Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 132
Filter
1.
Clinical Toxicology ; 60:47-47, 2022.
Article in English | Web of Science | ID: covidwho-2030814
2.
31st ACM Web Conference, WWW 2022 ; : 673-676, 2022.
Article in English | Scopus | ID: covidwho-2029540

ABSTRACT

The COVID-19 pandemic exacerbated the ongoing opioid crisis in the United States. Individuals with a substance use disorder are vulnerable to relapse during times of acute stress. Online peer support communities (OPSCs) have the potential to decrease social isolation and increase social support for participants. In September 2020, we launched a private, professional-moderated OPSC using the Facebook Group platform to study its effects on the mental health wellness of women undergoing substance use treatment. This study was particularly meaningful as the participants were not able to join in-person treatment sessions due to the COVID-19 pandemic. Preliminary findings indicate that study participants reported decreased loneliness and increased online social support three months after initiating the OPSC. They tended to interact with content initiated by a clinical professional more than those generated by peers. © 2022 ACM.

3.
Journal of Medical Internet Research ; 2022.
Article in English | ProQuest Central | ID: covidwho-2022357

ABSTRACT

Background: Opioid addiction is currently one of the most pressing public health issues. Despite several treatment options for opioid addiction, the recurrence of use episodes during remission remains high. Research indicates that meaningful membership in various social groups underpins the successful transition from addiction to long-term remission. However, much of the current literature focuses on online peer-support groups for individuals in remission from substance use, sometimes also called recovery groups, a term we will use in line with the terminology used by the online community we studied. In contrast, online group memberships that promote substance use and groups that are unrelated to substance use and remission (non–drug-related groups) are rarely studied. Objective: This study aims to understand whether engagement with a variety of Reddit subforums (subreddits) provides those in remission from opioid use disorder (OUD) with social capital, thereby reducing their risk of a use episode over several years. More specifically, it aims to examine the different effects of engagement with substance use, recovery, and non–drug-related subreddits. Methods: A data set of 457 individuals in remission from OUD who posted their remission start date on Reddit was collected, of whom 219 (47.9%) indicated at least one use episode during the remission period. Using a Cox proportional hazards model, the effects of the number of non–drug-related, recovery, and substance use subreddits an individual had engaged with on the risk of a use episode were tested. Group engagement was assessed both in terms of the absolute number of subreddits and as a proportion of the total number of subreddits in which an individual had posted. Results: Engagement with a larger number of non–drug-related online communities reduced the likelihood of a use episode irrespective of the number of posts and comments made in these forums. This was true for both the absolute number of non–drug-related communities (P<.001) and the proportion of communities with which a person engaged (P<.001). The findings were less conclusive for recovery support and substance use groups;although participating in more recovery support subreddits reduced the risk of a use episode (P<.001), being part of a higher proportion of recovery support groups relative to other subreddits increased the risk (P=.01). A higher proportion of substance use subreddits marginally increased the risk of a use episode (P=.06);however, the absolute number of substance use subreddits significantly reduced the risk of a use episode (P=.002). Conclusions: Our work indicates that even minimal regular engagement with several non–drug-related online forums may provide those in remission from OUD with an opportunity to grow their social capital and reduce the risk of a use episode over several years.

4.
Dissertation Abstracts International: Section B: The Sciences and Engineering ; 83(10-B):No Pagination Specified, 2022.
Article in English | APA PsycInfo | ID: covidwho-2012329

ABSTRACT

The purpose of this study was to discuss the experience of this doctoral student engaging in the political process through the lens of advocating for alternative treatment methods for opioid use disorders (OUDs). A policy brief was created that aimed to have the Illinois General Assembly reschedule the psychedelic substance ibogaine so that it may be researched and potentially utilized as a treatment for OUDs in the state of Illinois. This project attempted to create a coalition with potential allies and held two meetings with Illinois House of Representative Members before ending the action phase of this project. While the intended efforts of this project were not successful, the writer learned to adapt to change including facing the COVID-19 pandemic, stigma of psychedelics, hesitancy of potential allies to get involved, and critique the underdeveloped planning and research in this project, all important factors when engaging in policy work. This project also encountered positive outcomes including positive relationships with professionals and firsthand experience of policy work. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

5.
Human Organization ; 79(4):292-303, 2020.
Article in English | CAB Abstracts | ID: covidwho-2011288

ABSTRACT

As a response to the COVID- 19 pandemic, the United States Drug Enforcement Administration (DEA) has temporarily relaxed restrictions to serve people who are opioid dependent during social distancing mandates. Changes include allowing patients to take home more doses of methadone and buprenorphine rather than coming to the clinic every day (for methadone) or weekly (for buprenomhine) and relaxed restrictions on telehealth delivery. Telemedicine Program representatives have described the relaxing of federal regulations as a "silver lining" to the COVID-19 pandemic. Drawing from medical anthropology approaches to epidemic surveillance and understandings of risk, we critically evaluate media representations of recent changes to telemedicine' prescribing, and opioid treatment delivery. Ethnographic research with providers and stakeholders in Arizona from 2017 to the present add insight to our analysis of media reports on these topics. Our findings demonstrate that media portrayal of access to medication-assisted treatment (MAT) as the key to preventing both COVID-19 and overdose among people who are opioid dependent misses important risks and potential inequities. Applied social science questions raised by the new guidelines include: who receives take-home doses of methadone and buprenorphine and why;and how media representations of risk and benefit rationales shape real-world policy and practice.

6.
Health Psychol Res ; 10(3):38012, 2022.
Article in English | PMC | ID: covidwho-2010623

ABSTRACT

COVID-19 caused a drastic change in clinical medicine around the globe. In the United States, telemedicine was rapidly adopted on a wide scale to minimize direct patient interaction and to reduce the spread of the COVID-19 virus. Telemedicine also went hand in hand with the rapid movement of working remotely. This has provided several challenges to chronic pain management clinics along with other subspecialties. Telemedicine has also opened opportunities for providing valuable care for patients with significant barriers to healthcare professionals. Given the benefits and downfalls of telemedicine, it is ultimately up to the provider who has an established patient-physician relationship and best understands the patient's limitations and healthcare needs who can best determine which patient population telemedicine is appropriate for and how frequently it can be utilized for each individual patient.

7.
Policing ; 45(5):727-740, 2022.
Article in English | ProQuest Central | ID: covidwho-2001565

ABSTRACT

Purpose>The Kensington transit corridor runs between Huntingdon and Allegheny stations in the Kensington area of Philadelphia, Pennsylvania, and is one of the largest illicit drug areas in the country. The authors report qualitative findings from ride-alongs with transit police officers assigned to a vehicle patrol dedicated to reducing the response time to opioid overdoses in and around the transit system (trains and buses) in this large open-air drug market. This study's focus was on management and mitigation of the criminogenic harms associated with the illicit drug environment.Design/methodology/approach>For ten months, transit officers patrolled the Kensington transit corridor in a dedicated vehicle (callsign “Oscar One”). Oscar One operated during either an early (8 a.m. to 4 p.m.) or late (4 p.m. to midnight) shift, between September 2020 and June 2021. 269 shifts were randomly selected for Oscar One from 574 possible shifts. Researchers accompanied Oscar One for 51 observations (19%), 45 of which were completed by the authors. Semi-structured interviews occurred during these shifts, as well as ethnographic field observations.Findings>Four main themes emerged from the study. These centered on the role of law enforcement in a large drug market, the politics of enforcement within the city of Philadelphia, the policing world around risk and proactive engagement post–George Floyd, and the sense of police being overwhelmed on the front-line of community safety.Originality/value>Police officers have a community safety as well as a law enforcement mandate, and this study explores the community safety and harm mitigation role from their perspective. The article draws on their words, based on approximately 400 h of field observation.

8.
Harm Reduct J ; 19(1): 89, 2022 Aug 10.
Article in English | MEDLINE | ID: covidwho-1978779

ABSTRACT

Opioid agonist treatment (OAT) is the primary intervention for opioid use disorder (OUD) in Canada and the USA. Yet, a number of barriers contribute to sub-optimal treatment uptake and retention, including daily-supervised medication administration. Thus, clients are eventually granted access to take-home OAT doses (i.e., 'carries') to reduce this burden. However, this decision is based on physician discretion and whether patients can demonstrate stability in various life domains, many of which are inextricably linked to the social determinants of health (SDOH). Current Canadian and USA OAT carry guidance documents are not standardized and do not take the SDOH into consideration, resulting in the potential for inequitable access to OAT carries, which may be the case particularly among marginalized populations such as individuals with OUD who have been released from custody. This perspective article posits that current OAT guidelines contribute to inequities in access to OAT carries, and that these inequities likely result in disproportionately low coverage for OUD treatment among some high-risk groups, including individuals on release from incarceration in particular. Relevant impacts of COVID-19 and related policy changes are considered, and suggestions and recommendations to amend current OAT guidance documents are provided.


Subject(s)
COVID-19 , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Canada , Humans , Methadone/therapeutic use , Opiate Substitution Treatment/methods , Opioid-Related Disorders/drug therapy
9.
J Interprof Educ Pract ; 29: 100524, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1967225

ABSTRACT

Telemedicine may provide equitable, accessible, and affordable healthcare to individuals globally. Recently tele-medicine has emerged as a vital resource for interdisciplinary healthcare professionals to provide critical medical care on the frontlines during the combined COVID-19 pandemic and the drug and opioid crisis. With the recent 2020 expansion of insurance coverage of telemedicine services by the United States Centers for Medicare & Medicaid Services, there has been an uptick in the need to understand how to comprehensively train physicians and health care professionals on telemedicine during a public health crisis. This study gathered 98 survey responses from interdisciplinary healthcare professionals regarding their telemedicine experience, focusing on trends of use with the drug and opioid crisis during the COVID-19 pandemic. The results demonstrate that during the COVID-19 pandemic, telemedicine provided a novel, innovative way to address an unmet need in healthcare and may aid to improve safe medication stewardship (SaMS) practice guidelines. Further expanded population-based research and randomized clinical trials are necessary to confirm these preliminary recommendations and form best practices for use in digital health and telemedicine. In addition, further studies will confirm the benefits of interdisciplinary healthcare professionals' engagement in harm reduction strategies via telemedicine to address improving safe medication use.

10.
Am J Psychiatry ; : appiajp21111141, 2022 Jul 28.
Article in English | MEDLINE | ID: covidwho-1962560

ABSTRACT

OBJECTIVE: The authors examined the impact of COVID-19-related policies reducing barriers to telehealth delivery of buprenorphine treatment for opioid use disorder (OUD) on buprenorphine treatment across different modalities (telephone, video, and in-person visits). METHODS: This was a national retrospective cohort study with interrupted time-series analyses to examine the impact of policy changes in March 2020 on buprenorphine treatment for OUD in the Veterans Health Administration, during the year before the start of the COVID-19 pandemic (March 2019 to February 2020) and during the first year of the pandemic (March 2020 to February 2021). The authors also examined trends in the use of telephone, video, and in-person visits for buprenorphine treatment and compared patient demographic characteristics and retention in buprenorphine treatment across the two periods. RESULTS: The number of patients receiving buprenorphine increased from 13,415 in March 2019 to 15,339 in February 2021. By February 2021, telephone visits were used by the most patients (50.2%; 4,456 visits), followed by video visits (32.4%; 2,870 visits) and in-person visits (17.4%; 1,544 visits). During the pre-pandemic period, the number of patients receiving buprenorphine increased significantly by 103 patients per month. After the COVID-19 policy changes, there was an immediate increase of 265 patients in the first month, and the number continued to increase significantly, at a rate of 47 patients per month. The demographic characteristics of patients receiving buprenorphine during the pandemic period were similar to those during the pre-pandemic period, but the proportion of patients reaching 90-day retention on buprenorphine treatment decreased significantly from 49.6% to 47.7%, while days on buprenorphine increased significantly from 203.8 to 208.7. CONCLUSIONS: The number of patients receiving buprenorphine continued to increase after the COVID-19 policy changes, but the delivery of care shifted to telehealth visits, suggesting that any reversal of COVID-19 policies must be carefully considered.

11.
Pain Physician ; 25(5): 387-390, 2022 08.
Article in English | MEDLINE | ID: covidwho-1957840

ABSTRACT

BACKGROUND: The COVID-19 pandemic resulted in a novel challenge for healthcare delivery and implementation in the United States (US) in 2020 and beyond. Telemedicine arose as a significant and effective medium for safe and efficacious physician-patient interactions. Prior to the COVID-19 pandemic, telemedicine while available, had infrequently been utilized in pain medicine practices due to difficulties with reimbursement, the learning curve associated with new technology usage, and the need for new logistical systems in place to implement telemedicine effectively. Given the unique constraints on the healthcare system during the COVID-19 pandemic, the ubiquitous utilization of telemedicine among pain medicine physicians increased, giving insight into potential future roles for the technology beyond the pandemic. OBJECTIVES: To survey and understand the state of implementation of telemedicine into pain medicine practices across practice settings and geographical areas; to identify potential barriers to the implementation of telemedicine in pain medicine practice; and to identify the likelihood of telemedicine continuing beyond the pandemic in pain medicine practice. STUDY DESIGN: Online questionnaire targeting Pain Medicine physicians in the US. Participants were asked questions related to the use of telemedicine during the first peak of the COVID-19 pandemic. SETTING: Online-based questionnaire distributed to academic and private practice pain medicine physicians nationally in the United States. METHODS: A 34 web-based questionnaires were distributed by the American Society of Regional Anesthesia and Pain Medicine and the Society of Interventional Spine to all active members. Data were analyzed using SAS v9.4. RESULTS: Between December 3, 2020, and February 18, 2021, 164 participants accessed the survey with a response rate of 14.3%. Overall, academic physicians were more likely to implement telemedicine than private practice physicians. Telemedicine was also more frequently utilized for follow-up appointments rather than initial visits. LIMITATIONS: Although our n = 164, the overall low response rate of 14.3% warrants further investigation into the utilization of telemedicine throughout the COVID-19 pandemic. CONCLUSIONS: Telemedicine as an emerging technology for efficient communication played a key role in mitigating the adverse effects of the COVID -19 pandemic on chronic pain patients. The utilization of telemedicine remarkably increased after the start of the pandemic within 1 to 2 weeks. Overall, private hospital-based centers were significantly less likely to implement telemedicine than academic centers, possibly due to limited access to secure telemedicine platforms and high start-up costs. Telemedicine was used more frequently for follow-up visits than initial visit encounters at most centers. In spite of the unforeseen consequences to the healthcare system and chronic pain practices in the US from COVID-19, telehealth has emerged as a unique model of care for patients with chronic pain. Although it has flaws, telehealth has the ability to increase access to care beyond the end of the pandemic. Further identification of barriers to the use of telemedicine platforms in private practices should be addressed from a policy perspective to facilitate increased care access.


Subject(s)
COVID-19 , Chronic Pain , Telemedicine , Analgesics , Humans , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine/methods , United States
12.
Annals of Epidemiology ; 67:102-131, 2022.
Article in English | GIM | ID: covidwho-1957708

ABSTRACT

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.

13.
Am J Transl Res ; 14(4): 2685-2688, 2022.
Article in English | MEDLINE | ID: covidwho-1939917

ABSTRACT

Data from a single state indicated there was an increase in opioid overdose related emergency services during the COVID-19 pandemic. The current study examined the provisional rolling 12-month drug overdose deaths between January 2019 and October 2021 at the national, state, and specific-drug levels, to identify trends in drug-overdose deaths before and during the COVID-19 pandemic. The trend in provisional U.S. drug overdose deaths accelerated at the beginning of the pandemic (December 2019). This acceleration slowed in the middle of pandemic (October 2020). Additionally, there was significant state and drug heterogeneity of drug overdose deaths.

14.
Addiction ; 117(8): 2135-2140, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1922808

ABSTRACT

BACKGROUND/AIMS: The COVID-19 pandemic has significantly impacted face-to-face research. This has propelled ideas and plans for more remote styles of research and provided new perspectives on conducting research. This paper aimed to identify challenges specific to conducting remote forms of experimental addiction research, although some of these challenges apply to all types of addiction research. ARGUMENT: The impact of the COVID-19 pandemic has led to important lessons for future addiction research. Although remote research has been conducted for decades, little experimental research has been performed remotely. To do so require a new perspective on what research questions we can ask and could also enable preferential capture of those who may be more reluctant to engage in research based in clinical settings. There may, however, be crucial factors that will compromise this process. We illustrate our argument with three real-world, ongoing case studies centred on gambling behaviour, opioid overdose, and cannabinoid psychopharmacology. We highlight the obstacles to overcome to enable more remote methods of study. CONCLUSIONS: The future of experimental research and, more generally, addiction research, will be shaped by the pandemic and may result in advantages, such as reaching different populations and conducting addiction research in more naturalistic settings.


Subject(s)
Behavior, Addictive , COVID-19 , Opiate Overdose , Behavior, Addictive/epidemiology , Forecasting , Humans , Pandemics
15.
Expert Rev Clin Pharmacol ; 15(6): 787-793, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1900960

ABSTRACT

BACKGROUND: The COVID-19 lockdown has resulted in limited access to most of the conventional chronic pain management services. Subsequently, changes in opioids' utilization could be expected. This study assessed the impact of the first COVID-19 lockdown on opioid utilization using aggregated-level, community dispensing dataset covering the whole English population. RESEARCH DESIGN AND METHODS: A segmented-linear regression analysis was applied to monthly dispensed opioid prescriptions from March 2019 to March 2021. Opioid utilization was measured using the number of opioids' items dispensed/1000 inhabitants and Defined Daily Dose (DDD)/1000 inhabitants/day during 12-months pre/post the lockdown in March 2020 stratified by strong and weak opioids. RESULTS: For all opioids' classes, there were nonsignificant changes in the number of opioids' items dispensed/1000 inhabitants trend pre-lockdown, small increases in their level immediately post-lockdown, and a non-significant decline in the trend post-lockdown. Similarly, a non-significant reduction in the DDD/1000 inhabitant/day baseline trend pre-lockdown, nonsignificant immediate increases in the level post-lockdown, and declines in the trend post-lockdown for all opioids' classes were observed. CONCLUSION: Unexpectedly, opioid utilization does not appear to have been significantly affected by the lockdown measures during the study period. However, patient-level data is needed to determine more accurate estimates of any changes in the opioid prescribing including incident prescribing/use.


Subject(s)
Analgesics, Opioid , COVID-19 , Analgesics, Opioid/therapeutic use , Communicable Disease Control , Drug Prescriptions , Humans , Pandemics , Practice Patterns, Physicians' , Primary Health Care , Regression Analysis
16.
AJPM Focus ; : 100007, 2022.
Article in English | ScienceDirect | ID: covidwho-1895047

ABSTRACT

Introduction Stay-at-home orders during the COVID-19 pandemic decreased population mobility to reduce SARS-CoV-2 infection rates. We empirically tested the hypothesis that public health measure was associated with a higher likelihood of opioid- and stimulant-involved deaths occurring in homes located in Cook County, Illinois. Methods The stay-at-home period was March 21, 2020 to May 30, 2020. We analyzed overdose data from the Cook County Medical Examiner's Office using a death location description from case investigations categorized as home, medical, motel, scene and other. Two groups of decedents were defined as either having an opioid or stimulant listed in the primary cause of death field. We modeled a weekly time series in order to detect changes in deaths (number) and trends during segmented time periods. Chi-square or Fisher's exact and adjusted logistic regression was used for testing differences between the stay-at-home and a 13-week preceding period. Results There were 4,169 and 2,012 opioid- and stimulant-involved deaths, respectively, from 2018 to 2020. People in both groups were demographically similar: 75% male, 52% white, 45 years old (mean). In the 13 weeks prior to stay-at-home orders, 51% of opioid-involved deaths occurred in homes, which increased to 59% (p<0.0001) during the 10 weeks of the order and decreased back to 51% in the 18 weeks after the order expired. For stimulant-involved deaths, 51% were residential immediately before the orders;with a non-significant increase to 52% during stay-at-home. Prior to the pandemic, there were 20 deaths/week, increasing to 37 deaths/week (p<0.0001) during stay-at-home enactment. Deaths involving fentanyl among the opioid-involved group increased from 76% to 89% whereas heroin decreased from 55% to 37%. The adjusted odds ratio (aOR) for opioid-involved fatal overdoses occurring at home during this period compared to the 13 weeks prior was 1.37 (95% CI:1.05-1.79). Conclusions The likelihood of a death occurring at home especially for people using opioids increased during the stay-at-home order period. Findings have implications for mitigating overdose risks during social isolation.

17.
Harm Reduct J ; 19(1): 52, 2022 05 25.
Article in English | MEDLINE | ID: covidwho-1866364

ABSTRACT

BACKGROUND: Worsening of the overdose crisis in the USA has been linked to the continuing proliferation of non-pharmaceutical fentanyl (NPF). The recent wave of NPF spread in the USA has been fueled by an increased presence of counterfeit pills that contain NPF. This qualitative study aims to characterize the motivation and practices of counterfeit NPF pill initiation and use among individuals using illicit opioids in Arizona. METHODS: Between October 2020 and May 2021, semi-structured interviews were conducted with 22 individuals meeting the following eligibility criteria: (1) 18 years or older; (2) residence in Arizona; and (3) use of illicit opioids in the past 30 days and/or opioid use disorder treatment in the past 12 months. Participants were recruited through referrals by a harm reduction organization, craigslist ads, and referrals by other participants. Interviews were conducted virtually via Zoom. Qualitative interviews were transcribed and analyzed thematically using NVivo. RESULTS: Out of 22 participants, 64% were male, and 45% were ethnic minorities. Age ranged between 25 and 51 years old. Participants noted significant recent increases in the availability of counterfeit NPF pills ("blues," "dirty oxys") that were most commonly used by smoking. The majority indicated first trying NPF pills in the past year, and the first use often occurred in situations of reduced access to heroin or pharmaceutical opioids. Participant decisions to switch over to more frequent NPF pill use or to maintain some levels of heroin use were shaped by local drug availability trends and personal experiences with NPF effects. They were also influenced by conflicting views of social acceptability of pharmaceutical-like drugs, perceived harms of NPF in terms of overdose risks and increased difficulty of quitting, and perceived benefits of switching to the non-injection route of opioid administration (e.g., from injecting heroin to smoking NPF pills). CONCLUSION: Our findings highlight the need for the implementation of novel policy, treatment, and harm reduction approaches to address the growing unpredictability of drug supply and NPF pill-specific risks, attitudes, and behaviors.


Subject(s)
Drug Overdose , Illicit Drugs , Adult , Analgesics, Opioid/therapeutic use , Drug Overdose/drug therapy , Female , Fentanyl , Heroin/therapeutic use , Humans , Male , Middle Aged
18.
The Journal for Nurse Practitioners ; 18(6):649-652, 2022.
Article in English | ProQuest Central | ID: covidwho-1873216

ABSTRACT

Prescription opioids were identified as being responsible for 14,000 deaths in 2019, with 9.3 million people admitting to misuse in 2020. This quality improvement project implemented the Institute for Clinical Systems Improvement (ICSI) guideline on pain management in acute care to decrease opioid prescriptions >90 morphine milliequivalents for acute-on-chronic pain. The change to current practice included completion of comprehensive functional assessments and opioid risk screening tools to guide a goal-directed shared decision-making discussion with patients. There was a statistically significant decrease in morphine milliequivalents per prescription (t43 = 2.579, P = .013).

19.
Int J Drug Policy ; 106: 103752, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1867048

ABSTRACT

BACKGROUND: People Who Inject Drugs (PWID) are subject to distinct socio-structural inequalities that can expose them to high risks of COVID-19 transmission and related health and social complications. In response to COVID-19 mitigation strategies, these vulnerabilities are being experienced in the context of adapted drug treatment service provision, including reduced in-person support and increased regulatory flexibility in opioid substitution therapy (OST) guidelines. This study aimed to explore the longer-term impact of the pandemic on the health and wellbeing of PWID in the UK, including provider and client experiences of treatment changes. METHODS: Interviews were conducted with 19 PWID and 17 drug treatment providers between May and September 2021, recruited from drug and homelessness charities providing treatment services and healthcare in the UK. Data were analysed using reflexive thematic analysis. RESULTS: Most participants expressed ongoing fears of COVID-19 transmission, although socio-structural inequalities limited the contexts in which physical distancing could be practised. In addition, virus mitigation strategies altered the risk environment for PWID, resulting in ongoing physical (e.g. changing drug use patterns, including transitions to crack cocaine, benzodiazepine and pregabalin use) and socio-economic harms (e.g. limited opportunities for sex work engagement and income generation). Finally, whilst clients reported some favourable experiences from service adaptations prompted by COVID-19, including increased regulatory flexibility in OST guidelines, there was continued scepticism and caution among providers toward sustaining any treatment changes beyond the pandemic period. CONCLUSIONS: Whilst our findings emphasize the importance of accessible harm reduction measures attending to changing indices of drug-related harm during this period, there is a need for additional structural supports to ensure pre-existing disparities and harms impacting PWID are not exacerbated further by the conditions of the pandemic. In addition, any sustained policy and service delivery adaptations prompted by COVID-19 will require further attention if they are to be acceptable to both service users and providers.


Subject(s)
COVID-19 , Drug Users , Substance Abuse, Intravenous , COVID-19/epidemiology , Harm Reduction , Humans , Pandemics , Pharmaceutical Preparations , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/epidemiology , Substance Abuse, Intravenous/therapy , United Kingdom/epidemiology
20.
MedEdPORTAL ; 18: 11255, 2022.
Article in English | MEDLINE | ID: covidwho-1865664

ABSTRACT

Introduction: During the first year of the COVID-19 pandemic, over 93,000 Americans lost their lives to a preventable overdose. Medications for opioid use disorder (OUD) have been shown to decrease mortality in OUD but are underutilized. Through this case-based learning exercise, first-year medical students applied physiologic and pharmacologic principles to the diagnosis and treatment of OUD. Methods: Faculty facilitated a case discussion over a 1-hour large-group case-based learning (CBL) session. Facilitators utilized PowerPoint slides to illustrate graphs and figures while discussing the case. To evaluate students on the CBL learning objectives, three pharmacology exam questions were administered; students also evaluated the CBL's effectiveness in meeting educational objectives on three Likert-scale questions and via open-ended feedback. Results: First-year medical students (n = 200) completed the CBL. The mean score on the exam questions was 91%. Students agreed or strongly agreed that the CBL was an effective way to learn pharmacology principles (69%), that it reinforced pharmacologic fundamentals (70%), and that it showed how pharmacology fundamentals were important in the real world of clinical medicine (86%). Qualitative feedback on the CBL was generally positive, including satisfaction with the small-group setting and practical applications of pharmacology to clinical practice. Discussion: This CBL exercise contains content critical for preparing students to combat the modern opioid epidemic. The exercise provides an opportunity for learners to review fundamental pharmacodynamic and pharmacokinetic principles so as to ready them for clinical clerkships and beyond.


Subject(s)
COVID-19 , Opioid-Related Disorders , Students, Medical , COVID-19/drug therapy , Curriculum , Humans , Opioid-Related Disorders/drug therapy , Pandemics
SELECTION OF CITATIONS
SEARCH DETAIL