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1.
Subst Abus ; 43(1): 993-998, 2022.
Article in English | MEDLINE | ID: covidwho-1795543

ABSTRACT

Background: US local health departments (LHDs) have faced the COVID-19 pandemic and the opioid epidemic simultaneously. This article investigates the perceived impact of COVID-19 on the continuation of locally available services for addressing opioid use disorder (OUD). Methods: A national survey of US LHDs was conducted from November to December 2020. The survey asked key personnel in LHDs about the availability of OUD services in their jurisdiction, and how COVID-19 impacted such availability (i.e., whether terminated or continued at a reduced, the same, or an increased level after the arrival of COVID-19). Proportions for each impact category were estimated for prevention, treatment, harm reduction, and recovery services. Logistic regression tested for rural-urban and regional differences in perceived service impact. Results: An 11.4% (214 out of 1873) response rate was attained. Of the returned surveys, 187 were used in the analysis. Reported terminations were generally low, especially for treatment services. School-based prevention initiatives had the highest termination rate (17.2%, 95% CI = 11.4-25.1%). Prevention services had the highest proportions for continuing at a reduced level, except for recovery mutual help programs (53.9%, 95% CI = 45.2-62.4%). LHDs reported continuing services at an increased level at a higher frequency than terminating. Notably, 72.2% (95% CI = 62.7-80.0%) continued telehealth/telemedicine options for OUD at an increased level, and 23.8% (95% CI = 17.8-31.1%) and 10.0% (95% CI = 5.7-16.7%) reported doing the same for naloxone distribution and medications for opioid use disorder (MOUD), respectively. More harm reduction services were continued at the same versus at a reduced level. Service continuation differed little between rural-urban LHDs or by region. Conclusions: The impacts of COVID-19 on OUD service availability in LHD jurisdictions may depend on the specific area of opioid response while the long-term consequences of these changes remain unknown.


Subject(s)
COVID-19 , Opioid-Related Disorders , Harm Reduction , Humans , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Pandemics/prevention & control
2.
Int J Environ Res Public Health ; 19(6)2022 03 08.
Article in English | MEDLINE | ID: covidwho-1765699

ABSTRACT

The street homeless, those who spend their nights either in shelters or unofficial camps, whether in tents on a street or in society's hidden spaces such as beneath an overpass, face multiple challenges beyond finding a safe place to sleep. Of further concern is how official actions can worsen these situations, through day-to-day activities or planned intervention strategies. In this paper we explore how a planned intervention may be negatively perceived-even as a form of "structural violence"-and may prevent Narcan (naloxone) use to stop an overdose related death in the Skid Row of Los Angeles. Data for this study consisted of a combination of Spatial Video Geonarratives (SVGs) and 325 incident reports from the Homeless Health Care Los Angeles Center for Harm Reduction (HHCLA-HRC) between November 2014 and December 2015. Chi-square and simple logistic regression models were used to examine the association between fear-of-arrest and other covariates of interest. Mapping results are presented with different sets of shapefiles created for (1) all Narcan uses, (2) all homeless, (3) all homeless with a worry about being arrested, (4) all Narcan uses where an ambulance attended, (5) and the same as 4 but also with police attendance. In the multivariable model, the estimated adjusted odds of fear-of-arrest is over three times higher among Narcan users ages 30-39 when compared to users under the age of 30. Analyzing the association of calling 9-1-1 on Narcan user demographics, socio-contextual characteristics, and overdose victim demographics, the crude estimated probability of calling 9-1-1 for Narcan users aged 50 and older is nearly three times higher when compared to Narcan users aged 19-29. Conclusion: Results suggest that the fear-of-arrest and calling 9-1-1 during an overdose is still a concern among Narcan users despite protective legislation and access to harm reduction resources.


Subject(s)
Drug Overdose , Naloxone , Aged , Attitude , Drug Overdose/drug therapy , Drug Overdose/prevention & control , Harm Reduction , Humans , Law Enforcement/methods , Middle Aged , Naloxone/therapeutic use
3.
BMC Public Health ; 22(1): 500, 2022 03 15.
Article in English | MEDLINE | ID: covidwho-1741939

ABSTRACT

INTRODUCTION: People who use drugs (PWUD) are considered vulnerable to COVID-19 exposure and the sequelae of infection due to their social circumstances, health conditions, drug purchasing, and substance use. They can depend on access to services that provide harm reduction, substance use treatment, recovery and support, and general healthcare. Social distancing measures and service restrictions posed significant challenges to the health and wellbeing of PWUD. METHODS: Ethical approvals were secured. PWUD were recruited from voluntary sector homeless and housing, harm reduction, and recovery organisations across central Scotland. Data was collected via semi-structured interviews and analysed using the Framework Method. RESULTS: Twenty nine PWUD participated and reported mixed experiences of the impacts of COVID-19 lockdown. Several benefitted from policy and practice developments designed to sustain or increase access to harm reduction services. Some PWUD reported improved access to substitute prescribing and/or appreciated being trusted to manage multiple take-home doses. Others noted the loss of regular in-person contact with treatment providers and dispensers. Access to recovery support was challenging for many, especially those unable to access or uncomfortable with online provision who experienced greater isolation. Lack of access to general healthcare services was common, and especially problematic for PWUD with chronic physical and mental health conditions. CONCLUSIONS: This qualitative research describes the impacts of COVID-19 social and service restrictions on PWUD in Scotland. These impacts were anticipated by policy makers and service providers. Effective and acceptable developments were shown to maintain and even increase service provision for PWUD. Developments were geographically dependent and significant challenges remained for many people. The learning generated can inform responses to increase service access and uptake in post-pandemic times.


Subject(s)
COVID-19 , Substance-Related Disorders , Communicable Disease Control , Harm Reduction , Health Services Accessibility , Humans , Qualitative Research , Substance-Related Disorders/therapy
4.
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
5.
Drug Alcohol Depend ; 232: 109323, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1670416

ABSTRACT

OBJECTIVES: This study describes harm reduction and health services provided by U.S syringe services programs (SSPs) in 2019 and changes in provision of those services in 2020. METHODS: SSPs were invited to participate in the Dave Purchase Memorial survey in August 2020. We collected programmatic data on services provided in 2019 and at the time of the survey in 2020. We conducted descriptive analyses using Chi-square and McNemar's tests. RESULTS: At the time of the survey, > 60% of SSPs reported increased monthly syringe and naloxone distribution and expansion of home-based and mail-based naloxone delivery in Fall 2020 compared to 2019. Approximately three-quarters of SSPs decreased or stopped providing on-site HIV and HCV testing. Nearly half of SSPs offering on-site medications for opioid use disorder (MOUD) in 2019 increased provision of MOUD in 2020. The proportion of SSPs offering on-site mental health care services and primary care services statistically significantly decreased from 2019 to Fall 2020, but telehealth offerings of these services increased. CONCLUSIONS: Many SSPs that offered health services in 2019 and remained operational in 2020 increased telehealth provision of mental health and primary care services, increased MOUD provision, and expanded harm reduction services, but most SSPs reduced or stopped on-site HIV and HCV testing. Sustaining SSP growth and innovation is paramount for preventing overdose deaths and HIV/HCV outbreaks after the deadliest year of the opioid epidemic in 2020.


Subject(s)
COVID-19 , Substance Abuse, Intravenous , COVID-19/prevention & control , Harm Reduction , Health Services , Humans , Needle-Exchange Programs , SARS-CoV-2 , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/epidemiology , Syringes
6.
Harm Reduct J ; 19(1): 9, 2022 02 04.
Article in English | MEDLINE | ID: covidwho-1666657

ABSTRACT

OBJECTIVES: Unpredictable fluctuations in the illicit drug market increase overdose risk. Drug checking, or the use of technology to provide insight into the contents of illicit drug products, is an overdose prevention strategy with an emerging evidence base. The use of portable spectrometry devices to provide point-of-service analysis of the contents of illicit drugs been adopted by harm reduction organizations internationally but is only emerging in the United States. This study aimed to identify barriers and facilitators of implementing drug checking services with spectrometry devices in an urban harm reduction organization and syringe service program serving economically marginalized people who use drugs in Boston, Massachusetts (USA). METHODS: In-vivo observations and semi-structured interviews with harm reduction staff and participants were conducted between March 2019 and December 2020. We used the consolidated framework for implementation research to identify implementation barriers and facilitators. RESULTS: This implementation effort was facilitated by the organization's shared culture of harm reduction-which fostered shared implementation goals and beliefs about the intervention among staff persons-its horizontal organizational structure, strong identification with the organization among staff, and strong relationships with external funders. Barriers to implementation included the technological complexity of the advanced spectroscopy devices utilized for drug checking. Program staff indicated that commercially available spectroscopy devices are powerful but not always well-suited for drug checking efforts, describing their technological capacities as "the Bronze Age of Drug Checking." Other significant barriers include the legal ambiguity of drug checking services, disruptive and oppositional police activity, and the responses and programmatic changes demanded by the COVID-19 pandemic. CONCLUSIONS: For harm reduction organizations to be successful in efforts to implement and scale drug checking services, these critical barriers-especially regressive policing policies and prohibitive costs-need to be addressed. Future research on the impact of policy changes to reduce the criminalization of substance use or to provide explicit legal frameworks for the provision of this and other harm reduction services may be merited.


Subject(s)
COVID-19 , Drug Overdose , Harm Reduction , Illicit Drugs , Police , Boston , Drug Overdose/prevention & control , Humans , Pandemics , Violence
7.
Harm Reduct J ; 18(1): 128, 2021 Dec 09.
Article in English | MEDLINE | ID: covidwho-1566524

ABSTRACT

The COVID-19 had a substantial impact on the provision of harm reduction services for people who use drugs globally. These front-line public health interventions serve a population that due to stigma, discrimination and criminalisation, faces barriers to accessing health and social services and are particularly vulnerable to public health crises. Despite this, the pandemic has seen many harm reduction services close, reduce operations or have their funding reduced. Simultaneously, around the world, harm reduction services have been forced to adapt, and in doing so have demonstrated resilience, flexibility and innovation. Governments must recognise the unique abilities of harm reduction services, particularly those led by the community, and identify them as essential health services that must be protected and strengthened in times of crisis.


Subject(s)
COVID-19 , Harm Reduction , Humans , Pandemics , Public Health , SARS-CoV-2
8.
Harm Reduct J ; 18(1): 125, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1555202

ABSTRACT

BACKGROUND: Harm reduction programs often lack community-based support and can be controversial, despite data demonstrating effectiveness. This article describes one small Alaskan community's development of a harm reduction managed alcohol program (MAP) in the context of a city-run quarantine site for individuals experiencing homelessness. The MAP was developed to support quarantining by COVID-19-exposed or COVID-positive individuals who also experienced chronic homelessness, a severe alcohol use disorder, and heightened health risks related to potentially unsupported alcohol withdrawal. METHOD: Five interviews with key informants involved in planning or implementation of the MAP were conducted using rapid qualitative analysis and narrative analysis techniques. OUTCOME: This study documents the planning and implementation of an innovative application of a managed alcohol harm reduction intervention in the context of the COVID-19 pandemic. In this instance, a MAP was used specifically to limit hospital admissions for alcohol withdrawal during a surge of cases in the community, as well as to mitigate spread of the virus. Key informants report no residents enrolled in the MAP program as a part of quarantine required hospitalization for withdrawal or for COVID symptoms, and no shelter resident left the quarantine site while still contagious with COVID-19. Additionally, the level of community support for the program was much higher than originally expected by organizers. CONCLUSIONS: This program highlighted an example of how a community recognized the complexity and potential risk to individuals experiencing structural vulnerability related to homelessness and a severe AUD, and the community at large, and was able to create an alternative path to minimize those risks using a harm reduction strategy.


Subject(s)
Alcoholism , COVID-19 , Homeless Persons , Substance Withdrawal Syndrome , Alcoholism/epidemiology , Alcoholism/prevention & control , Harm Reduction , Humans , Pandemics , Risk Management , SARS-CoV-2
9.
Int J Environ Res Public Health ; 18(23)2021 11 28.
Article in English | MEDLINE | ID: covidwho-1542540

ABSTRACT

People who experience homelessness and alcohol dependency are more vulnerable than the general population to risks/harms relating to COVID-19. This mixed methods study explored stakeholder perspectives concerning the impact of COVID-19 and the potential utility of introducing managed alcohol programmes (MAPs) in Scotland as part of a wider health/social care response for this group. Data sources included: 12 case record reviews; 40 semi-structured qualitative interviews; and meeting notes from a practitioner-researcher group exploring implementation of MAPs within a third sector/not-for-profit organisation. A series of paintings were curated as a novel part of the research process to support knowledge translation. The case note review highlighted the complexity of health problems experienced, in addition to alcohol dependency, including polysubstance use, challenges related to alcohol access/use during lockdown, and complying with stay-at-home rules. Qualitative analysis generated five subthemes under the theme of 'MAPs as a response to COVID-19': changes to alcohol supply/use including polysubstance use; COVID-19-related changes to substance use/homelessness services; negative changes to services for people with alcohol problems; the potential for MAPs in the context of COVID-19; and fears and concerns about providing MAPs as a COVID-19 response. We conclude that MAPs have the potential to reduce a range of harms for this group, including COVID-19-related harms.


Subject(s)
COVID-19 , Homeless Persons , Communicable Disease Control , Harm Reduction , Humans , SARS-CoV-2
10.
Addict Sci Clin Pract ; 16(1): 68, 2021 11 13.
Article in English | MEDLINE | ID: covidwho-1515451

ABSTRACT

BACKGROUND: The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. METHODS: Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. RESULTS: Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. CONCLUSIONS: The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.


Subject(s)
COVID-19 , Opioid-Related Disorders , Harm Reduction , Humans , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , SARS-CoV-2
11.
Am J Prev Med ; 61(5 Suppl 1): S118-S129, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1499600

ABSTRACT

Diagnoses of HIV among people who inject drugs have increased in the U.S. during 2014-2018 for the first time in 2 decades, and multiple HIV outbreaks have been detected among people who inject drugs since 2015. These epidemiologic trends pose a significant concern for achieving goals of the federal initiative for Ending the HIV Epidemic in the U.S. Syringe services programs are cost effective, safe, and highly effective in reducing HIV transmission and are an essential component of a comprehensive, integrated approach to addressing these concerns. Yet, geographic coverage of these programs remains limited in the U.S., and many jurisdictions continue to have laws and policies that limit or disallow syringe services programs. An in-depth literature review was conducted on the role of syringe services programs in the Ending the HIV Epidemic initiative. Empirical and model-based evidence consistently shows that syringe services programs have the highest impact in HIV prevention when combined with access to medications for substance use disorder and antiretroviral therapy. Their effectiveness is further maximized when they provide services without restrictions and include proven and innovative strategies to expand access to harm-reduction and clinical services (e.g., peer outreach, telehealth). Increasing geographic and service coverage of syringe services programs requires strong and sustainable policy, funding, and community support and will need to address new challenges related to the COVID-19 pandemic. Syringe services programs have a key role in all 4 Ending the HIV Epidemic initiative strategies-Prevent, Diagnose, Treat, and Respond-and thus are instrumental to its success in preventing disease and saving lives.


Subject(s)
COVID-19 , HIV Infections , Substance Abuse, Intravenous , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , Harm Reduction , Humans , Pandemics , SARS-CoV-2 , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/epidemiology , Syringes
12.
J Subst Abuse Treat ; 132: 108648, 2022 01.
Article in English | MEDLINE | ID: covidwho-1487873

ABSTRACT

INTRODUCTION: The COVID-19 pandemic collided with the opioid epidemic and longstanding health inequities to exacerbate the disproportionate harms experienced by persons with opioid use disorder (OUD) who self-identify as from racial and ethnic minority groups. Disrupted access to harm reduction services (e.g., naloxone, sterile syringes, recovery support) is one pathway whereby COVID-19 might exacerbate health disparities. We tested the hypothesis that persons receiving medication for opioid use disorder (MOUD) who self-identify as from racial/ethnic minority groups would experience more disruptions in access to harm reduction services than persons identifying as non-Hispanic White, even when controlling for severity of opioid use and sociodemographics (e.g., education, income, biological sex, age). METHODS: Analyses used data from a cluster randomized trial that had enrolled 188 patients, all of whom had provided baseline data on sociodemographics and severity of opioid use, across eight opioid treatment programs. Data collectors re-contacted participants between May and June 2020 and 133 (71% response rate) agreed to complete a survey about access to harm reduction services. RESULTS: Twenty-six respondents (20%) identified as from racial/ethnic minority groups (predominantly Black, Hispanic, and/or biracial). Between 7% and 27% of respondents reported disrupted access to harm reduction services. Logistic regressions indicated that persons identifying as from racial/ethnic minority groups were 8-10 times more likely than persons identifying as non-Hispanic White to report reduced access to naloxone and sterile syringes (p < .01), even when accounting for potential confounding variables. CONCLUSIONS: This report concludes with a discussion of potential outreach strategies and policies to advance more equitable access to essential harm reduction services.


Subject(s)
COVID-19 , Opioid-Related Disorders , Harm Reduction , Humans , Minority Groups , Pandemics , SARS-CoV-2 , United States
13.
Hypertension ; 79(2): 325-334, 2022 02.
Article in English | MEDLINE | ID: covidwho-1476907

ABSTRACT

In a cross-sectional analysis of a case-control study in 2015, we revealed the association between increased arterial stiffness (pulse wave velocity) and aircraft noise exposure. In June 2020, we evaluated the long-term effects, and the impact of a sudden decline in noise exposure during the coronavirus disease 2019 (COVID-19) lockdown, on blood pressure and pulse wave velocity, comparing 74 participants exposed to long-term day-evening-night aircraft noise level >60 dB and 75 unexposed individuals. During the 5-year follow-up, the prevalence of hypertension increased in the exposed (42% versus 59%, P=0.048) but not in the unexposed group. The decline in noise exposure since April 2020 was accompanied with a significant decrease of noise annoyance, 24-hour systolic (121.2 versus 117.9 mm Hg; P=0.034) and diastolic (75.1 versus 72.0 mm Hg; P=0.003) blood pressure, and pulse wave velocity (10.2 versus 8.8 m/s; P=0.001) in the exposed group. Less profound decreases of these parameters were noticed in the unexposed group. Significant between group differences were observed for declines in office and night-time diastolic blood pressure and pulse wave velocity. Importantly, the difference in the reduction of pulse wave velocity between exposed and unexposed participants remained significant after adjustment for covariates (-1.49 versus -0.35 m/s; P=0.017). The observed difference in insomnia prevalence between exposed and unexposed individuals at baseline was no more significant at follow-up. Thus, long-term aircraft noise exposure may increase the prevalence of hypertension and accelerate arterial stiffening. However, even short-term noise reduction, as experienced during the COVID-19 lockdown, may reverse those unfavorable effects.


Subject(s)
Aircraft , Blood Pressure/physiology , COVID-19 , Environmental Exposure , Noise, Transportation/adverse effects , Noise/adverse effects , Quarantine , Vascular Stiffness/physiology , Aged , Arteriosclerosis/epidemiology , Arteriosclerosis/etiology , Female , Harm Reduction , Humans , Hypertension/epidemiology , Hypertension/etiology , Life Style , Male , Middle Aged , Poland/epidemiology , Pulse Wave Analysis , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/etiology , Urban Health
15.
BMC Public Health ; 21(1): 1678, 2021 09 15.
Article in English | MEDLINE | ID: covidwho-1430414

ABSTRACT

BACKGROUND: The well-being of people who use drugs (PWUD) continues to be threatened by substances of unknown type or quantity in the unregulated street drug supply. Current efforts to monitor the drug supply are limited in population reach and comparability. This restricts capacity to identify and develop measures that safeguard the health of PWUD. This study describes the development of a low-barrier system for monitoring the contents of drugs in the unregulated street supply. Early results for pilot sites are presented and compared across regions. METHODS: The drug content monitoring system integrates a low-barrier survey and broad spectrum urine toxicology screening to compare substances expected to be consumed and those actually in the drug supply. The system prototype was developed by harm reduction pilot projects in British Columbia (BC) and Montreal with participation of PWUD. Data were collected from harm reduction supply distribution site clients in BC, Edmonton and Montreal between May 2018-March 2019. Survey and urine toxicology data were linked via anonymous codes and analyzed descriptively by region for trends in self-reported and detected use. RESULTS: The sample consisted of 878 participants from 40 sites across 3 regions. Reported use of substances, their detection, and concordance between the two varied across regions. Methamphetamine use was reported and detected most frequently in BC (reported: 62.8%; detected: 72.2%) and Edmonton (58.3%; 68.8%). In Montreal, high concordance was also observed between reported (74.5%) and detected (86.5%) cocaine/crack use. Among those with fentanyl detected, the percentage of participants who used fentanyl unintentionally ranged from 36.1% in BC, 78.6% in Edmonton and 90.9% in Montreal. CONCLUSIONS: This study is the first to describe a feasible, scalable monitoring system for the unregulated drug supply that can contrast expected and actual drug use and compare trends across regions. The system used principles of flexibility, capacity-building and community participation in its design. Results are well-suited to meet the needs of PWUD and inform the local harm reduction services they rely on. Further standardization of the survey tool and knowledge mobilization is needed to expand the system to new jurisdictions.


Subject(s)
Drug Overdose , Illicit Drugs , Substance-Related Disorders , British Columbia/epidemiology , Fentanyl , Harm Reduction , Humans , Illicit Drugs/supply & distribution , Substance-Related Disorders/epidemiology , Substance-Related Disorders/prevention & control
16.
Curr HIV/AIDS Rep ; 18(4): 261-270, 2021 08.
Article in English | MEDLINE | ID: covidwho-1408775

ABSTRACT

PURPOSE OF REVIEW: This review highlights the intersection of the COVID-19, HIV, and STI pandemics and examines how harm reduction strategies can be applied broadly to controlling a pandemic. RECENT FINDINGS: Since the onset of the COVID-19 pandemic, remarkable advances in the understanding of COVID-19 prevention, diagnosis, and treatment have been made at a much faster pace than prior pandemics, yet much more still remains to be discovered. Many of the strategies to control the COVID-19 pandemic mirror those employed to stem the HIV pandemic. Harm reduction principles used in the HIV pandemic can be applied to reduce the morbidity and mortality of the COVID-19 pandemic through effective prevention, detection, and treatment strategies.


Subject(s)
COVID-19/prevention & control , HIV Infections/prevention & control , Harm Reduction , SARS-CoV-2 , Sexually Transmitted Diseases/prevention & control , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Chemoprevention , HIV Infections/diagnosis , HIV Infections/therapy , Humans , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/therapy , Vaccination
17.
Patient Educ Couns ; 105(2): 269-276, 2022 02.
Article in English | MEDLINE | ID: covidwho-1401769

ABSTRACT

OBJECTIVE: We propose that harm reduction messages advocating moderation versus abstinence from social interaction will be seen as less threatening and increase intentions to follow COVID-19 guidelines. We also examine two important moderators: the influence of risk framing and willingness to risk infection. METHOD: A 2 × 2 between-participants, randomized experiment (N = 476) varied infographics portraying low-risk behaviors, like going camping, versus high-risk behaviors, like attending a concert, followed by either moderation or abstinence guidelines. Participants in two additional control groups saw an infographic displaying either a full range of risk behaviors or behaviors that pose no risk, each followed by generic guidelines. RESULTS: Regression analyses show moderation messages are less freedom-threatening only when presenting low-risk behaviors. Persons more willing to risk infection found all messages more freedom-threatening; however, for these individuals, moderation messages increased behavioral intentions when risks were presented as high. CONCLUSION: This study suggests harm reduction may be applied effectively in a pandemic, where the behavior of risk-tolerant individuals, at a population level, could have suboptimal effects on curbing virus transmission. PRACTICE IMPLICATIONS: Health educators should communicate harm reduction with certain populations but also test to ensure messaging, including visuals communicating relative risks, are received as intended.


Subject(s)
COVID-19 , Data Visualization , Harm Reduction , Humans , Intention , SARS-CoV-2
18.
Int J Prison Health ; ahead-of-print(ahead-of-print)2021 08 21.
Article in English | MEDLINE | ID: covidwho-1364887

ABSTRACT

PURPOSE: This paper aims to describe the impact of the COVID-19 containment measures on the provision of drug treatment and harm reduction services in European prisons in15 countries during the early phase of the pandemic (March -June 2020). DESIGN/METHODOLOGY/APPROACH: The paper is based on a mixed method research approach that triangulates different data sources, including the results of an on-line survey, the outcome of a focus group and four national case studies. FINDINGS: The emergence of COVID-19 led to a disruption in prison drug markets and resulted in a number of challenges for the drug services provision inside prison. Challenges for health services included the need to maintain the provision of drug-related interventions inside prison, while introducing a range of COVID-19 containment measures. To reduce contacts between people, many countries introduced measures for early release, resulted in around a 10% reduction of the prison population in Europe. Concerns were expressed around reduction of drug-related interventions, including group activities, services by external agencies, interventions in preparation for release and continuity of care. PRACTICAL IMPLICATIONS: Innovations aimed at improving drug service provision included telemedicine, better partnership between security and health staff and an approach to drug treatment more individualised. Future developments must be closely monitored. ORIGINALITY/VALUE: The paper provides a unique and timely overview of the main issues, challenges and initial adaptations implemented for drug services in European prisons in response to the COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Health Services Accessibility , Prisoners , Prisons , Substance-Related Disorders/therapy , Continuity of Patient Care , Europe/epidemiology , Harm Reduction , Humans , SARS-CoV-2
19.
Harm Reduct J ; 18(1): 85, 2021 08 05.
Article in English | MEDLINE | ID: covidwho-1344110

ABSTRACT

BACKGROUND: Spotting is an informal practice among people who use drugs (PWUD) where they witness other people using drugs and respond if an overdose occurs. During COVID-19 restrictions, remote spotting (e.g., using a telephone, video call, and/or a social media app) emerged to address physical distancing requirements and reduced access to harm reduction and/or sexually transmitted blood borne infection (STBBI's) prevention services. We explored spotting implementation issues from the perspectives of spotters and spottees. METHODS: Research assistants with lived/living expertise of drug use used personal networks and word of mouth to recruit PWUD from Ontario and Nova Scotia who provided or used informal spotting. All participants completed a semi-structured, audio-recorded telephone interview about spotting service design, benefits, challenges, and recommendations. Recordings were transcribed and thematic analysis was used. RESULTS: We interviewed 20 individuals between 08/2020-11/2020 who were involved in informal spotting. Spotting was provided on various platforms (e.g., telephone, video calls, and through texts) and locations (e.g. home, car), offered connection and community support, and addressed barriers to the use of supervised consumption sites (e.g., location, stigma, confidentiality, safety, availability, COVID-19 related closures). Spotting calls often began with setting an overdose response plan (i.e., when and who to call). Many participants noted that, due to the criminalization of drug use and fear of arrest, they preferred that roommates/friends/family members be called instead of emergency services in case of an overdose. Both spotters and spottees raised concerns about the timeliness of overdose response, particularly in remote and rural settings. CONCLUSION: Spotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/STBBI's prevention services, additional supports (e.g., changes to Good Samaritan Laws) are needed. The criminalization of drug use may limit uptake of formal spotting services.


Subject(s)
COVID-19 , Communication , Drug Overdose/therapy , Pandemics , Substance-Related Disorders/complications , Crime , Emergency Treatment , Fear , Harm Reduction , Humans , Needle-Exchange Programs , Nova Scotia , Ontario , Social Stigma , Socioeconomic Factors , Surveys and Questionnaires
20.
Int J Drug Policy ; 93: 102908, 2021 07.
Article in English | MEDLINE | ID: covidwho-1343193

ABSTRACT

An unprecedented public health crisis confronts the world. Iran is among the hardest-hit countries, where effects of the COVID-19 pandemic are stretched across society and felt by the most marginalised people. Among people who use drugs, a comprehensive response to the crisis calls for broad collaboration, coordination, and creativity involving multiple government and non-government organisations. This commentary provides early insights into an unfolding experience, demonstrating the operational and policy impact of an initiative, bringing together a diverse array of harm reduction stakeholders to address the pandemic. In the context of lived experiences of social and economic marginalization, this initiative intends to lead efforts in developing an equitable response to the COVID-19 pandemic.


Subject(s)
COVID-19 , Pharmaceutical Preparations , Harm Reduction , Humans , Iran , Pandemics , SARS-CoV-2
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