The impact of a 24-hour syringe dispensing machine on a face-to-face needle and syringe program and targeted primary healthcare clinic.

OBJECTIVE: Automatic syringe dispensing machines (ADM) have become an important adjunct to Australia's needle and syringe programs (NSP). However, concerns that they reduce face-to-face contact with health staff and other health interventions remain. We examined changes in the number of needle/syringes dispensed at an ADM and occasions of service at a co-located face-to-face NSP and targeted primary healthcare clinic during the first wave of COVID-19 restrictions. METHODS: We reviewed data from an inner-city harm reduction program during the study period of April 2020 to March 2021 compared to the previous year. Multivariable linear regression models were used to estimate the association between occasions of service and equipment distribution. RESULTS: ADM-dispensed equipment increased significantly by 41.1%, while face-to-face NSP occasions decreased by 16.2%. Occasions provided by the targeted primary healthcare clinic increased by 59.7% per month. CONCLUSION: We have shown that 24-hour ADM access did not adversely affect the number of people using targeted primary healthcare when provided within close proximity. Implication for public health: These findings reinforce the demand for 24-hour needle/syringe access and can be used to support the expanded access to ADMs, especially where people who inject drugs (PWID) have access to appropriate healthcare.

Montana's Hard Right Turn

Budgets, combined with tax policy, provide rich evidence of the applied values of legislative bodies and executives. This paper evaluates budget and tax legislation in Montana that resulted from the 67th legislative session in 2021 that set policy for the 2023 biennium. Montana, whose political complexation has long been purple, moved unambiguously red in the elections of November 2020. This paper speaks to how this changed things in Montana's public policy, in the areas of budget and tax, and a series of other policy areas. One of the more notable findings is that while budget and tax certainly shifted right with the dominance of the Republican Party that itself has moved further right than where it was as recently as 2019, it did not move as far right as many observers had anticipated. The explanation provided here is that this was largely a result of the large infusion of federal COVID relief funds.

Are bottle shops using Twitter to increase advertising or encourage drinking during COVID-19?

OBJECTIVE: Preliminary reports suggested that liquor retailers used COVID-19 to promote alcohol through sponsored posts on Facebook and Instagram. To further understand the advertising practices during this period, we aimed to determine whether packaged liquor retailers increased their posts during COVID-19 or used COVID-19 to promote alcohol on Twitter. METHODS: 'Tweets' (Twitter posts) from all packaged liquor retailers in NSW written since 2018 were collected. Tweets written during the first COVID-19 lockdown period were coded for: references of COVID-19, types of marketing message, use of links to online stores and use of an alcohol-related 'meme'. RESULTS: There was no evidence of increased tweet frequency, however, some COVID-specific alcohol advertising was detected that leveraged the pandemic (4.0%) or referencing the pandemic without explicitly promoting alcohol (12.0%). The most popular market messages used in the tweets were encouraging alcohol use (15.4%) and easy access to alcohol at home (9.5%). CONCLUSIONS: At least on Twitter, there was no marked increase in posts from packaged liquor retailers in NSW and only some tweets used COVID-19 to promote alcohol. Implications for public health: The use of COVID-specific alcohol marketing on social media raises important considerations for legislative and regulatory requirements, particularly during major health events such as a pandemic.

Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic.

The impact of COVID-19 across health services, including treatment services for people who use drugs, is emerging but likely to have a high impact. Treatment services for people who use drugs provide essential treatment services including opiate agonist treatment and needle syringe programmes alongside other important treatment programmes across all substance types including withdrawal and counselling services. Drug and alcohol hospital consultation-liaison clinicians support emergency departments and other services provided in hospital settings in efficiently managing patients who use drugs and present with other health problems.COVID-19 will impact on staff availability for work due to illness. Patients may require home isolation and quarantine periods. Ensuring ongoing supply of opiate treatment during these periods will require significant changes to how treatment is provided. The use of monthly depot buprenorphine as well as moving from a framework of supervised dosing will be required for patients on sublingual buprenorphine and methadone. Ensuring ready access to take-home naloxone for patients is crucial to reduce overdose risks. Delivery of methadone and buprenorphine to the homes of people with confirmed COVID-19 infections is likely to need to occur to support home isolation.People who use drugs are likely to be more vulnerable during the COVID-19 epidemic, due to poorer health literacy and stigma and discrimination towards this group. People who use drugs may prioritise drug use above other health concerns. Adequate supply of clean injecting equipment is important to prevent outbreaks of blood-borne viruses. Opiate users may misinterpret SARS-CoV2 symptoms as opiate withdrawal and manage this by using opioids. Ensuring people who use drugs have access to drug treatment as well as access to screening and testing for SARS-CoV2 where this is indicated is important.