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One of the biggest global public health crisis began in Wuhan, China at the end of 2019. That emergency was the emergence of SARS-CoV-2 and the disease COVID-19, a highly transmissible acute respiratory syndrome. The pandemic declaration by the WHO in March 2020 caused the world to take on several measures to combat and contain the virus. Initially, social isolation and lockdown were the main initiatives, as there were no forms of treatment or prevention of the disease. These restrictive measures generate a change in the habit of the population that triggered serious physical and psychological impairments. One of the consequences was the increase in the use of substances of abuse and, consequently, substance use disorder, including tobacco. During the pandemic, cigarette consumption increased from 10 to 30% worldwide, whereas smoking is the main cause of preventable death and a risk factor for several diseases. Along with alcohol, nicotine has a greater addictive power than illicit drugs. Substance use disorders and COVID-19 have a synergistic effect, in this way, we seek to integrate neurochemical, cognitive and behavioral aspects that led to increased consumption and/or relapse in nicotine consumption and the used therapy.
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The article presents results of the study "State of Mental Health: American Healthcare Workers Report," commissioned by recovery and rehabilitation center All Points North. Topics discussed include findings on the average number of physicians who admitted consuming alcohol or controlled substances while working to cope with occupational stress, the implications of the study, and the percentage of healthcare workers who checked into a rehabilitation or detox facility.
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Study Objectives: A non-food-borne hepatitis A outbreak occurred in Michigan between August 2016 and September 2019, resulting in 920 cases, 738 hospitalizations, and 30 deaths. To support the Michigan Department of Health and Human Services' efforts to increase hepatitis A vaccination rates among high-risk individuals, our multicenter health system implemented an electronic medical record (EMR)-based vaccination intervention across its nine emergency departments (ED). The primary objective of this retrospective cohort and survey analysis was to quantitatively determine whether this intervention was successful in increasing vaccination rates. The secondary objective was to qualitatively assess the attitudes towards, and barriers to use of, the computerized vaccine reminder system.
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In response to a sharp rise in opioid-involved overdose deaths in the USA, states have deployed increasingly aggressive strategies to limit the loss of life, including civil commitment-the forcible detention of individuals whose opioid use presents a clear and convincing danger to themselves or others. While civil commitment often succeeds in providing short-term protection from overdose, emerging evidence suggests that it may be associated with long-term harms, including heightened risk of severe withdrawal, relapse and opioid-involved mortality. To better assess and mitigate these harms, states should collect more robust data on long-term health outcomes, decriminalise proceedings and stays, provide access to medications for opioid use disorder and strengthen post-release coordination of community-based treatment.
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Drug Overdose , Opioid-Related Disorders , Analgesics, Opioid/adverse effects , Drug Overdose/prevention & control , Humans , Opioid-Related Disorders/prevention & controlABSTRACT
This conference proceeding contain 39 articles that discuss epidemiology in the US. Topics include the Millenium Cohort Study, The CRONICAS Cohort Study, religious beliefs, coping mechanisms and type 2 diabetes, spatio-temporal modelling of COVID-19, cigarette smoking and spinal pain, self-perceived health status and obesity, oral cancer and smoking, renal impairment and diabetes, depression and BMI, affordable housing and COVID-19, opioid misuse among youth, emotions and cancer prevention, influenza vaccination among adults, blood lead levels and private wells, and air pollution and amyotrophic lateral sclerosis.
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Introduction: The emergence of the new coronavirus SARS-CoV-2 and the resulting COVID-19 pandemic have challenged all aspects of social and economic life in different countries, their health care systems, as well as the mental health of the population. The introduction of anti-epidemic measures with different duration and severity temporarily deprived of any of democratic freedoms and achievements and marked social communication with new rules. The tension and fear of the unknown, caused by the new disease, limited access to health facilities, impoverishment and job loss, increased mortality, restriction of contacts affected somewhat the mentality of every human being. Various researchers, including in Bulgaria, report significant negative effects on mental health, as this situation shows a clear negative trend. Aim: The article aims to present the second phase of the NCPHA study on the impact of COVID-19 pandemic on the mental health of Bulgarian citizens.
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Background: During the COVID-19 pandemic, most peer recovery programs had to end face-to-face services and move to an online and or phone-based format. It is not clear what impact if any, this may have had on individual referrals, contact and services rendered. The goal of this study was to explore the impact of the COVID-19 pandemic on a community-based peer-recovery program.
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BACKGROUND: Opioid-related harms, including fatal and non-fatal overdoses, rose dramatically during the COVID-19 pandemic and presented unique challenges during outbreaks in congregate settings such as shelters. People who are deprived of permanent housing have a high prevalence of substance use and substance use disorders, and need nimble, rapid, and portable harm reduction interventions to address the harms of criminalized substance use in an evidence-based manner. CASE STUDY: In February 2021, a COVID-19 outbreak was declared at an emergency men's shelter in Hamilton, Ontario, Canada. Building on pre-existing relationships, community and hospital-based addictions medicine providers and a local harm reduction group collaborated to establish a shelter-based opioid agonist treatment and safer supply program, and a volunteer run safer drug use space that also distributed harm reduction supplies. In the 4 weeks preceding the program, the rate of non-fatal overdoses was 0.93 per 100 nights of shelter bed occupancy. During the 26 days of program operation, there were no overdoses in the safer use space and the rate of non-fatal overdoses in the shelter was 0.17 per 100 nights of shelter bed occupancy. The odds ratio of non-fatal overdose pre-intervention to during intervention was 5.5 (95% CI 1.63-18.55, p = 0.0059). We were not able to evaluate the impact of providing harm reduction supplies and did not evaluate the impact of the program on facilitating adherence to public health isolation and quarantine orders. The program ended as the outbreak waned, as per the direction from the shelter operator. CONCLUSIONS: There was a significant reduction in the non-fatal overdose rate after the safer drug use and safer supply harm reduction program was introduced. Pre-existing relationships between shelter providers, harm reduction groups, and healthcare providers were critical to implementing the program. This is a promising approach to reducing harms from the criminalization of substance use in congregate settings, particularly in populations with a higher prevalence of substance use and substance use disorders.
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COVID-19 , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Emergency Shelter , Humans , Male , Ontario , Pandemics/prevention & controlABSTRACT
Based on data from mandatory HIV declarations in France, this article presents the characteristics of new HIV diagnoses among people who inject drugs (PWID), by their birthplace, for the period 2016-2019, and the evolutions of these characteristics since the 2004-2007 period. For 2016-2019, PWID represented 0.8% of all new HIV diagnoses declared, a decreased percentage compared to 2004-2007 (1.7%). The main evolutions observed are an increasing trend of PWID aged 50 years or over, an increase of unemployed PWID, a sharp rise in PWID from Eastern Europe and a decrease in those born in France, as well as an improvement in the early diagnosis indicator for PWID born in France that was not observed for those born abroad. Almost three-quarters of PWID had never been tested before their diagnosis. The rising proportion of unemployed PWID probably reflects worsened levels of precarity. The very high proportion of PWID never tested before the HIV diagnosis indicates that part of this population remains distant from the health system. These conclusions show the need to enhance targeted screening and support policies for PWID and migrants.
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RATIONALE: Ketamine has been used as a sedative analgesic in trauma setting, but data regarding its efficacy and safety is lacking in severe ARDS. This retrospective study aims to determine if Ketamine is safer as a sedative agent in mechanically ventilated patients. During the COVID pandemic, as there was a shortage of sedative agents, Ketamine was used. OBJECTIVES: The primary objective was to compare the safety of ketamine to other sedatives. The secondary objective was to compare the effect of ketamine to other sedatives regarding the need for vasopressor, incidence of delirium, infectious complications, acute kidney injury, hospital length of stay, and length of ventilator days. METHODS: A retrospective, observational cohort study was conducted. MEASUREMENTS AND MAIN RESULTS: One hundred and twenty-four patients (63 men and 61 women) were included. Thirty-four patients received ketamine, while 90 patients received other traditionally used sedatives such as propofol and midazolam. The patients' median age was 64 years in the ketamine group and 68 years in the non-ketamine group. Seventeen patients in the ketamine group (50%) and 65 patients (72%) in the non-ketamine group had mortality (p < 0.02). The hospital length of stay was 22.85 days (± 16.36) in the ketamine group and 15.62 days (± 14.63) in the non-ketamine group (p < 0.02). There was no statistically significant difference among the outcomes of the need for vasopressor, the incidence of delirium, infectious complications, and acute kidney injury. CONCLUSIONS: Ketamine as a sedative-analgesic agent in COVID-19 patients with severe acute respiratory distress syndrome demonstrated safety with reduced mortality. The ketamine group had a higher hospital length of stay, but a similar complication profile compared to the non-ketamine group. Further prospective randomized controlled trials are warranted to confirm these findings.
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BACKGROUND: Despite changing federal regulations for providing telehealth services and provision of controlled substances during the COVID-19 pandemic, there is little guidance available for office-based opioid treatment (OBOT) programs integrated into primary care settings. PURPOSE: (1) Develop disaster-preparedness protocols specific to the COVID-19 pandemic for an urban OBOT program, and (2) evaluate the impacts of the protocol and telehealth on care. METHODS: Disaster-preparedness protocols specific to the COVID-19 pandemic were developed for an urban OBOT program, implemented on March 16, 2020. Retrospective chart review compared patients from January 1, 2020 to March 13, 2020, to patients from March 16, 2020 to April 30, 2020, abstracting patient demographics and comparing show and no-show rates between studied groups. RESULTS: The disaster-preparedness protocol was developed under a deliberative process to address social issues of the urban underserved population. Of 852 visits conducted between Jan 1, 2020, and April 30, 2020, a 91.7% show rate (n = 166/181) was documented for telemedicine visits after protocol implementation compared with a 74.1% show rate (n = 497/671) for routine in-person care (P = .06) without significant differences between the study populations. The no-show rate was significantly lower after protocol implementation (8.3% vs 25.9%; P <0.05). CONCLUSIONS: OBOTs require organized workflows to continue to provide services during the COVID-19 pandemic. Telemedicine, in the face of relaxed federal regulations, has the opportunity to enhance addiction care, creating a more convenient as well as an equally effective mechanism for OBOTs to deliver care that should inform future policy.
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Buprenorphine/therapeutic use , Narcotic Antagonists/therapeutic use , Opioid-Related Disorders/drug therapy , Telemedicine/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Male , Pandemics/legislation & jurisprudence , Retrospective Studies , SARS-CoV-2 , Telemedicine/statistics & numerical dataABSTRACT
Before COVID-19 pandemic, advocates had long urged drug policy reforms based on health, security, civil rights, racial justice, fiscal stewardship, and other considerations. In the United States, such calls went largely unanswered. In response to COVID-19, public health and occupational safety concerns have rapidly transformed some drug policies, along with their enforcement. Almost contemporaneously, nationwide protests against violence and racism by militarized police have highlighted the enduring legacy of the Drug War in fueling carceral systems. Disruption from these historical events provides a once-in-a-century opportunity to reconsider the legal architecture of drug policy and policing-both in the U.S. and elsewhere. Rather than returning to a fundamentally broken and inequitable status quo, we urge envisioning a new drug policy in service to life, liberty, and the pursuit of happiness.