ABSTRACT
BACKGROUND: The coronavirus pandemic resulted in many changes which had the potential to impact mortality related to opioid agonist therapy (OAT; methadone, buprenorphine), including changes in the prescribing and dispensing of OAT and patterns of drug availability and use. We aimed to assess the impact of the first lockdown (initiated March 23rd 2020) on methadone- and buprenorphine-related deaths in England in people both prescribed and not prescribed OAT using data from the National Programme on Substance Abuse Deaths. METHODS: This was a retrospective post-mortem toxicology study of OAT-related deaths which occurred in the 3-month period March 23rd to June 22nd in the years 2016-2020. Provisional data regarding numbers accessing treatment for opioid use disorder was provided by the National Drug Treatment Monitoring System. RESULTS: We found a 64% increase in methadone-related deaths in March to June 2020 compared to March to June 2019 (2019 n = 96; 2020 projected n = 157). There were increases in the mortality rate of both in-treatment decedents (22% increase; 2019 n = 45; an exponential smoothing model of the 2016-19 trend [α=0.5] predicted 44 deaths in 2020, 55 were reported) and decedents not prescribed methadone (74% increase; 2019 n = 46; 2016-19 trend predicted 43 deaths in 2020, 80 were reported). There was no increase in buprenorphine-related deaths (2019 n = 9/529; 2020 n = 11/566). There were no changes in the numbers of deaths where other opioids or multiple substances were detected, or in methadone levels detected. Numbers of people accessing treatment for opioid use disorder in 2020 did not decrease relative to previous years (p >0.05). CONCLUSIONS: Methadone-related deaths in non-prescribed individuals, but not prescribed individuals, increased considerably above the annual trend forecast for 2020 during the first COVID-19 lockdown in England. Further studies are thus needed to understand this difference.
ABSTRACT
Background : The coronavirus pandemic resulted in many changes which had the potential to impact mortality related to opioid agonist therapy (OAT;methadone, buprenorphine), including changes in the prescribing and dispensing of OAT and patterns of drug availability and use. We aimed to assess the impact of the first lockdown (initiated March 23rd 2020) on methadone- and buprenorphine-related deaths in England in people both prescribed and not prescribed OAT using data from the National Programme on Substance Abuse Deaths. Methods : This was a retrospective post-mortem toxicology study of OAT-related deaths which occurred in the 3-month period March 23rd to June 22nd in the years 2016-2020. Provisional data regarding numbers accessing treatment for opioid use disorder was provided by the National Drug Treatment Monitoring System. Results : We found a 64% increase in methadone-related deaths in March to June 2020 compared to March to June 2019 (2019 n=96;2020 projected n=157). There were increases in the mortality rate of both in-treatment decedents (22% increase;2019 n=45;an exponential smoothing model of the 2016-19 trend [α=0.5] predicted 44 deaths in 2020, 55 were reported) and decedents not prescribed methadone (74% increase;2019 n=46;2016-19 trend predicted 43 deaths in 2020, 80 were reported). There was no increase in buprenorphine-related deaths (2019 n=9/529;2020 n=11/566). There were no changes in the numbers of deaths where other opioids or multiple substances were detected, or in methadone levels detected. Numbers of people accessing treatment for opioid use disorder in 2020 did not decrease relative to previous years (p >0.05). Conclusions : Methadone-related deaths in non-prescribed individuals, but not prescribed individuals, increased considerably above the annual trend forecast for 2020 during the first COVID-19 lockdown in England. Further studies are thus needed to understand this difference. Graphical Image, graphical
ABSTRACT
Introduction: The COVID-19 pandemic increased the volume of critically ill patients in hospital. Healthcare professionals (HCPs), many of whom had limited experience of communicating bad news to relatives, needed to be able to do this and often by telephone. Aim: To design, deliver and evaluate a simulation based course to help HCPs communicate about death and dying by telephone during the pandemic. Methods: In March 2020 a multi-professional group of clinicians and educators developed a 2-hour, socially distanced communication skills course for HCPs in our Trust. Courses ran through March-June 2020, each course facilitated by 3-5 faculty. The course taught the 'SPIKES' structure for breaking bad news (BBN), using it to critique a pre-recorded conversation and role play of simulated scenarios, with faculty feedback. Participant confidence (using 1-5 scale) was assessed by pre and post course questionnaire, and analysed by descriptive statistics. Qualitative feedback was from participant questionnaires and thematic analysis of a faculty focus group. Ethical approval was gained. Results: 79 HCPs attended a course;55 gave feedback: nurses (24), doctors (21), allied health professionals (10). There was significant improvement in participant confidence in having a communication structure for BBN (mean change 1.69 (CI 1.94,1.44), p=0.03);applying SPIKES to BBN by telephone (mean change 1.82 (CI 2.05,1.59), p=0.005);giving and seeking feedback to improve communication (mean change 1.55 (CI 1.79,1.3), p=0.012). Qualitative data indicated excellent engagement and relevance beyond the pandemic. A faculty focus group identified key themes: applicability post COVID-19, greater openness to communication challenges, and awareness of emotionality in practice. Conclusion: An innovative course developed during the COVID-19 pandemic demonstrated improved HCP confidence in communicating bad news. Skills taught are applicable post pandemic and will inform further course development.