases to create hepatitis C care cascades for 2020 and 2019. Bivariate associations for demographic characteristics and screening locations per year and care cascade comparisons were assessed using a chi-squared test. RESULTS In 2020 compared to 2019, the total number of persons screened for HCV antibodies decreased by 25% (from 975,416 to 726,735), 59% fewer people with viremic infection were treated for HCV infection (3188 vs. 7868), 46% fewer achieved SVR (1345 vs. 2495), a significantly smaller percentage of persons with viremic infection initiated treatment for HCV (59% vs. 62%), while the percentage of persons who achieved SVR (99.2% vs. 99.3%) remained stable. CONCLUSIONS The COVID-19 pandemic had a negative impact on the hepatitis C elimination program in Georgia. To ensure Georgia reaches its elimination goals, mitigating unintended consequences of delayed diagnosis and treatment of hepatitis C due to the COVID-19 pandemic are paramount.
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Peprah E, Myers B, Kengne AP, Peer N, El-Shahawy O, Ojo T, Mukasa B, Ezechi O, Iwelunmor J, Ryan N, Sakho F, Patena J, Gyamfi J. Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1097. [PMID: 35162121 PMCID: PMC8834153 DOI: 10.3390/ijerph19031097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023]
Abstract
Substance use is increasing throughout Africa, with the prevalence of alcohol, tobacco, cannabis, and other substance use varying regionally. Concurrently, sub-Saharan Africa bears the world's largest HIV burden, with 71% of people living with HIV (PWH) living in Africa. Problematic alcohol, tobacco, and other substance use among PWH is associated with multiple vulnerabilities comprising complex behavioral, physiological, and psychological pathways that include high-risk behaviors (e.g., sexual risk-taking), HIV disease progression, and mental health problems, all of which contribute to nonadherence to antiretroviral therapy. Physiologically, severe substance use disorders are associated with increased levels of biological markers of inflammation; these, in turn, are linked to increased mortality among PWH. The biological mechanisms that underlie the increased risk of substance use among PWH remain unclear. Moreover, the biobehavioral mechanisms by which substance use contributes to adverse health outcomes are understudied in low- and middle-income countries (LMIC). Syndemic approaches to understanding the co-occurrence of substance use and HIV have largely been limited to high-income countries. We propose a syndemic coupling conceptual model to disentangle substance use from vulnerabilities to elucidate underlying disease risk for PWH. This interventionist perspective enables assessment of biobehavioral mechanisms and identifies malleable targets of intervention.
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Affiliation(s)
- Emmanuel Peprah
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia;
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7925, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.-P.K.); (N.P.)
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.-P.K.); (N.P.)
| | - Omar El-Shahawy
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD 21287, USA
| | - Temitope Ojo
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | | | - Oliver Ezechi
- Nigerian Institute of Medical Research, Yaba, Lagos 101245, Nigeria;
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Department of Behavioral Science and Health Education, Saint Louis University, St. Louis, MO 63104, USA;
| | - Nessa Ryan
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Fatoumata Sakho
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - John Patena
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Joyce Gyamfi
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
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del Palacio-Gonzalez A, Thylstrup B, Houborg E. The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users’ needs and recommendations for the future. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:175-189. [PMID: 35757093 PMCID: PMC9189563 DOI: 10.1177/14550725211069229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study was to document employees’ experiences of changes in service provision for substance use disorders (SUDs) during the first COVID-19 lockdown in Denmark (spring 2020), as well as to examine their relation to challenges in meeting the service users’ needs. Methods: Employees (N = 373) working in SUD treatment and harm reduction services completed an online survey soon after the first national lockdown. The survey included questions about changes in service provision during the lockdown, perceived concerns of the service users, and challenges in meeting the users’ emerging needs. Results: Employees reported some positive changes in service provisions, such as increased flexibility in appointments, administering medication-assisted treatment (MAT), and use of telehealth. Negative changes were related to reduced contact with practitioners and harm reduction facilities. Approximately one third of employees reported significant challenges in meeting the users’ emerging needs. This was particularly so when users’ concerns were about physical and mental well-being, and substance use. In regression models, negative changes in the access to practitioners and MAT administration (but not other changes) predicted difficulties meeting the users’ needs. Conclusion: Employees in SUD treatment and harm reduction services in Denmark experienced both positive and negative changes as a result of the first lockdown. However, not all the provision changes were linked to challenges in meeting the users’ needs. We discuss practical and research implications of our findings with a focus on the users’ physical and mental health, use of telehealth, MAT, and overall service reorganisation.
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Affiliation(s)
- Laura G Leahy
- Laura G. Leahy, DrNP, APRN, PMH-CNS/FNP, CARN-AP, FAANP, FAAN, APNSolutions, LLC, Sewell, NJ, USA
| | - Susan E Caverly
- Susan E. Caverly, PhD, ARPN, PMH-NP, BC, PMH-CNS Child Adolescent and Adult, Therapeutic Health Service, Everett, WA, USA
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Arya S, Ghosh A, Mishra S, Swami MK, Prasad S, Somani A, Basu A, Sharma K, Padhy SK, Nebhinani N, Singh LK, Choudhury S, Basu D, Gupta R. A multicentric survey among patients with substance use disorders during the COVID-19 lockdown in India. Indian J Psychiatry 2022; 64:48-55. [PMID: 35400749 PMCID: PMC8992763 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_557_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/27/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The unprecedented first wave of the COVID-19 pandemic severely impacted mental health services globally. However, the negative impact of such disruptions on people with substance use disorders (SUD) seeking treatment remains unclear. We aim to explore the behaviors adopted by these individuals to overcome the service disruptions. MATERIALS AND METHODS We explored the changes related to substance use behavior (quit attempts, withdrawal experienced, treatment-seeking, and risky behaviors), and behavioral changes in response to COVID-19 lockdown. A cross-sectional survey was conducted among 404 people with SUD seeking treatment from seven centers across India. They were assessed by a specially designed structured questionnaire during the first wave (June-September) of the pandemic. RESULTS An overwhelming majority experienced withdrawal symptoms, with close to half making quit attempts and seeking treatment during the lockdown. Three-fourth of the sample reported difficulty in accessing treatment services and medications. Patients with opioid use were significantly more likely to think about quitting (χ2 = 20.408, P = 0.000), make attempts (χ2 = 12.436, P = 0.000), seek treatment (χ 2 = 7.536, P = 0.006), and self-medicate for withdrawal symptoms (χ2 = 5.885, P = 0.015). In turn, those with alcohol use were more likely to use telepsychiatry services (χ2 = 35.143, P = 0.000) and experience stigma by family members (χ2 = 29.951, P = 0.000) and neighbors (χ2 = 17.725, P = 0.000). Among COVID-19 safety precautions, majority practised wearing masks and social distancing but not others. CONCLUSION COVID-19 lockdown led a significant proportion of substance users, especially opioid users, to make quit attempts and seek help. However, these could not be sustained due to difficulty in accessing treatment services. Further, significant proportion failed to adhere to COVID-19 safety precautions.
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Affiliation(s)
- Sidharth Arya
- State Drug Dependence Treatment Centre, Institute of Mental Health, Pt. BDS University of Health Sciences, Rohtak, Haryana, India
| | - Abhishek Ghosh
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shree Mishra
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mukesh Kumar Swami
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sambhu Prasad
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Aditya Somani
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Aniruddha Basu
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Kshitiz Sharma
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Susanta Kumar Padhy
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Lokesh Kumar Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Shinjini Choudhury
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debasish Basu
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajiv Gupta
- State Drug Dependence Treatment Centre, Institute of Mental Health, Pt. BDS University of Health Sciences, Rohtak, Haryana, India
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Supporting Parents' Services Access During the COVID-19 Pandemic Through the Infant-Toddler Court Team Program. Matern Child Health J 2022; 26:2377-2384. [PMID: 36346566 PMCID: PMC9643928 DOI: 10.1007/s10995-022-03527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Infant-Toddler Court Teams (ITCTs) are a collaborative practice designed to improve timely identification and receipt of needed services for families of infants and toddlers involved in the child welfare system and their families. The goal of the study was to explore the impact of the first year of COVID compared to the previous year, in the context of ITCT support, on: (1) parents' access to services; (2) parents' services receipt and access within 30 days and within 14 days from referral; and (3) predictors of services access and receipt. METHODS Overall, 897 instances of services needs were analyzed, 411 pre-COVID and 486 during COVID. Logistic regression models were used to test for differences pre- and during COVID, controlling for covariates. RESULTS A reduction in service access was found across all services during COVID (OR = 0.2, CI: 0.1-0.3, p < .0001). Nevertheless, if a service was still available, parents were able to maintain similar levels of receipt within 30 days and within 14 days as before COVID. Moreover, a higher percentage of parents in need received mental health services in 30 or fewer days and substance use disorder services in both 14 and 30 or fewer days during COVID compared to pre-COVID. DISCUSSION This success is notable given the significant disruption to the availability of services and barriers to accessing services caused by the pandemic. ITCTs provided a robust platform for supporting the health and well-being of families with very young children in the face of a severely reduced service landscape due to COVID-19.
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Torrens M, Fonseca F. Opioid use and misuse in Europe: COVID-19 new challenges? Eur Neuropsychopharmacol 2022; 54:67-69. [PMID: 34565653 DOI: 10.1016/j.euroneuro.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Marta Torrens
- Addiction Research Group (GRAd), Neuroscience Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain.
| | - Francina Fonseca
- Addiction Research Group (GRAd), Neuroscience Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
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Salamanca-Buentello F, Cheng DK, Sabioni P, Majid U, Upshur R, Sud A. Mal/adaptations: A qualitative evidence synthesis of opioid agonist therapy during major disruptions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103556. [PMID: 34902805 DOI: 10.1016/j.drugpo.2021.103556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/12/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Opioid agonist therapy (OAT) has been severely disrupted by the COVID-19 pandemic. The risks of opioid withdrawal, overdose, and diversion have increased, so there is an urgent need to adapt OAT to best support people who use drugs (PWUD). This review examines the views and experiences of PWUD, health care providers, and health system administrators on OAT during major disruptions to medical care to inform appropriate health system responses during the current pandemic and beyond. METHODS We conducted a systematic review and qualitative evidence synthesis. We searched three comprehensive datasets for qualitative and mixed-methods studies that examined OAT in the context of major disruptions such as natural disasters, and analyzed included studies using thematic analysis and the constant comparative method. We used conceptual frameworks of health systems resilience and adaptive systems to interpret our findings. RESULTS We included 10 studies published between 2002 and 2020 that examined OAT in the context of hurricanes, earthquakes, and terrorist attacks. We organized our results into three themes: uncertainty, inconsistency, and vulnerability; regulatory inflexibility; and lack of coordination. The highly regulated but poorly coordinated systems of OAT provision lacked flexibility to adapt to major disruptions, thereby manufacturing vulnerability for both PWUD and health workers. CONCLUSIONS OAT programs must be resilient and adaptable to face major disruptions while maintaining quality care. Our findings provide guidance to develop and implement innovative strategies that increase the adaptive potential of OAT programs while focusing on the needs of PWUD.
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Affiliation(s)
- Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Darren K Cheng
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Pamela Sabioni
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Umair Majid
- Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada; Division of Clinical Public Health, Dalla Lana Faculty of Public Health, 155 College Street, Toronto, Ontario M5G 1L4, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada
| | - Abhimanyu Sud
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada.
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Aponte-Melendez Y, Mateu-Gelabert P, Fong C, Eckhardt B, Kapadia S, Marks K. The impact of COVID-19 on people who inject drugs in New York City: increased risk and decreased access to services. Harm Reduct J 2021; 18:118. [PMID: 34819070 PMCID: PMC8611635 DOI: 10.1186/s12954-021-00568-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background While people who inject drugs (PWID) are vulnerable to the adverse outcomes of events like COVID-19, little is known regarding the impact of the current pandemic on PWID. We examine how COVID-19 has affected PWID in New York City across four domains: substance use, risk behaviors, mental health, and service utilization. Methods As part of a randomized trial to improve access to HCV treatment for PWID, we recruited 165 participants. Eligibility criteria included detectable HCV RNA and recent drug injection. The present cross-sectional analysis is based on a subsample of 106 participants. We compared responses between two separate samples: 60 participants interviewed prior to the pandemic (pre-COVID-19 sample) and 46 participants interviewed during the pandemic (COVID-19 sample). We also assessed differences by study group [accessible care (AC) and usual care (UC)]. Results Compared to the pre-COVID-19 sample, those interviewed during COVID-19 reported higher levels of mental health issues, syringe reuse, and alcohol consumption and greater reductions in syringe-service programs and buprenorphine utilization. In the analysis conducted by study group, the UC group reported significantly higher injection risk behaviors and lower access to buprenorphine treatment during COVID-19, while during the same period, the AC group reported lower levels of substance use and injection risk behaviors. Conclusion The current study provides insight on how COVID-19 has negatively affected PWID. Placing dispensing machines of harm-reduction supplies in communities where PWID live and increasing secondary exchange, mobile services, and mail delivery of supplies may help maintain access to lifesaving supplies during big events, such as COVID-19. Trial registration ClinicalTrials.gov NCT03214679. Registered July 11 2017. https://clinicaltrials.gov/ct2/show/NCT03214679.
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Affiliation(s)
- Yesenia Aponte-Melendez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA. .,NYU Rory Meyers College of Nursing, 380 Second Avenue, New York, NY, 10010, USA.
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA
| | | | - Shashi Kapadia
- Weill Cornell Medicine, 1305 York Ave 4th Floor, New York, NY, 10021, USA
| | - Kristen Marks
- Weill Cornell Medicine, 1305 York Ave 4th Floor, New York, NY, 10021, USA
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Cousins G, Durand L, Boland F, Harnedy N, Delargy Í, Scully M, Bourke M, Ebbitt W, Otero Vázquez M, Keenan E. Impact of the COVID-19 pandemic on opioid agonist treatment in Ireland: Protocol for an interrupted time series analysis. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13341.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
While opioid agonist treatment (OAT) is the most effective treatment for opioid dependence, it is heavily dependent on regular face-to-face healthcare delivery placing both clients and treatment providers at risk of COVID-19. Following the emergence of COVID-19, policies were rapidly changed in Ireland, with the introduction of national contingency guidelines by the HSE National Social Inclusion Office, beginning in March 2020 to ensure rapid and uninterrupted access to OAT while balancing efforts to mitigate COVID-19 risk. This study aims to assess the impact of the national contingency guidelines, on the quality of OAT care delivered in Ireland. An interrupted time series analysis will be conducted using anonymised aggregated level data obtained from the Central Treatment List (CTL), the national register of people receiving OAT, administered by the National Drug Treatment Centre Board on behalf of the HSE. Separate segmented regressions will be conducted to estimate the impact of the national contingency guidelines on the following outcomes: (1) number of patients in treatment; (2) number of patients starting OAT; (3) average waiting time for treatment; (4) number of people on waiting list; (5) number of patients dropping out of treatment. The study period will be divided into pre-(March 2019 to February 2020) and post- intervention (April 2020 to March 2021) segments. Immediate (change in level) and longer-term impacts (change in slope) of changes to provision of OAT in each of the outcomes will be investigated. Regression coefficients (β) and 95% confidence intervals (CIs) will be reported.
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Cousins G, Durand L, Boland F, Harnedy N, Delargy Í, Scully M, Bourke M, Ebbitt W, Otero Vázquez M, Mayock P, Corrigan N, Killeen N, Goff P, Pate M, Byrne P, Keenan E. Development of quality indicators for the continued and safe delivery of Opioid Agonist Treatment (OAT), throughout and beyond COVID-19, using a Delphi Consensus technique. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13366.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Opioid agonist treatment (OAT) is the most effective treatment for opioid dependence, although it relies heavily on regular face-to-face healthcare delivery. Following the emergence of COVID-19, policies were rapidly changed in Ireland to reduce the risk of contracting the virus for both clients and treatment providers. From March 2020, the Health Service Executive (HSE) National Social Inclusion Office introduced a series of national contingency guidelines, to ensure fast and uninterrupted access to OAT while balancing efforts to mitigate COVID-19 risks. The Programme for Government 2020 states they will retain many of the measures introduced during the COVID-19 pandemic to reduce waiting times in accessing treatment services and reduce overdose mortality. It is therefore essential to examine the impacts, benefits and unintended consequences of the special measures introduced during COVID-19 at a national level, thus informing which measures can and should be sustained throughout and beyond COVID-19 to support effective, safe and patient-centered care promoting the health and wellbeing of all people with opioid dependence. The aim of this project is to identify priorities for quality improvements which will inform clinical decision making throughout and beyond the pandemic. This will be achieved through a Delphi consensus study. Quality indicators will be identified by comparing the national contingency guidelines with the national 2016 Clinical Guidelines. The project steering group will review the proposed indicators, and the agreed quality indicators will be integrated into an on-line Delphi questionnaire. One hundred participants will be invited to form the Delphi consensus panel and will include a wide range of stakeholders, including people accessing OAT services, general practitioners, pharmacists and outreach workers. Evidence generated from this study will inform national policy decisions in relation to improving quality of care in OAT.
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Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168470. [PMID: 34444219 PMCID: PMC8394531 DOI: 10.3390/ijerph18168470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 12/28/2022]
Abstract
People who use drugs (PWUD) experience many social and health harms and are considered at greater risk of acquiring COVID-19. Little research has examined the impact of coronaviruses either on PWUD, or on services targeted to PWUD. We report the findings of a systematic review of empirical evidence from studies which have examined the impact of coronaviruses (Severe Acute Respiratory Syndrome (SARS-CoV-1) and Middle Eastern Respiratory Syndrome (MERS-CoV) and COVID-19) on PWUD or on service responses to them. Five databases were searched (MEDLINE, PsycINFO, CINAHL, ASSIA and EMBASE) as well as COVID-19 specific databases. Inclusion criteria were studies reporting any impact of SARS, MERS or COVID-19 or any service responses to those, published between January 2000 and October 2020. Weight of Evidence judgements and quality assessment were undertaken. In total, 27 primary studies were included and grouped by seven main themes: treatment/recovery services; emergency medical settings; low-threshold services; prison setting, PWUD/substance use disorder (SUD) diagnosis; people with SUD and HIV; ‘Sexual minority’ men. Overall, research in the area was scant, and of average/poor quality. More robust research is required to inform on-going and future responses to coronavirus epidemics for PWUD.
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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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Sen LT, Siste K, Hanafi E, Murtani BJ, Christian H, Limawan AP, Adrian, Siswidiani LP. Insights Into Adolescents' Substance Use in a Low-Middle-Income Country During the COVID-19 Pandemic. Front Psychiatry 2021; 12:739698. [PMID: 34721110 PMCID: PMC8551572 DOI: 10.3389/fpsyt.2021.739698] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/13/2021] [Indexed: 01/29/2023] Open
Abstract
Introduction: The COVID-19 pandemic and its lockdown have been a significant life event for many individuals, particularly adolescents. The immense psychological pressure could drive risky behavior, e.g., substance use, while lockdown might lead to decreased use. This study aimed to observe the change in substance use among adolescents in Indonesia and the moderating variables to consumption during the COVID-19 lockdown period. Methods: This study utilized an online survey from April 28, 2020 to June 30, 2020. The hyperlink was disseminated to school administrators and parenting groups through social media and direct messages. A total of 2,932 adolescents (17.4 ± 2.24 and 78.7% females) submitted valid responses. The survey was comprised of a sociodemographic section, substance use details, and psychometric sections, including the Alcohol Use Disorders Identification Test (AUDIT), Cigarette Dependence Scale 12 (CDS-12), Pittsburgh Sleep Quality Index (PSQI), and Strength and Difficulties Questionnaire (SDQ). Results: Overall, adolescent alcohol use during the pandemic was 5.1%, cigarette smoking was 3.1%, and drug consumption was 0.4%. Over half (53.4%) of alcohol drinkers reported increased drinking, and 33.1% had harmful or dependence-like drinking behavior; in contrast, 44.4% of adolescent smokers disclosed reduced cigarette consumption. Around 37.8% of the drug users indicated increased use. During the pandemic, adolescent alcohol use was associated with higher education [adjusted odds ratio (AOR) = 2.67, 95% confidence interval (CI) 1.02-4.86, p = 0.04], higher AUDIT scores (AOR = 1.33, 95% CI 1.25-1.42, p < 0.001), and very low prosocial behavior (AOR = 2.46, 95% CI 1.52-3.88, p < 0.001). Cigarette smoking was correlated with male sex (AOR = 9.56, 95% CI 5.64-16.62, p < 0.001), age (AOR = 1.40, 95% CI 1.14-1.75, p < 0.001), and higher CDS score (AOR = 1.17, 95% CI 1.13-1.20, p < 0.001). Conclusions: Rates of adolescent substance use were significant, with sizeable proportions reporting higher usage. This appeared to occur predominantly in specific demographics and those with a lower protective psychosocial attribute, i.e., prosocial behavior, during the lockdown. These findings should urge the strengthening of adolescent addiction care during and after the pandemic.
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Affiliation(s)
- Lee Thung Sen
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Kristiana Siste
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Enjeline Hanafi
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Belinda Julivia Murtani
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Hans Christian
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Albert Prabowo Limawan
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Adrian
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Levina Putri Siswidiani
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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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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