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1.
Drug Alcohol Depend ; 236: 109499, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1850940

ABSTRACT

BACKGROUND: Drug overdose is the leading cause of death among people 25-44 years of age in the United States. Existing drug surveillance methods are important for prevention and directing treatment, but are limited by delayed reporting and lack of geographic granularity. METHODS: Laboratory urine drug screen and complete metabolic panel data from patients presenting to the emergency department was used to observe long-term and short-term temporal and geospatial changes at the zip code-level in St. Louis. Multivariate linear regression was performed to investigate associations between zip code-level socioeconomic factors and drug screening positivity rates. RESULTS: An increase in the fentanyl positive drug screens was seen during the initial COVID-19 shutdown period in the spring of 2020. A decrease in cocaine positivity was seen in the fall and winter of 2020, with a return to baseline coinciding with the second major COVID-19 shutdown in the summer of 2021. These changes appeared to be independent of changes in emergency department utilization as measured by complete metabolic panels ordered. Significant short-term changes in fentanyl and cocaine positivity rates between specific time periods were able to be localized to individual zip codes. Zip code-level multivariate analysis demonstrated independent associations between socioeconomic/demographic factors and fentanyl/cocaine positivity rates as determined by laboratory drug screening data. CONCLUSIONS: Analyzing clinical laboratory drug screening data can enable a more temporally and geographically granular view of population-level drug use surveillance. Additionally, laboratory data can be utilized to find population-level socioeconomic associations with illicit drug use, presenting a potential avenue for the use of this data to guide public health and healthcare policy decisions.


Subject(s)
COVID-19 , Cocaine , Drug Overdose , Illicit Drugs , Substance-Related Disorders , COVID-19/epidemiology , Drug Overdose/epidemiology , Fentanyl , Humans , Risk Factors , Socioeconomic Factors , United States/epidemiology
2.
BMC Emerg Med ; 22(1): 62, 2022 04 09.
Article in English | MEDLINE | ID: covidwho-1840946

ABSTRACT

BACKGROUND: Opioid-related overdoses cause substantial numbers of preventable deaths. Naloxone is an opioid antagonist available in take-home naloxone (THN) kits as a lifesaving measure for opioid overdose. As the emergency department (ED) is a primary point of contact for patients with high-risk opioid use, evidence-based recommendations from the Society of Hospital Pharmacists of Australia THN practice guidelines include the provision of THN, accompanied by psychosocial interventions. However, implementation of these guidelines in practice is unknown. This study investigated ED opioid-related overdose presentations, concordance of post-overdose interventions with the THN practice guidelines, and the impact, if any, of the SARS-CoV-2 (COVID-19) pandemic on case presentations. METHODS: A single-centre retrospective audit was conducted at a major tertiary hospital of patients presenting with overdoses involving opioids and non-opioids between March to August 2019 and March to August 2020. Patient presentations and interventions delivered by the paramedics, ED and upon discharge from the ED were collated from medical records and analysed using descriptive statistics, chi square and independent T-tests. RESULTS: The majority (66.2%) of patients presented to hospital with mixed drug overdoses involving opioids and non-opioids. Pharmaceutical opioids were implicated in a greater proportion (72.1%) of overdoses than illicit opioids. Fewer patients presented in March to August 2020 as compared with 2019 (26 vs. 42), and mixed drug overdoses were more frequent in 2020 than 2019 (80.8% vs. 57.1%). Referral to outpatient psychology (22.0%) and drug and alcohol services (20.3%) were amongst the most common post-discharge interventions. Naloxone was provided to 28 patients (41.2%) by the paramedics and/or ED. No patients received THN upon discharge. CONCLUSIONS: This study highlights opportunities to improve ED provision of THN and other interventions post-opioid overdose. Large-scale multi-centre studies are required to ascertain the capacity of EDs to provide THN and the impact of COVID-19 on opioid overdose presentations.


Subject(s)
COVID-19 , Drug Overdose , Opiate Overdose , Aftercare , Analgesics, Opioid , COVID-19/epidemiology , Drug Overdose/drug therapy , Drug Overdose/epidemiology , Emergency Service, Hospital , Humans , Naloxone/therapeutic use , Patient Discharge , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers
3.
J Comp Eff Res ; 11(9): 643-648, 2022 06.
Article in English | MEDLINE | ID: covidwho-1834209

ABSTRACT

Aim: To evaluate the impact of the COVID-19 pandemic on the economic burden of drug overdose deaths in the USA. Methods: Overdose death counts from 2019 to 2020 were obtained from the CDC's National Vital Statistics System. Years of potential life lost and value of statistical life were computed. Results: The financial burden of overdose deaths increased by nearly 30%, from US$624.90 billion before the pandemic in 2019 to US$825.31 billion during the pandemic in 2020. Temporal analysis demonstrated that overdose deaths peaked in the second quarter of 2020 and contributed to nearly a third of the total 2020 value of statistical life. Conclusion: The authors' findings suggest that the COVID-19 pandemic has exacerbated the US drug overdose epidemic.


Subject(s)
COVID-19 , Drug Overdose , Drug Overdose/epidemiology , Financial Stress , Humans , Pandemics , United States/epidemiology
4.
Int J Environ Res Public Health ; 19(9)2022 04 28.
Article in English | MEDLINE | ID: covidwho-1820230

ABSTRACT

People who inject drugs (PWID) are a population that disproportionately struggles with economic and mental health challenges. However, despite numerous reports of people globally experiencing new or exacerbated economic and/or mental health challenges during the COVID-19 pandemic, the literature on the effect of the pandemic on PWID and their risk for harm (e.g., overdose) remains sparse. The present study will describe reported changes during the pandemic in risk factors for drug overdose (including changes in mental health symptoms and care access) among PWID in Chicago, and it will examine associations between such risk factor changes and the experience of economic challenges during the pandemic. Participants from an ongoing longitudinal study of young PWID from the Chicago suburbs and their injection risk network members (N = 138; mean age = 28.7 years) were interviewed about changes in their experiences, substance use behavior, and mental health since the start of the COVID-19 pandemic. Bivariate cross tabulations were computed of each "overdose risk factor" with experiences of economic challenges during the pandemic. Fisher's Exact Tests were used to assess statistical significance. Adjusted logistic regression models were also conducted that controlled for sociodemographic characteristics, for time elapsed since the start of the pandemic, and for pre-pandemic income, homelessness, and injection frequency. Over half of our sample reported using alone more than usual during the pandemic, and over 40% reported using more than usual and/or buying drugs that were of a decreased purity or quality. Additionally, a large proportion of our sample (52.5% of those asked) reported more difficulty than usual accessing mental health care. Experiencing loss of a source of income during the pandemic was associated with using more drugs, using alone more, using a larger amount of drugs while using alone, wanting to stop using but being unable, and difficulty accessing mental health care. The preliminary associations found by the present study suggest that economic challenges or disruptions experienced during the pandemic are likely to increase risk for overdose among PWID experiencing such challenges, via changes in the above behaviors and/or conditions that are associated with risk for overdose. Intervention efforts should therefore be focused not only directly on overdose prevention, but also on assisting PWID with their economic challenges and helping them regain economic stability and access to services that may have been impeded by financial difficulty.


Subject(s)
COVID-19 , Drug Overdose , Drug Users , Substance Abuse, Intravenous , Adult , COVID-19/epidemiology , Drug Overdose/epidemiology , Drug Users/psychology , Humans , Longitudinal Studies , Mental Health , Pandemics , Substance Abuse, Intravenous/complications
5.
Addict Sci Clin Pract ; 17(1): 24, 2022 04 25.
Article in English | MEDLINE | ID: covidwho-1808386

ABSTRACT

BACKGROUND: Drug overdose rates in the United States have been steadily increasing, particularly in rural areas. The COVID-19 pandemic and associated mitigation strategies may have increased overdose risk for people who use drugs by impacting social, community, and structural factors. METHODS: The study included a quantitative survey focused on COVID-19 administered to 50 people who use drugs and semi-structured qualitative interviews with 17 people who use drugs, 12 of whom also participated in the quantitative survey. Descriptive statistics were run for the quantitative data. Qualitative coding was line-by-line then grouped thematically. Quantitative and qualitative data were integrated during analysis. RESULTS: Findings demonstrate how COVID-19 disruptions at the structural and community level affected outcomes related to mental health and drug use at the individual level. Themes that emerged from the qualitative interviews were (1) lack of employment opportunities, (2) food and housing insecurity, (3) community stigma impacting health service use, (4) mental health strains, and (5) drug market disruptions. Structural and community changes increased anxiety, depression, and loneliness on the individual level, as well as changes in drug use patterns, all of which are likely to increase overdose risk. CONCLUSION: The COVID-19 pandemic, and mitigation strategies aimed at curbing infection, disrupted communities and lives of people who use drugs. These disruptions altered individual drug use and mental health outcomes, which could increase risk for overdose. We recommend addressing structural and community factors, including developing multi-level interventions, to combat overdose. Trial registration Clinicaltrails.gov: NCT04427202. Registered June 11, 2020: https://clinicaltrials.gov/ct2/show/NCT04427202?term=pho+mai&draw=2&rank=3.


Subject(s)
COVID-19 , Drug Overdose , Substance-Related Disorders , Drug Overdose/drug therapy , Drug Overdose/epidemiology , Humans , Pandemics , Rural Population , United States/epidemiology
6.
Ann Med ; 54(1): 1081-1088, 2022 12.
Article in English | MEDLINE | ID: covidwho-1805936

ABSTRACT

INTRODUCTION: Alongside the emergence of COVID-19 in the United States, several reports highlighted increasing rates of opioid overdose from preliminary data. Yet, little is known about how state-level opioid overdose death trends and decedent characteristics have evolved using official death records. METHODS: We requested vital statistics data from 2018-2020 from all 50 states and the District of Columbia, receiving data from 14 states. Accounting for COVID-19, we excluded states without data past March 2020, leaving 11 states for analysis. We defined state-specific analysis periods from March 13 until the latest reliable date in each state's data, then conducted retrospective year-over-year analyses comparing opioid-related overdose death rates, the presence of specific opioids and other psychoactive substances, and decedents' sex, race, and age from 2020 to 2019 and 2019 to 2018 within each state's analysis period. We assessed whether significant changes in 2020 vs. 2019 in opioid overdose deaths were new or continuing trends using joinpoint regression. RESULTS: We found significant increases in opioid-related overdose death rates in Alaska (55.3%), Colorado (80.2%), Indiana (40.1%), Nevada (50.0%), North Carolina (30.5%), Rhode Island (29.6%), and Virginia (66.4%) - all continuing previous trends. Increases in synthetic opioid-involved overdose deaths were new in Alaska (136.5%), Indiana (27.6%), and Virginia (16.5%), whilst continuing in Colorado (44.4%), Connecticut (3.6%), Nevada (75.0%), and North Carolina (14.6%). We found new increases in male decedents in Indiana (12.0%), and continuing increases in Colorado (15.2%). We also found continuing increases in Black non-Hispanic decedents in Massachusetts (43.9%) and Virginia (33.7%). CONCLUSION: This research analyzes vital statistics data from 11 states, highlighting new trends in opioid overdose deaths and decedent characteristics across 10 of these states. These findings can inform state-specific public health interventions and highlight the need for timely and comprehensive fatal opioid overdose data, especially amidst concurrent crises such as COVID-19. Key messages:Our results highlight shifts in opioid overdose trends during the COVID-19 pandemic that cannot otherwise be extracted from aggregated or provisional opioid overdose death data such as those published by the Centres for Disease Control and Prevention.Fentanyl and other synthetic opioids continue to drive increases in fatal overdoses, making it difficult to separate these trends from any possible COVID-19-related factors.Black non-Hispanic people are making up an increasing proportion of opioid overdose deaths in some states.State-specific limitations and variations in data-reporting for vital statistics make it challenging to acquire and analyse up-to-date data on opioid-related overdose deaths. More timely and comprehensive data are needed to generate broader insights on the nature of the intersecting opioid and COVID-19 crises.


Subject(s)
COVID-19 , Drug Overdose , Opiate Overdose , Analgesics, Opioid/adverse effects , COVID-19/epidemiology , Drug Overdose/epidemiology , Humans , Male , Opiate Overdose/epidemiology , Pandemics , Retrospective Studies , United States/epidemiology
7.
Drug Alcohol Depend ; 236: 109471, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1803874

ABSTRACT

OBJECTIVES: Driven by an increasingly toxic drug supply, drug toxicity deaths in the United States and Canada have risen to unprecedented levels during the COVID-19 pandemic. This study aimed to characterize the prevalence of and the factors associated with a perceived decline in the quality of drugs during the COVID-19 pandemic among community-recruited cohorts of PWUD in Vancouver, Canada. METHODS: Data collection took place between July and November 2020. In adherence with COVID-19 safety protocols, questionnaires were administered by interviewers through remote means (e.g., phone or videoconference). Using multivariable logistic regression, we characterized the prevalence of and factors associated with a perceived decline in drug quality during the start of the COVID-19 pandemic in Vancouver, Canada. RESULTS: Of the 738 individuals included in this analysis, 272 (36.9%) reported that the quality of drugs declined during the COVID-19 pandemic. In multivariable analysis, perceived decline in the quality of drugs was significantly associated with: recent non-fatal overdose (adjusted odds ratio [AOR]=2.01, 95% Confidence Interval [CI]: 1.29-3.15), at least weekly injection drug use (AOR=1.94, 95% CI: 1.40-2.71), at least weekly crack use (AOR=1.61, 95%CI: 1.10-2.36), and at least weekly crystal methamphetamine use (AOR=1.46, 95%CI: 1.03-2.08). DISCUSSION: Over a third of PWUD perceived that the quality of drugs declined during the COVID-19 pandemic and these individuals were significantly more likely to report experiencing a recent non-fatal overdose, engaging in frequent injection drug and stimulant use. Study findings indicate the need for interventions to address the toxic drug supply, including providing a regulated supply.


Subject(s)
COVID-19 , Drug Overdose , COVID-19/epidemiology , Canada/epidemiology , Drug Overdose/epidemiology , Humans , Pandemics , Prospective Studies
10.
Am J Public Health ; 112(S2): S151-S158, 2022 04.
Article in English | MEDLINE | ID: covidwho-1736599

ABSTRACT

Objectives. To explore the implementation and effectiveness of the British Columbia, Canada, risk mitigation guidelines among people who use drugs, focusing on how experiences with the illicit drug supply shaped motivations to seek prescription alternatives and the subsequent impacts on overdose vulnerability. Methods. From February to July 2021, we conducted qualitative interviews with 40 people who use drugs in British Columbia, Canada, and who accessed prescription opioids or stimulants under the risk mitigation guidelines. Results. COVID-19 disrupted British Columbia's illicit drug market. Concerns about overdose because of drug supply changes, and deepening socioeconomic marginalization, motivated participants to access no-cost prescription alternatives. Reliable access to prescription alternatives addressed overdose vulnerability by reducing engagement with the illicit drug market while allowing greater agency over drug use. Because prescriptions were primarily intended to manage withdrawal, participants supplemented with illicit drugs to experience enjoyment and manage pain. Conclusions. Providing prescription alternatives to illicit drugs is a critical harm reduction approach that reduces exposure to an increasingly toxic drug supply, yet further optimizations are needed. (Am J Public Health. 2022;112(S2):S151-S158. https://doi.org/10.2105/AJPH.2021.306692).


Subject(s)
COVID-19 , Drug Overdose , Analgesics, Opioid/therapeutic use , British Columbia/epidemiology , COVID-19/epidemiology , Canada/epidemiology , Drug Overdose/drug therapy , Drug Overdose/epidemiology , Drug Overdose/prevention & control , Emergencies , Humans
11.
Int J Drug Policy ; 101: 103554, 2022 03.
Article in English | MEDLINE | ID: covidwho-1729687

ABSTRACT

BACKGROUND: Concurrent opioid-related overdose and COVID-19 crises in the U.S. have imposed unprecedented challenges on people who use illicit opioids. METHODS: Using the experiences of 324 people who use illicit opioids between April 2020 and March 2021, we examined four domains of health and well-being potentially impacted by COVID-19: drug risks and responses, healthcare and related services, material hardship, and mental health. Data were drawn from participants' completed monthly survey assessments which were grouped into four periods of interest for the unfolding pandemic: April-June 2020, July-October 2020, November-January 2021, and February-March 2021. RESULTS: A majority of measures in our four domains showed early COVID-19 related impacts, which quickly diminished as people and agencies responded to the pandemic. Difficulty obtaining food was the most frequently reported material hardship and appeared worst in April-June 2020. Over half of the population reported depression in April-June 2020, but this declined over the study period. Some participants reported changes to the heroin supply, including higher prices, lower quality, difficulty finding the drug, and fentanyl contamination. There was no discernable temporal shift in the frequency of use of each substance or the frequency of withdrawal symptoms. Over the study period, the mean number of overdoses per month decreased while the percent of opioid use events at which both a witness and naloxone were present (i.e., protected events) increased. Most participants receiving MOUD experienced an increase in take-home doses. CONCLUSIONS: Findings speak to the resilience of people who use drugs as a population with disproportionate experience of trauma and crisis and also to the rapid response of NYC health agencies and service providers working with this population. Despite evident signs of adaptability and resilience, the COVID-19 pandemic has highlighted some of the unique vulnerabilities of people who use illicit opioids and the need for greater rates of "protected" opioid use and greater availability of wrap-around services to efficiently address the safety, food security, mental health, and treatment needs of the population.


Subject(s)
COVID-19 , Drug Overdose , Analgesics, Opioid , COVID-19/epidemiology , Drug Overdose/drug therapy , Drug Overdose/epidemiology , Humans , New York City/epidemiology , Pandemics , SARS-CoV-2
12.
Drug Alcohol Depend ; 232: 109340, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1729685

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused disruptions in the delivery of health services, which may have adversely affected access to substance use disorder (SUD) treatment services. Medicaid expansion has been previously associated with increased access to SUD services for low-income adults. Thus, the pandemic may have differentially impacted overdose mortality depending on expansion status. This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. METHODS: State-level data on overdose mortality were obtained from the Centers for Disease Control and Prevention's WONDER database for 2013-2020 (N = 408 state-years). The primary outcomes were drug and opioid overdose deaths per 100,000 residents. The primary exposure was Medicaid expansion status as of January 1st, 2020. Difference-in-difference (DID) models were used to compare changes in outcomes between expansion and non-expansion states after the onset of the COVID-19 pandemic. RESULTS: The U.S. experienced 91,799 drug overdose deaths in 2020, a 29.9% relative increase from 2019. Expansion states experienced an adjusted increase of 7.0 drug overdose deaths per 100,000 residents (95% CI 3.3, 10.7) and non-expansion states experienced an increase of 4.3 deaths (95% CI 1.5, 8.2) from 2019 to 2020. Similar trends were observed in opioid overdose deaths. In DID models, Medicaid expansion was not associated with changes in drug (0.9 deaths, 95% CI -2.0, 3.7) or opioid overdose deaths (0.8 deaths, 95% CI -1.8, 3.5). CONCLUSIONS: The increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.


Subject(s)
COVID-19 , Drug Overdose , Adult , Analgesics, Opioid/therapeutic use , Drug Overdose/epidemiology , Humans , Medicaid , Pandemics , SARS-CoV-2 , United States/epidemiology
14.
Int J Environ Res Public Health ; 19(4)2022 02 16.
Article in English | MEDLINE | ID: covidwho-1708513

ABSTRACT

BACKGROUND: The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. METHODS: We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. RESULTS: Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated "beans" and "buttons". Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. CONCLUSIONS: The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.


Subject(s)
COVID-19 , Drug Overdose , Pharmaceutical Preparations , Analgesics, Opioid/therapeutic use , COVID-19/epidemiology , Drug Overdose/drug therapy , Drug Overdose/epidemiology , Fentanyl , Harm Reduction , Humans , Pandemics , Rural Population , SARS-CoV-2
15.
J Urban Health ; 99(2): 316-327, 2022 04.
Article in English | MEDLINE | ID: covidwho-1706416

ABSTRACT

The effects of the opioid crisis have varied across diverse and socioeconomically defined urban communities, due in part to widening health disparities. The onset of the COVID-19 pandemic has coincided with a spike in drug overdose deaths in the USA. However, the extent to which the impact of the pandemic on overdose deaths has varied across different demographics in urban neighborhoods is unclear. We examine the influence of COVID-19 pandemic on opioid overdose deaths through spatiotemporal analysis techniques. Using Milwaukee County, Wisconsin as a study site, we used georeferenced opioid overdose data to examine the locational and demographic differences in overdose deaths over time (2017-2020). We find that the pandemic significantly increased the monthly overdose deaths. The worst effects were seen in the poor, urban neighborhoods, affecting Black and Hispanic communities. However, more affluent, suburban White communities also experienced a rise in overdose deaths. A better understanding of contributing factors is needed to guide interventions at the local, regional, and national scales.


Subject(s)
COVID-19 , Drug Overdose , Opiate Overdose , Analgesics, Opioid , Drug Overdose/epidemiology , Humans , Opiate Overdose/epidemiology , Pandemics , Spatio-Temporal Analysis
16.
Int J Drug Policy ; 102: 103608, 2022 04.
Article in English | MEDLINE | ID: covidwho-1693692

ABSTRACT

BACKGROUND: Given the global economic recessions mediated by the COVID-19 pandemic and that many countries have implemented direct income support programs, we investigated the timing of the COVID-19 economic impact payments and opioid overdose deaths. METHODS: A longitudinal, observational study design that included data from the Ohio Department of Health was utilized. Statistical change point analyses were conducted to identify significant changes in weekly number of opioid overdose deaths from January 1 of 2018 to August 1 of 2020. Additional analyses including difference-in-difference, time series tests, interrupted time series regression analysis and Granger causality test were performed. RESULTS: A single change point was identified and occurred at week 16, 2020. For 2020, the median opioid overdose deaths numbers for weeks 1-16 and weeks 17-32 were 68.5 and 101, respectively. The opioid overdose deaths numbers from weeks 17-32 of 2020 were significantly higher than those in weeks 1-16 of 2020 and those in 2018 and 2019 (before and after week 16). The interrupted time series regression analysis indicated more than 203 deaths weekly for weeks 17-32 of 2020 compared to all other weeks. The result of the Granger causality test found that the identified change point (week 16 of 2020) directly influenced the increase in opioid overdose deaths in weeks 17-32 of 2020. CONCLUSION: The identified change point may refer to the timing of many factors, not only the economic payments and further research is warranted to investigate the potential relationship between the COVID-19 economic impact payments and overdose deaths.


Subject(s)
COVID-19 , Drug Overdose , Opiate Overdose , Analgesics, Opioid/therapeutic use , Drug Overdose/epidemiology , Humans , Interrupted Time Series Analysis , Opiate Overdose/epidemiology , Pandemics
17.
Int J Drug Policy ; 103: 103626, 2022 05.
Article in English | MEDLINE | ID: covidwho-1693691

ABSTRACT

BACKGROUND: The COVID-19 pandemic has greatly exacerbated the United States' overdose crisis. However, the overlapping impacts of COVID-19 and the overdose crisis have not been experienced equally, with unstably housed people who use drugs (PWUD) disproportionately impacted. Amid these changes, there is a need to understand how risk is experienced and managed among unstably housed PWUD to address health and social needs more effectively. METHODS: This project draws on ethnographic research conducted from June 2020 to April 2021 in Rhode Island. Data include 39 in-depth interviews with unstably housed PWUD and approximately 50 h of ethnographic fieldwork conducted alongside street-based outreach workers. RESULTS: COVID-19 risks were primarily contextualized in relation to participants' prior experiences of overdose events and adverse health outcomes. However, participants had varying levels of risk tolerance that were managed in ways that allowed them to reassert control and agency within the uncertainty of overlapping public health crises. Given participants' level of structural vulnerabilities, COVID-19 risk was managed alongside meeting their basic needs to survive. CONCLUSIONS: Findings demonstrate how COVID-related public health measures (e.g., stay-at-home orders, service closures) reinforced participants' structural vulnerabilities in ways that increased their risk of health and social harms. Implementing and scaling up programs that meet the basic needs of individuals, including permanent housing, social supports, and overdose prevention interventions (e.g., supervised consumption sites) is critically needed to address intersecting risks faced by unstably housed PWUD.


Subject(s)
COVID-19 , Drug Overdose , Drug Overdose/epidemiology , Drug Overdose/prevention & control , Housing , Humans , Negotiating , Pandemics , Rhode Island/epidemiology
18.
Addiction ; 117(6): 1692-1701, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1672926

ABSTRACT

AIMS: To examine how weekly rates of emergency department (ED) visits for drug overdoses changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the pre-pandemic, peak, and re-opening periods of the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN: Population-based retrospective cohort study conducted between September 30, 2018 and September 26, 2020. SETTING: Ontario, Canada. PARTICIPANTS: A total of 38 617 IRHH, 15 022 369 housed individuals, and 186 858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MEASUREMENTS: ED visits for drug overdoses of accidental and undetermined intent. FINDINGS: Average rates of ED visits for drug overdoses between January and September 2020 were higher among IRHH compared with housed individuals (rate ratio [RR], 148.0; 95% CI, 142.7-153.5) and matched housed individuals (RR, 22.3; 95% CI, 20.7-24.0). ED visits for drug overdoses decreased across all groups by ~20% during the peak period (March 17 to June 16, 2020) compared with corresponding weeks in 2019. During the re-opening period (June 17 to September 26, 2020), rates of ED visits for drug overdoses were significantly higher among IRHH (RR, 1.56; 95% CI, 1.44-1.69), matched housed individuals (RR, 1.25; 95% CI, 1.08-1.46), and housed individuals relative to equivalent weeks in 2019 (RR, 1.07; 95% CI, 1.02-1.11). The relative increase in drug overdose ED visits among IRHH was larger compared with both matched housed individuals (P = 0.01 for interaction between group and year) and housed individuals (P < 0.001) during this period. CONCLUSIONS: Recently homeless individuals in Ontario, Canada experienced disproportionate increases in ED visits for drug overdoses during the re-opening period of the COVID-19 pandemic compared with housed people.


Subject(s)
COVID-19 , Drug Overdose , Homeless Persons , COVID-19/epidemiology , Drug Overdose/epidemiology , Emergency Service, Hospital , Humans , Ontario/epidemiology , Pandemics , Retrospective Studies
20.
Curr Opin Psychiatry ; 34(4): 344-350, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1631191

ABSTRACT

PURPOSE OF REVIEW: This review provides an update on recently published literature on the rise of illicit fentanyls, risks for overdose, combinations with other substances, e.g. stimulants, consequences, and treatment. RECENT FINDINGS: Overdose due to illicit synthetic opioids (e.g. fentanyl and fentanyl analogs) continues to rise in the US both preceding and during the COVID-19 pandemic. Fentanyl-related overdose is rising in new geographic areas e.g. the western USA. Stimulant-related overdose is also increasing nationwide driven by methamphetamine and cocaine. Polysubstance use, e.g. the use of a stimulant along with an opioid is driving stimulant-related overdose. Other medical consequences of injection drug use are rising including HIV and hepatitis C infections. Medication approaches to treating opioid use disorder remain the standard of care and there are new promising pharmacological approaches to treating methamphetamine use disorder. SUMMARY: A 'fourth wave' of high mortality involving methamphetamine and cocaine use has been gathering force in the USA. Availability and use of illicit fentanyls are still the major drivers of overdose deaths and the current rise in stimulant-related deaths appears entwined with the ongoing opioid epidemic.


Subject(s)
Analgesics, Opioid/poisoning , Central Nervous System Stimulants/poisoning , Cocaine-Related Disorders/epidemiology , Fentanyl/poisoning , Opiate Overdose/epidemiology , Opioid Epidemic/statistics & numerical data , Cocaine/poisoning , Comorbidity , Drug Overdose/epidemiology , Humans , Illicit Drugs/poisoning , Methamphetamine/poisoning
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