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Brothers TD, Leaman M, Bonn M, Lewer D, Atkinson J, Fraser J, Gillis A, Gniewek M, Hawker L, Hayman H, Jorna P, Martell D, O'Donnell T, Rivers-Bowerman H, Genge L. Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness. Drug Alcohol Depend 2022; 235:109440. [PMID: 35461084 PMCID: PMC8988445 DOI: 10.1016/j.drugalcdep.2022.109440] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND During a COVID-19 outbreak in the congregate shelter system in Halifax, Nova Scotia, Canada, a healthcare team provided an emergency "safe supply" of medications and alcohol to facilitate isolation in COVID-19 hotel shelters for residents who use drugs and/or alcohol. We aimed to evaluate (a) substances and dosages provided, and (b) outcomes of the program. METHODS We reviewed medical records of all COVID-19 isolation hotel shelter residents during May 2021. The primary outcome was successful completion of 14 days isolation, as directed by public health orders. Adverse events included (a) overdose; (b) intoxication; and (c) diversion, selling, or sharing of medications or alcohol. RESULTS Seventy-seven isolation hotel residents were assessed (mean age 42 ± 14 years; 24% women). Sixty-two (81%) residents were provided medications, alcohol, or cigarettes. Seventeen residents (22%) received opioid agonist treatment (methadone, buprenorphine, or slow-release oral morphine) and 27 (35%) received hydromorphone. Thirty-one (40%) residents received prescriptions stimulants. Six (8%) residents received benzodiazepines and forty-two (55%) received alcohol. Over 14 days, mean daily dosages increased of hydromorphone (45 ± 32 - 57 ± 42 mg), methylphenidate (51 ± 28 - 77 ± 37 mg), and alcohol (12.3 ± 7.6 - 13.0 ± 6.9 standard drinks). Six residents (8%) left isolation prematurely, but four returned. During 1059 person-days, there were zero overdoses. Documented concerns regarding intoxication occurred six times (0.005 events/person-day) and medication diversion/sharing three times (0.003 events/person-day). CONCLUSIONS COVID-19 isolation hotel residents participating in an emergency safe supply and managed alcohol program experienced high rates of successful completion of 14 days isolation and low rates of adverse events.
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Affiliation(s)
- Thomas D Brothers
- Department of Medicine (General Internal Medicine & Clinician-Investigator Program), Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, UK.
| | - Malcolm Leaman
- North End Community Health Centre, Halifax, Nova Scotia, Canada
| | - Matthew Bonn
- Canadian Association of People who Use Drugs, Dartmouth, Nova Scotia, Canada
| | - Dan Lewer
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | | | - John Fraser
- North End Community Health Centre, Halifax, Nova Scotia, Canada; Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Anesthesia, Pain Management & Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amy Gillis
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Gniewek
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Direction 180, Halifax, Nova Scotia, Canada
| | - Leisha Hawker
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Direction 180, Halifax, Nova Scotia, Canada
| | - Heather Hayman
- North End Community Health Centre, Halifax, Nova Scotia, Canada
| | | | - David Martell
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Direction 180, Halifax, Nova Scotia, Canada
| | | | | | - Leah Genge
- North End Community Health Centre, Halifax, Nova Scotia, Canada; Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Direction 180, Halifax, Nova Scotia, Canada
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