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1.
BMJ Open Qual ; 11(1)2022 02.
Article in English | MEDLINE | ID: covidwho-1685602

ABSTRACT

SETTING: Based at a busy city hospital, the alcohol care team is a drug and alcohol specialist service, taking referrals for a wide range of patients with substance use disorders (SUD). OBJECTIVES: Patients with SUD are at high risk of vitamin D deficiency; this relates to frequent fractures and proximal myopathy. The coronavirus pandemic brought vitamin D into focus. Local guidelines advise that patients at high risk of vitamin D deficiency are offered replacement. There were no local data on vitamin D deficiency prevalence or any mention of patients with SUD in local vitamin D guidelines. The main aim of this project was to offer vitamin D checks and replacement to all appropriate patients. RESULTS: We collected data on 207 patients, [pilot study (n=50) and two subsequent samples (n=95 and n=62)]. Our pilot study showed that no patients were offered vitamin D testing or replacement. We then offered vitamin D checks to 95 patients. Most had low vitamin D (30 patients were vitamin D deficient and 26 were vitamin D insufficient). We provided vitamin D replacement and follow-up advice. Quality improvement was demonstrated 6 months later. We collected data on a further 62 patients who were all on our current or recent caseload. Following exclusions, nearly half (48%) of patients had had a vitamin D check. Almost all of these (95%) had low vitamin D (60% being classified as deficient). CONCLUSIONS: Patients had not been offered vitamin D replacement despite often having multiple risk factors for vitamin D deficiency. Vitamin D checks (and subsequent replacement) rose in frequency since the outset of this project. Local guidelines should add SUD as a risk factor for vitamin D deficiency. Hospital admission provides a rich opportunity to offer this simple intervention to patients who are often poorly engaged with community services.


Subject(s)
Substance-Related Disorders , Vitamin D Deficiency , Hospitals , Humans , Pilot Projects , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Vitamin D , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/epidemiology
2.
J Contin Educ Nurs ; 52(11): 505-510, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1497419

ABSTRACT

Health care providers are challenged to meet the simultaneous demands of delivering clinical care and acquiring new information, especially in the context of the coronavirus disease 2019 pandemic, the opioid epidemic, and concurrent escalation in alcohol and other drug use. To address the gap in knowledge related to substance use, screening, brief intervention, and referral to treatment (SBIRT), a self-paced online educational program, was developed and delivered to 169 learners. Posttest knowledge scores increased for all learners and did not differ based on their pace of completion. Results indicated that this module provides a means for busy clinicians to increase their ability to manage substance use, even if their learning occurs in multiple sessions interrupted by other pressing demands. Future iterations of this course could further enhance clinical competency by addition of an online clinical simulation component. [J Contin Educ Nurs. 2021;52(11):505-510.].


Subject(s)
COVID-19 , Substance-Related Disorders , Clinical Competence , Humans , Mass Screening , Referral and Consultation , SARS-CoV-2 , Substance-Related Disorders/diagnosis
3.
Am J Emerg Med ; 50: 472-476, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1401140

ABSTRACT

BACKGROUND: The COVID-19 pandemic can exacerbate underlying substance use disorder and has impacted this vulnerable population in a variety of ways. There are limited data regarding how this pandemic has impacted emergency department (ED) patient presentations. METHODS: We extracted data on ED visits from the electronic health record (EHR) of a large healthcare system in the Washington, DC/Baltimore, MD metropolitan area. The dataset includes data from 7 hospitals on ED visits between 11/1/2019-6/30/2020. The health system utilizes a validated screening program for substance use, Screening, Brief Intervention, and Referral to Treatment (SBIRT), for ED patients who are clinically stable and willing to complete screening. We evaluated trends in patients with a positive SBIRT screen and those presenting with a clinical diagnosis of acute alcohol or substance intoxication/overdose before (11/1/19-2/29/2020-pre) and during the first wave of the COVID pandemic (3/1/2020-6/30/2020-post). Data were described using descriptive statistics. Bivariate analyses were conducted using chi-square test and two-sample t-tests. Interrupted time series analysis was used to evaluate the changes in the weekly trends with the start of the pandemic. RESULTS: There were 107,930 screens performed in the EDs during the study period (61,961 pre, 45,969 post). The population was primarily African American (64.7%) and female (57.1%). Positive SBIRT screens increased from 12.5% to 15.8% during COVID (p < 0.001). Alcohol intoxication presentations increased as a proportion of positive screens from 12.6% to 14.4% (p = 0.001). A higher percentage of screened patients reported problem drinking (AUDIT score ≥ 7) during the pandemic (2.4% pre vs 3.2% post, p < 0.001). Substance intoxication/overdoses among all screened increased from 2.1% to 3.1% (p < 0.001) and as a percentage of positive screens during the pandemic (16.8% to 20%, p < 0.001). The proportion of opioid vs. non-opioid overdoses remained unchanged before (67%) and during the pandemic (64%, p = 0.33). DISCUSSION: There was an increase in the proportion of positive SBIRT screens and visits for acute overdoses and intoxication during the first wave of the COVID-19 pandemic. Additional research should focus on mitigation strategies to address substance use during this vulnerable time.


Subject(s)
COVID-19/epidemiology , Drug Overdose/epidemiology , Emergency Service, Hospital , Substance Abuse Detection , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Adult , Aged , Drug Overdose/diagnosis , Drug Overdose/therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Substance-Related Disorders/therapy
5.
Int J Drug Policy ; 98: 103348, 2021 12.
Article in English | MEDLINE | ID: covidwho-1267652

ABSTRACT

People who use drugs, or who have in the past, often report that doctors and/or treatment providers devalue, or are unwilling to believe their claims in regards to substance use issues, in particular the presence and severity of withdrawal. In the case of benzodiazepine withdrawal this can not only lead to significant discomfort, frustration, and trauma for patients, but can lead to serious medical problems. This commentary uses the authors' recent first-person experience with a disbelieving doctor in order to illustrate the lack of value often given to the claims and narratives of people with lived substance use experience. I outline some of the potential problems with this approach, including the effects on patients themselves and the loss of an important source of evidence-based knowledge. It also discusses potential risks associated with the recent increase in benzodiazepine prescription due to Covid-19 and offers suggestions for improving treatment outcomes.


Subject(s)
COVID-19 , Foodborne Diseases , Substance-Related Disorders , Benzodiazepines , Humans , SARS-CoV-2 , Substance-Related Disorders/diagnosis
6.
Cogn Behav Ther ; 50(3): 179-184, 2021 05.
Article in English | MEDLINE | ID: covidwho-1238117

ABSTRACT

The novel 2019 SARS-2-CoV causing COVID-19 has had a devastating impact on the entire world. COVID-19 is a broad-based stressor, and research to date has documented increases in mental health problems, including anxiety, depression, and substance use, since the onset of COVID-19. By taking a transdiagnostic approach, scholars can help elucidate mechanisms and vulnerability as well as resiliency related to behavioral health problems in the context of COVID-19. The aim of the current special issue of Cognitive Behaviour Therapy was to showcase ongoing research focused on transdiagnostic factors in the context of COVID-19. The purpose of this issue is to highlight the significance of this work in the pandemic for research and practice; illustrate some of the many domains currently being explored via innovative approaches; and explicate fruitful areas for programmatic study. We hope that readers will recognize the important role of transdiagnostic models and their potential to offset the mental, addictive, and physical health disease burden of COVID-19.


Subject(s)
Anxiety Disorders/diagnosis , Anxiety/diagnosis , Behavior, Addictive/diagnosis , COVID-19/psychology , Depression/diagnosis , Depressive Disorder/diagnosis , Substance-Related Disorders/diagnosis , Anxiety/psychology , Anxiety Disorders/psychology , Behavior, Addictive/psychology , Depression/psychology , Depressive Disorder/psychology , Humans , Pandemics , Risk Factors , Substance-Related Disorders/psychology
7.
Popul Health Manag ; 24(S1): S43-S51, 2021 02.
Article in English | MEDLINE | ID: covidwho-1236195

ABSTRACT

The convergence of the opioid epidemic and the coronavirus disease 2019 (COVID-19) pandemic has created new health care challenges. The authors analyzed changes in clinical drug testing patterns and results at a national clinical laboratory, comparing data obtained before and during the pandemic. Testing for prescription and illicit drugs declined rapidly during the pandemic, with weekly test volumes falling by approximately 70% from the baseline period to the trough (the week beginning March 29) before rising in subsequent weeks. Among individuals tested, positivity increased by 35% for non-prescribed fentanyl and 44% for heroin during the pandemic. Positivity for non-prescribed fentanyl increased significantly among patients positive for other drugs: by 89% for specimens positive for amphetamines; 48% for benzodiazepines; 34% for cocaine; and 39% for opiates (P < 0.01 for all comparisons). These findings suggest significant increases in dangerous drug combinations. Positivity for non-prescribed use of many other drugs remained consistent or declined for some drugs, relative to pre-pandemic patterns. Models adjusting for potential confounding variables, including medication-assisted treatment and treatment at a substance use disorder facility indicated that the risk for non-prescribed fentanyl positivity rose by more than 50% during the pandemic. In summary, these findings demonstrate decreased drug testing overall, with increased positivity for high-risk drugs and dangerous drug combinations. The convergence of the drug abuse epidemic and COVID-19 pandemic has led to an increased need for health care and public health resources dedicated to supporting vulnerable patients and addressing the underlying causes of these disturbing trends.


Subject(s)
COVID-19 , Opioid Epidemic/statistics & numerical data , Opioid-Related Disorders , Substance Abuse Detection/statistics & numerical data , Adolescent , Adult , Aged , Analgesics, Opioid/urine , Female , Fentanyl/urine , Humans , Male , Middle Aged , Opioid-Related Disorders/diagnosis , Opioid-Related Disorders/epidemiology , Pandemics , SARS-CoV-2 , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Young Adult
9.
BMC Health Serv Res ; 21(1): 340, 2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1183533

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, youth mental health and substance use services rapidly moved to virtual modalities to meet social distancing requirements. It is important to understand youth attitudes toward and experience of virtual services. OBJECTIVE: This study examined the attitudes toward and experiences of virtual mental health and substance use services among youth drawn from clinical and non-clinical samples. METHOD: Four hundred nine youth completed a survey including questions about their attitudes toward and experience of virtual services. The survey included quantitative and open-ended questions on virtual care, as well as a mental health and substance use screener. RESULTS: The majority of youth with mental health or substance use challenges would be willing to consider individual virtual services, but fewer would consider group virtual services. However, many have not received virtual services. Youth are interested in accessing a wide variety of virtual services and other supportive wellness services. Advantages and disadvantages of virtual services are discussed, including accessibility benefits and technological barriers. DISCUSSION: As youth mental health and substance use services have rapidly gone virtual during the COVID-19 pandemic, it is essential that we hear the perspectives of youth to promote service utilization among those in need. Diverse, accessible, technologically stable virtual services are required to meet the needs of different youth, possibly with in-person options for some youth. Future research, engaging youth in the research process, is needed to evaluate the efficacy of virtual services to plan for the sustainability of some virtual service gains beyond the pandemic period.


Subject(s)
COVID-19 , Health Services Accessibility , Mental Disorders/therapy , Mental Health Services/organization & administration , Pandemics/prevention & control , Substance-Related Disorders/therapy , Telemedicine , Adolescent , Female , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , SARS-CoV-2 , Substance-Related Disorders/diagnosis , Substance-Related Disorders/psychology
10.
Drug Alcohol Depend ; 223: 108701, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1174194

ABSTRACT

BACKGROUND: Substantial concern exists regarding the impact of the COVID-19 pandemic on substance use behaviors. This is especially true for subpopulations like young men who have sex with men and young transgender women (YMSM-YTW) who report higher rates of substance use. This study examines changes in prevalence and frequency of marijuana and non-marijuana drug use among YMSM-YTW following the onset of the pandemic. METHOD: Data for this analysis (n = 458 participants, 1356 observations) come from an ongoing longitudinal cohort study of YMSM-YTW. A series of Bayesian multilevel models were used to examine change in prevalence and frequency of use for marijuana and non-marijuana drugs. RESULTS: Results indicated no systematic change in prevalence or frequency of marijuana use. However, a decrease in non-marijuana drug use was observed (OR = 0.60, 95 % CrI: [0.37, 0.94]) following the onset of the pandemic. Furthermore, a small increase in the frequency of non-marijuana drug use was observed (OR = 1.79, 95 % CrI: [1.02, 3.21]) among individuals who used these substances. CONCLUSIONS: These findings concur with a small number of studies identifying a decrease in drug use prevalence but increase in frequency among those who continue to use drugs. Despite the protective effect of lower drug use prevalence, higher frequency of use may lead to additional negative health outcomes of drug use, particularly among groups facing multiple health challenges such as YMSM-YTW. However, the pandemic likely has a unique impact on substance use behaviors across subpopulations.


Subject(s)
COVID-19/epidemiology , Homosexuality, Male , Marijuana Use/epidemiology , Substance-Related Disorders/epidemiology , Transgender Persons , Adolescent , Adult , COVID-19/psychology , Cohort Studies , Female , Homosexuality, Male/psychology , Humans , Longitudinal Studies , Male , Marijuana Use/psychology , Pandemics , Prevalence , Substance-Related Disorders/diagnosis , Transgender Persons/psychology , Young Adult
11.
Span J Psychol ; 24: e8, 2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1101609

ABSTRACT

In the midst of the COVID-19 epidemic, Spain was one of the countries with the highest number of infections and a high mortality rate. The threat of the virus and consequences of the pandemic have a discernible impact on the mental health of citizens. This study aims to (a) evaluate the levels of anxiety, depression and well-being in a large Spanish sample during the confinement, (b) identify potential predictor variables associated to experiencing both clinical levels of distress and well-being in a sample of 2,122 Spanish people. By using descriptive analyses and logistic regression results revealed high rates of depression, anxiety and well-being. Specifically, our findings revealed that high levels of anxiety about COVID-19, increased substance use and loneliness as the strongest predictors of distress, while gross annual incomes and loneliness were strongest predictors of well-being. Finding of the present study provide a better insight about psychological adjustment to a pandemic and allows us to identify which population groups are at risk of experiencing higher levels of distress and which factors contribute to greater well-being, which could help in the treatments and prevention in similar stressful and traumatic situations.


Subject(s)
Adaptation, Psychological , Anxiety Disorders/psychology , COVID-19/psychology , Depressive Disorder/psychology , Mental Health , Psychological Distress , Substance-Related Disorders/psychology , Adolescent , Adult , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , COVID-19/epidemiology , Cross-Sectional Studies , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Female , Health Surveys , Humans , Income , Internet , Loneliness/psychology , Male , Middle Aged , Pregnancy , Quality of Life/psychology , Risk Factors , Spain/epidemiology , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Young Adult
13.
Am J Drug Alcohol Abuse ; 47(2): 154-159, 2021 03 04.
Article in English | MEDLINE | ID: covidwho-1066068

ABSTRACT

The ongoing pandemic has led to a sudden disruption of routine treatment services. Consequently, the already existing treatment gap for substance use disorders is likely to widen. There is an opportunity to expand the scope of Screening and Brief Intervention (SBI) to meet this unprecedented challenge. Its brevity, flexibility, and generalizability have positioned SBI to deal with additional systemic, structural, and attitudinal barriers that pertain to the pandemic. The standard content of SBI could be modified to adapt to the current context. SBI could also be used as a vehicle to render strategies for infection risk minimization. In this Perspective, we anticipate the challenges of expanding and implementing SBI in the present circumstances and present potential solutions. SBI, with adaptations, could bridge the augmented treatment gap for substance use disorders during COVID-19.


Subject(s)
COVID-19 , Crisis Intervention/methods , Substance-Related Disorders/therapy , Crisis Intervention/organization & administration , Humans , Substance-Related Disorders/diagnosis
14.
Drug Test Anal ; 13(4): 867-870, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-938409

ABSTRACT

A lot has been published on the anticipated effects of the current COVID-19 pandemic on users of illegal drugs. In this study, we present evidence-based data on such effects, namely, the increased number of drug findings in post-mortem investigations. All post-mortem toxicology cases positive for at least one of the following: buprenorphine, amphetamine or cannabis, were investigated in the first 8 months of the year 2020, and the monthly numbers were compared to those in the previous 5 years from 2015 to 2019. These substances served as indicator analytes that could reveal changes in the drug using population. Right after the government restrictions came into force in March 2020, the numbers of buprenorphine, amphetamine and cannabis findings increased. The increase was most noticeable for amphetamine and was evident in all age groups. Our findings indicate that the assumptions on the increased risk of drug-related harm (including death) have become reality. Reduced access to harm-reduction services seems to have increased the mortality among individuals that use buprenorphine, amphetamine or cannabis. Significant and prompt actions need to be taken in order to find new ways in helping this vulnerable group of people.


Subject(s)
COVID-19 , Forensic Toxicology , Substance-Related Disorders/epidemiology , Amphetamine/analysis , Analgesics, Opioid/analysis , Autopsy , Buprenorphine/analysis , COVID-19/epidemiology , Cannabinoid Receptor Agonists/analysis , Central Nervous System Stimulants/analysis , Dronabinol/analogs & derivatives , Dronabinol/analysis , Finland/epidemiology , Harm Reduction , Humans , Illicit Drugs/analysis , Substance-Related Disorders/diagnosis
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