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Supporting Persons Who Use Drugs During the COVID-19 Pandemic: A Rapid Review of International Guidelines. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Lin PI, Srivastava G, Beckman L, Kim Y, Hallerbäck M, Barzman D, Sorter M, Eapen V. A Framework-Based Approach to Assessing Mental Health Impacts of the COVID-19 Pandemic on Children and Adolescents. Front Psychiatry 2021; 12:655481. [PMID: 34054613 PMCID: PMC8155579 DOI: 10.3389/fpsyt.2021.655481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/19/2021] [Indexed: 02/03/2023] Open
Abstract
The COVID-19 pandemic has yielded extensive impacts globally in the year of 2020. Although the mental health of children and adolescents may be particularly susceptible to stressors stemming from the pandemic and anti-contagion policies, most ongoing efforts are geared toward curbing the viral spread. In the current perspective, we have identified four domains of factors corresponding to an ecological framework that may directly or indirectly influence the mental health of children and adolescents during the pandemic. The evidence suggests that anti-contagion policies might trigger cascades that impact the mental health of children and their families through multiple different sectors that used to form a safety net for youths. Additionally, children with neuropsychiatric disorders could experience exacerbated symptoms during the pandemic. Furthermore, the risk of domestic violence has surged during the pandemic, which further compounds the imminent mental health crisis. A mental health pandemic could be inevitable if no proactive prevention strategies were in place. Therefore, we recommend understanding each individual mental health risk pathway via the ecological framework in order to develop integrative prevention and intervention strategies.
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Affiliation(s)
- Ping-I Lin
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Gautam Srivastava
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Linda Beckman
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Yunhwan Kim
- Centre for Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden
| | | | - Drew Barzman
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Michael Sorter
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
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53
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Vallecillo G, Perelló R, Güerri R, Fonseca F, Torrens M. Clinical impact of COVID-19 on people with substance use disorders. J Public Health (Oxf) 2021; 43:9-12. [PMID: 33103716 PMCID: PMC7665679 DOI: 10.1093/pubmed/fdaa181] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Background People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders. Methods an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020. Results Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died. Conclusion Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.
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Affiliation(s)
- G Vallecillo
- Drug Addiction Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona 08003, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona 08003, Spain
| | - R Perelló
- Emergency Department, Hospital Clínic, Barcelona 09036, Spain
| | - R Güerri
- Hospital del Mar Medical Research Institute (IMIM), Barcelona 08003, Spain.,Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona 08003, Spain
| | - F Fonseca
- Drug Addiction Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona 08003, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona 08003, Spain
| | - M Torrens
- Drug Addiction Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona 08003, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona 08003, Spain
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54
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Caton L, Cheng H, Garneau HC, Fisher T, Harris-Mills B, Hurley B, Newman S, McGovern MP. COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics. J Gen Intern Med 2021; 36:998-1005. [PMID: 33511572 PMCID: PMC7842998 DOI: 10.1007/s11606-020-06436-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND With the onset of the COVID-19 crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care. OBJECTIVE To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID-19. DESIGN A 14-item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project. Survey content focused on changes in service delivery because of COVID-19. The survey was open for 18 days. PARTICIPANTS We surveyed 338 clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes. A representative from all 57 clinics (100%) and 118 staff (34.8% of all staff clinicians) participated in the survey. MAIN MEASURES The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience. KEY RESULTS A total of 52 of 57 (91.2%) primary care clinics reported practice adaptations in response to COVID-19 regulatory changes. Many clinics indicated that both medical (40.4%) and behavioral health visits (53.8%) were now exclusively virtual. Two-thirds (65.4%) of clinics reported increased duration of buprenorphine prescriptions and reduced urine drug screenings (67.3%). The majority (56.1%) of clinics experienced an increase in patient demand for behavioral health services. Over half (56.2%) of clinics described having an easier or unchanged experience retaining patients in care. CONCLUSIONS Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID-19. Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID-19.
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Affiliation(s)
- Lauren Caton
- Center for Behavioral Health Services and Implementation Research, Division of Public Mental Health and Population Sciences, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hannah Cheng
- Center for Behavioral Health Services and Implementation Research, Division of Public Mental Health and Population Sciences, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hélène Chokron Garneau
- Center for Behavioral Health Services and Implementation Research, Division of Public Mental Health and Population Sciences, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | - Brian Hurley
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | | | - Mark P McGovern
- Center for Behavioral Health Services and Implementation Research, Division of Public Mental Health and Population Sciences, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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55
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Hall NY, Le L, Majmudar I, Mihalopoulos C. Barriers to accessing opioid substitution treatment for opioid use disorder: A systematic review from the client perspective. Drug Alcohol Depend 2021; 221:108651. [PMID: 33667783 DOI: 10.1016/j.drugalcdep.2021.108651] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To update the existing evidence to identify specific barriers to initiation of opioid substitution therapy (OST) for those with opioid use disorder (OUD). METHODS The review follows Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA) guidelines. Six databases were initially searched in November 2019, with the search updated on 11 November 2020, for qualitative or quantitative studies reporting the barriers to initiating OST from the client with OUD perspective. Thematic analysis of the barriers to OST was undertaken to determine barrier themes and subthemes. RESULTS There were 37 studies included in the review; 18 were qualitative, 15 were quantitative and four were mixed methods. The barrier themes identified were stigma and fear, regulatory, logistical, attitudinal and social factors. Within these barrier themes 19 barrier subthemes were identified. The most reported OST barrier subthemes were negative treatment perceptions, cost, stigma and lack of flexibility. CONCLUSION This review discusses important barriers to OST and examines reported barriers from the client perspective. OST guidelines and programs would benefit by introducing programs that reduce stigma, increase treatment knowledge and health literacy, reduce treatment costs, increase treatment flexibility and allow for easier treatment access.
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Affiliation(s)
- Natasha Yvonne Hall
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Long Le
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Ishani Majmudar
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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56
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Peckham AM, Ball J, Colvard MD, Dadiomov D, Hill LG, Nichols SD, Tallian K, Ventricelli DJ, Tran TH. Leveraging pharmacists to maintain and extend buprenorphine supply for opioid use disorder amid COVID-19 pandemic. Am J Health Syst Pharm 2021; 78:613-618. [PMID: 33411894 PMCID: PMC7929456 DOI: 10.1093/ajhp/zxab003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose Strategies for deploying clinical pharmacists to increase access to buprenorphine in inpatient, outpatient and transitional care, and community practice settings are described. Summary Access to medications for opioid use disorder (MOUD) is essential, but patients face many barriers when pursuing treatment and MOUD. The coronavirus disease 2019 (COVID-19) pandemic has compounded the opioid crisis and worsened outcomes by introducing new barriers to MOUD access. Many strategies to ensure continued access to MOUD have been described, but the role of leveraging pharmacists during the opioid/COVID-19 syndemic to improve medication access and outcomes remains underappreciated. Pharmacists, while both qualified and capable of liberalizing access to all forms of MOUD, may have the strongest impact by increasing access to buprenorphine. Herein, we present progressive strategies to maintain and extend buprenorphine access for patients with OUD through deployment of clinical pharmacists, particularly in the context of the COVID-19 pandemic, during which access may be further restricted. Conclusion Leveraging pharmacists to extend access to MOUD, particularly buprenorphine, remains an underutilized strategy that should be implemented, particularly during the concurrent COVID-19 global pandemic.
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Affiliation(s)
- Alyssa M Peckham
- Northeastern University School of Pharmacy, Boston, MA.,Massachusetts General Hospital Substance Use Disorders Initiative, Boston, MA, USA
| | - Jennifer Ball
- South Dakota State University College of Pharmacy and Allied Health Professions, Brookings, SD.,University of South Dakota School of Medicine, Vermillion, SD, USA
| | - Michelle D Colvard
- Substance Use Disorder Transitions of Care Clinic, Inpatient Psychiatry and Addiction Services, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - David Dadiomov
- University of Southern California School of Pharmacy, Los Angeles, CA, and Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Lucas G Hill
- University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Stephanie D Nichols
- University of New England College of Pharmacy, Portland, ME, and Maine Medical Center Consult-Liaison Service, Portland, ME, USA
| | | | - Daniel J Ventricelli
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
| | - Tran H Tran
- Chicago Midwestern University, Chicago College of Pharmacy, Downers Grove, IL.,Rush University Medical Center Substance Use Intervention Team, Chicago, IL, USA
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Hodder SL, Feinberg J, Strathdee SA, Shoptaw S, Altice FL, Ortenzio L, Beyrer C. The opioid crisis and HIV in the USA: deadly synergies. Lancet 2021; 397:1139-1150. [PMID: 33617769 DOI: 10.1016/s0140-6736(21)00391-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
The opioid epidemic is one of the greatest public health problems that the USA faces. Opioid overdose death rates have increased steadily for more than a decade and doubled in 2013-17, as the highly potent synthetic opioid fentanyl entered the drug supply. Demographics of new HIV diagnoses among people who inject drugs are also changing, with more new HIV diagnoses occurring among White people, young people (aged 13-34 years), and people who reside outside large central metropolitan areas. Racial differences also exist in syringe sharing, which decreased among Black people and Hispanic people but remained unchanged among White people in 2005-15. Recent HIV outbreaks have occurred in rural areas of the USA, as well as among marginalised people in urban areas with robust HIV prevention and treatment services (eg, Seattle, WA). Multiple evidence-based interventions can effectively treat opioid use disorder and prevent HIV acquisition. However, considerable barriers exist precluding delivery of these solutions to many people who inject drugs. If the USA is serious about HIV prevention among this group, stigma must be eliminated, discriminatory policies must change, and comprehensive health care must be accessible to all. Finally, root causes of the opioid epidemic such as hopelessness need to be identified and addressed.
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Affiliation(s)
- Sally L Hodder
- West Virginia Clinical and Translational Science Institute, University Health Sciences Center, West Virginia University, Morgantown, WV, USA.
| | - Judith Feinberg
- West Virginia Clinical and Translational Science Institute, University Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | | | | | | | | | - Chris Beyrer
- Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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58
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Shreffler J, Shoff H, Thomas JJ, Huecker M. Brief Report: The Impact of COVID-19 on Emergency Department Overdose Diagnoses and County Overdose Deaths. Am J Addict 2021; 30:330-333. [PMID: 33738889 PMCID: PMC8250732 DOI: 10.1111/ajad.13148] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/02/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives We sought to understand the impact of COVID‐19 on emergency department (ED) overdoses and county coroner verified overdose deaths. Methods Electronic medical health record and county coroner data were gathered and comparisons were made between three 16‐week time periods. In the three time periods, 873 individuals had an overdose diagnosis in the ED and 440 individuals in the county died of drug overdose. Results While total ED patient volume decreased substantially, the number of ED overdose patients increased between March 6 and June 25, 2020. Furthermore, during this same period, coroner data revealed an increase in overdose deaths. Conclusion and Scientific Significance This preliminary evidence provides a key insight into the impact of COVID‐19 on both overdose presentations to the ED and county overdose deaths. These results emphasize the critical need for increasing vigilance to prevent overdose by continuously developing and optimizing both accessible and quality treatment as we navigate through this pandemic and its ongoing effects on persons with substance use disorder. (Am J Addict 2021;00:00–00)
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Affiliation(s)
- Jacob Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Hugh Shoff
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - J Jeremy Thomas
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
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59
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Russell C, Ali F, Nafeh F, Rehm J, LeBlanc S, Elton-Marshall T. Identifying the impacts of the COVID-19 pandemic on service access for people who use drugs (PWUD): A national qualitative study. J Subst Abuse Treat 2021; 129:108374. [PMID: 34080545 DOI: 10.1016/j.jsat.2021.108374] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Closures and reductions in capacity of select health and social services in response to the COVID-19 pandemic may have placed people who use drugs (PWUD) at a disproportionately increased risk for experiencing harms, and resulted in critical treatment disruptions. We conducted the current national study among a cohort of PWUD to understand how COVID-19 has affected service access, including any significant impacts PWUD may have experienced. Results will contribute to the evidence base for informing future pandemic and public health policy planning for vulnerable populations. METHODS The project involved qualitative telephone-based interviews with 196 adult (aged 18+) PWUD from across Canada. Eligibility criteria included daily or weekly use of psychoactive substance(s), and/or current enrollment in opioid agonist treatment (OAT). Data collection took place between May and July 2020. Data underwent thematic analyses, and common themes informed the results. RESULTS Most participants experienced detrimental service access issues and treatment disruptions during COVID-19, including reduced access to harm reduction services, OAT, withdrawal management and treatment services, medical professionals (e.g., addictions and mental health counseling), shelters/housing, and food banks. Positive impacts included greater access to OAT take-home 'carries' and prescription deliveries. Decreases in service capacity resulted in increased health issues and risky substance use behaviors among PWUD, such as unaccompanied substance use, sharing/re-use of supplies, and overdose events. CONCLUSIONS Reductions in the accessibility of critical services PWUD rely on during COVID-19 has increased existent substance use and health issues among PWUD, while decreasing their ability to mitigate risks related to substance use. Thus, the expansion of the depth and breadth of support options is crucial. Services must remain open and flexible to the unique needs of PWUD during COVID-19, while novel and effective adaptations and interventions should remain available and accessible post-COVID-19.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Frishta Nafeh
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19с1, Moscow 119146, Russia.
| | - Sean LeBlanc
- Drug Users Advocacy League, 216 Murray St, Ottawa, Ontario K1N 5S6, Canada; Canadian Association of People who Use Drugs (CAPUD), Canada.
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, Ontario M6A 5C1, Canada; Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario P7B 5E1, Canada.
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60
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Emergency Department Visits for Nonfatal Opioid Overdose During the COVID-19 Pandemic Across Six US Health Care Systems. Ann Emerg Med 2021; 79:158-167. [PMID: 34119326 PMCID: PMC8449788 DOI: 10.1016/j.annemergmed.2021.03.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 01/28/2023]
Abstract
Study objective People with opioid use disorder are vulnerable to disruptions in access to addiction treatment and social support during the COVID-19 pandemic. Our study objective was to understand changes in emergency department (ED) utilization following a nonfatal opioid overdose during COVID-19 compared to historical controls in 6 healthcare systems across the United States. Methods Opioid overdoses were retrospectively identified among adult visits to 25 EDs in Alabama, Colorado, Connecticut, North Carolina, Massachusetts, and Rhode Island from January 2018 to December 2020. Overdose visit counts and rates per 100 all-cause ED visits during the COVID-19 pandemic were compared with the levels predicted based on 2018 and 2019 visits using graphical analysis and an epidemiologic outbreak detection cumulative sum algorithm. Results Overdose visit counts increased by 10.5% (n=3486; 95% confidence interval [CI] 4.18% to 17.0%) in 2020 compared with the counts in 2018 and 2019 (n=3020 and n=3285, respectively), despite a 14% decline in all-cause ED visits. Opioid overdose rates increased by 28.5% (95% CI 23.3% to 34.0%) from 0.25 per 100 ED visits in 2018 to 2019 to 0.32 per 100 ED visits in 2020. Although all 6 studied health care systems experienced overdose ED visit rates more than the 95th percentile prediction in 6 or more weeks of 2020 (compared with 2.6 weeks as expected by chance), 2 health care systems experienced sustained outbreaks during the COVID-19 pandemic. Conclusion Despite decreases in ED visits for other medical emergencies, the numbers and rates of opioid overdose-related ED visits in 6 health care systems increased during 2020, suggesting a widespread increase in opioid-related complications during the COVID-19 pandemic. Expanded community- and hospital-based interventions are needed to support people with opioid use disorder and save lives during the COVID-19 pandemic.
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McCormack L, Ponce J, Chatterjee A, Tan JK. Oxybutynin treatment for buprenorphine-naloxone-induced hyperhidrosis. JAAD Case Rep 2021; 10:22-24. [PMID: 33732840 PMCID: PMC7941000 DOI: 10.1016/j.jdcr.2020.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lindsay McCormack
- Boston Health Care for the Homeless Program, Boston, Massachusetts
- Massachusetts General Hospital, Department of Dermatology, Boston, Massachusetts
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joseph Ponce
- Boston Health Care for the Homeless Program, Boston, Massachusetts
- Massachusetts General Hospital, Department of Dermatology, Boston, Massachusetts
| | - Avik Chatterjee
- Boston Health Care for the Homeless Program, Boston, Massachusetts
- Boston University School of Medicine, Department of Internal Medicine, Boston, Massachusetts
| | - Jennifer K. Tan
- Boston Health Care for the Homeless Program, Boston, Massachusetts
- Massachusetts General Hospital, Department of Dermatology, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Correspondence to: Jennifer K. Tan, MD, Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Suite 200, Boston, MA 02114.
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Mehtani NJ, Ristau JT, Snyder H, Surlyn C, Eveland J, Smith-Bernardin S, Knight KR. COVID-19: A catalyst for change in telehealth service delivery for opioid use disorder management. Subst Abus 2021; 42:205-212. [PMID: 33684331 DOI: 10.1080/08897077.2021.1890676] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND COVID-19 has exacerbated income inequality, structural racism, and social isolation-issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-existence of these epidemics has necessitated care practice changes, including the use of telehealth-based encounters for the diagnosis and management of opioid use disorder (OUD). METHODS We describe the development of the "Addiction Telehealth Program" (ATP), a telephone-based program to reduce treatment access barriers for people with substance use disorders staying at San Francisco's COVID-19 Isolation and Quarantine (I&Q) sites. Telehealth encounters were documented in the electronic medical record and an internal tracking system for the San Francisco Department of Public Health (SFDPH) COVID-19 Containment Response. Descriptive statistics were collected on a case series of patients initiated on buprenorphine at I&Q sites and indicators of feasibility were measured. RESULTS Between April 10 and May 25, 2020, ATP consulted on the management of opioid, alcohol, GHB, marijuana, and stimulant use for 59 I&Q site guests. Twelve patients were identified with untreated OUD and newly prescribed buprenorphine. Of these, all were marginally housed, 67% were Black, and 58% had never previously been prescribed medications for OUD. Four self-directed early discharge from I&Q-1 prior to and 3 after initiating buprenorphine. Of the remaining 8 patients, 7 reported continuing to take buprenorphine at the time of I&Q discharge and 1 discontinued. No patients started on buprenorphine sustained significant adverse effects, required emergency care, or experienced overdose. CONCLUSIONS ATP demonstrates the feasibility of telephone-based management of OUD among a highly marginalized patient population in San Francisco and supports the implementation of similar programs in areas of the U.S. where access to addiction treatment is limited. Legal changes permitting the prescribing of buprenorphine via telehealth without the requirement of an in-person visit should persist beyond the COVID-19 public health emergency.
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Affiliation(s)
- Nicky J Mehtani
- Division of HIV, ID & Global Medicine, University of California, San Francisco, California, USA
| | - Jessica T Ristau
- Division of HIV, ID & Global Medicine, University of California, San Francisco, California, USA
| | - Hannah Snyder
- Department of Family & Community Medicine, University of California, San Francisco, California, USA
| | - Colleen Surlyn
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Joanna Eveland
- San Francisco Department of Public Health, San Francisco, California, USA
| | | | - Kelly R Knight
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, California, USA
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63
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Mallet J, Dubertret C, Le Strat Y. Addictions in the COVID-19 era: Current evidence, future perspectives a comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110070. [PMID: 32800868 PMCID: PMC7420609 DOI: 10.1016/j.pnpbp.2020.110070] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In the context of the COVID-19 worldwide pandemic, an up-to-date review of current challenges in addictions is necessary. While large scale disasters may have an impact on substance use and addictions, the use of some substances is also likely to modify the risk of COVID-19 infection or course. Many countries have imposed lockdowns. Whether this quarantine or the end of lockdown measures will have an impact on substance use is discussed. The aim of this review is to gather knowledge for clinicians and to guide public health policies during/after lockdown. METHODS PubMed was reviewed in August 6th (2020), to determine the current evidences and observations concerning the addictions and SARS-CoV2. We used all the names of the severe acute respiratory syndrome of coronavirus 2 (SARS-CoV2 previously 2019 nCoV), the name of the coronavirus disease 2019 (COVID-19), and common substances of abuse. For the physiopathological parts, searches were conducted using key words such as "infection" or "pneumonia". For the lockdown effects, key words such as "quarantine", "disaster" or "outbreak" were used. RESULTS Overall, pathophysiological data showed an increased risk of infections for individuals with Substance Use Disorders (SUD) and a possible protective role of nicotine. During lockdown, there is a substantial risk of increasing SUDs. Individuals with opioid use disorder are particularly at risk of relapse or of involuntary withdrawal. After lockdown, increase of use may be observed as far as years after. Individuals with addictions are at higher risk of multimorbidity and mortality during COVID outbreak. CONCLUSION This review describes useful strategies in clinical practice, including a systematic assessment of addiction comorbidity during this almost worldwide lockdown/pandemic. This review also highlights important areas for future research.
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Affiliation(s)
- Jasmina Mallet
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Université de Paris, Faculté de Médecine, Colombes, France; Institute of Psychiatry and Neurosciences of Paris (IPNP, Inserm U1266), 102 rue de la Santé, 75014 Paris, France.
| | - Caroline Dubertret
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Université de Paris, Faculté de Médecine, Colombes, France; Institute of Psychiatry and Neurosciences of Paris (IPNP, Inserm U1266), 102 rue de la Santé, 75014 Paris, France
| | - Yann Le Strat
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Université de Paris, Faculté de Médecine, Colombes, France; Institute of Psychiatry and Neurosciences of Paris (IPNP, Inserm U1266), 102 rue de la Santé, 75014 Paris, France
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Livingston NA, Ameral V, Banducci AN, Weisberg RB. Unprecedented need and recommendations for harnessing data to guide future policy and practice for opioid use disorder treatment following COVID-19. J Subst Abuse Treat 2021; 122:108222. [PMID: 33303255 PMCID: PMC7973255 DOI: 10.1016/j.jsat.2020.108222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
The COVID-19 pandemic struck in the midst of an ongoing opioid epidemic. To offset disruption to life-saving treatment for opioid use disorder (OUD), several federal agencies granted exemptions to existing federal regulations. This included loosening restrictions on medications for OUD (MOUD), including methadone and buprenorphine. In this commentary, we briefly review policy and practice guidelines for treating OUD prior to the onset of the COVID-19 pandemic. We then outline specific MOUD treatment policy and practice exemptions that went into effect in February and March 2020, and discuss the ways in which these unprecedented changes have dramatically changed MOUD treatment. Given the unprecedented nature of these changes, and unknown outcomes to date, we advocate for a data-driven approach to guide future policy and practice recommendations regarding MOUD. We outline several critical clinical, research, and policy questions that can inform MOUD treatment in a post-COVID-19 era.
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Affiliation(s)
- Nicholas A Livingston
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, United States of America; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States of America; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America.
| | - Victoria Ameral
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States of America
| | - Anne N Banducci
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States of America; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America; National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, MA, United States of America
| | - Risa B Weisberg
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States of America; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America; Department of Family Medicine, Alpert Medical School, Brown University, Providence, RI, United States of America
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Kleinman MB, Felton JW, Johnson A, Magidson JF. "I have to be around people that are doing what I'm doing": The importance of expanding the peer recovery coach role in treatment of opioid use disorder in the face of COVID-19 health disparities. J Subst Abuse Treat 2021; 122:108182. [PMID: 33160763 PMCID: PMC7577312 DOI: 10.1016/j.jsat.2020.108182] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/09/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic and ongoing opioid epidemic are causing notable morbidity and mortality among low-income and minority populations. Peer recovery coaches (PRCs), people with lived experience of substance use and recovery, are uniquely positioned to support underserved, minority individuals who face the greatest barriers to care. This commentary combines research and clinical perspectives to describe the potential role of PRCs in reaching and supporting particularly vulnerable populations in the setting of substantial changes in the opioid use disorder (OUD) recovery landscape during COVID-19. During this time, PRCs can provide guidance from their own experience navigating changes to routines and social support systems, reduce social isolation, build trust and buy-in, and support engagement in care. Specific barriers include access to technology and underlying distrust of public and medical authorities. This article highlights the importance of expanding the reach of the PRC workforce as well as supporting their specific needs at this time to combat the intersecting devastation of two epidemics.
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Affiliation(s)
- Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
| | - Julia W Felton
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | | | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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Krawczyk N, Bunting AM, Frank D, Arshonsky J, Gu Y, Friedman SR, Bragg MA. "How will I get my next week's script?" Reactions of Reddit opioid forum users to changes in treatment access in the early months of the coronavirus pandemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103140. [PMID: 33558165 DOI: 10.1016/j.drugpo.2021.103140] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic poses significant challenges to people with opioid use disorder (OUD). As localities enforce lockdowns and pass emergency OUD treatment regulations, questions arise about how these changes will affect access and retention in care. In this study, we explore the influence of COVID-19 on access to, experiences with, and motivations for OUD treatment through a qualitative analysis of public discussion forums on Reddit. METHODS We collected data from Reddit, a free and international online platform dedicated to public discussions and user-generated content. We extracted 1000 of the most recent posts uploaded between March 5th and May 13th, 2020 from each of the two most popular opioid subreddits "r/Opiates" and "r/OpiatesRecovery" (total 2000). We reviewed posts for relevance to COVID-19 and opioid use and coded content using a hybrid inductive-deductive approach. Thematic analysis identified common themes related to study questions of interest. RESULTS Of 2000 posts reviewed, 300 (15%) discussed topics related to the intersection of opioid use and COVID-19. Five major themes related to OUD treatment were identified: Concern about closure of OUD treatment services; transition to telehealth and virtual care; methadone treatment requirements and increased exposure to COVID-19; reactions to changing regulations on medications for OUD; and influences of the pandemic on treatment motivation and progress. CONCLUSION In the face of unprecedented challenges due to COVID-19, reactions of Reddit opioid forum users ranged from increased distress in accessing and sustaining treatment, to encouragement surrounding new modes of treatment and opportunities to engage in care. New and less restrictive avenues for treatment were welcomed by many, but questions remain about how new norms and policy changes will be sustained beyond this pandemic and impact OUD treatment access and outcomes long-term.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York NY, 10016, USA.
| | - Amanda M Bunting
- Section on Tobacco, Alcohol, & Drug Use, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York NY, 10016, USA
| | - David Frank
- Behavioral Science Training in Drug Abuse Research, NYU Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA
| | - Joshua Arshonsky
- Section on Health Choice, Policy, and Evaluation, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York NY, 10016, USA
| | - Yuanqi Gu
- Department of Public Health Nutrition, NYU School of Global Public Health, 26 Broadway, New York, NY 10012, USA
| | - Samuel R Friedman
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York NY, 10016, USA
| | - Marie A Bragg
- Section on Health Choice, Policy, and Evaluation, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York NY, 10016, USA; Department of Public Health Nutrition, NYU School of Global Public Health, 26 Broadway, New York, NY 10012, USA
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Roe L, Proudfoot J, Tay Wee Teck J, Irvine RDG, Frankland S, Baldacchino AM. Isolation, Solitude and Social Distancing for People Who Use Drugs: An Ethnographic Perspective. Front Psychiatry 2021; 11:623032. [PMID: 33519561 PMCID: PMC7838520 DOI: 10.3389/fpsyt.2020.623032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
COVID-19 has resulted in deepened states of crisis and vulnerability for people who use drugs throughout Europe and across the world, with social distancing measures having far-reaching implications for everyday life. Prolonged periods of isolation and solitude are acknowledged within much addiction literature as negatively impacting the experiences of those in recovery, while also causing harm to active users - many of whom depend on social contact for the purchasing and taking of substances, as well as myriad forms of support. Solitude, however, is proposed by the authors as inherent within some aspects of substance use, far from particular to the current pandemic. Certain forms of substance use engender solitary experience, even where use is predicated upon the presence of others. Adopting a cross-disciplinary perspective, this paper takes as its focus the urgent changes wrought by the pandemic upon everyday life for people who use drugs, drawing on recent ethnographic fieldwork with substance users in Scotland. Beyond the current crises, the paper proposes solitude, and by extension isolation, as an analytical framework for better apprehending lived experiences of substance use.
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Affiliation(s)
- Laura Roe
- Department of Social Anthropology, University of St Andrews, St Andrews, United Kingdom
| | - Jesse Proudfoot
- Department of Sociology, Durham University, Durham, United Kingdom
| | | | - Richard D. G. Irvine
- Department of Social Anthropology, University of St Andrews, St Andrews, United Kingdom
| | - Stan Frankland
- Department of Social Anthropology, University of St Andrews, St Andrews, United Kingdom
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Clinician perspectives on methadone service delivery and the use of telemedicine during the COVID-19 pandemic: A qualitative study. J Subst Abuse Treat 2021; 124:108288. [PMID: 33771285 PMCID: PMC7833320 DOI: 10.1016/j.jsat.2021.108288] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/07/2020] [Accepted: 01/11/2021] [Indexed: 12/04/2022]
Abstract
Objectives During the COVID-19 pandemic, opioid treatment programs (OTPs) in the U.S. were granted new flexibility in methadone dispensing and the use of telemedicine. To explore the impact of the pandemic and accompanying policy changes on service delivery, we asked OTP clinicians about changes in care patterns and perceptions of impacts on access and quality. Methods In May–June 2020, we completed semistructured telephone interviews with 20 OTP clinicians (physicians, physician assistants, and nurse practitioners) from 13 U.S. states. The study recruited participants through Medscape, an online platform where clinicians access clinical content. We used rapid thematic analysis, a qualitative approach, to summarize participants' expressed views related to the research objectives. Results Clinicians identified a range of changes to methadone and ancillary service delivery as a result of COVID-19. Most clinicians reported that OTPs were prescribing more take-home doses of methadone and providing psychosocial services and medication management via telemedicine. Many also reported reducing the frequency of urine toxicology screening and accepting fewer new patients. While some clinicians expressed support for the increased flexibility around dosing and use of telemedicine, others expressed concern about increased risk of medication diversion and overdose. Clinicians reported several advantages and disadvantages of the changes due to the pandemic and that continued reimbursement would be required to maintain telemedicine services. Conclusions The COVID-19 pandemic dramatically altered the delivery of methadone treatment in the U.S. This study's findings suggest that OTPs may have reduced their methadone treatment during the early months of the pandemic and that the flexibilities that policy changes offered may not have resulted in changes in care delivery for all patients. Careful consideration and additional analysis should inform which changes OTPs should maintain long-term.
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Mountain-Ray S, Finnell D, Roy P, Northup R, MacLane-Baeder D. Confronting COVID, racism, and addiction: The association of multidisciplinary education and research in substance use and addiction (AMERSA). Subst Abus 2021; 42:1-4. [PMID: 33428560 DOI: 10.1080/08897077.2020.1866144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The COVID-19 pandemic, the ongoing opioid epidemic, rise in substance use, and social and political unrest in the US and globally has impacted how substance use-related health needs are addressed. These issues were driving forces in planning AMERSA's 44th annual conference. True to the multidisciplinary spirit, and with diversity goals and advocacy at the forefront of mind, "together we rise" became the beacon for the AMERSA 2020 conference. This commentary provides an overview of the conference proceedings, topics that were highly relevant for clinicians, educators, researchers, and advocates for change.
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Affiliation(s)
- Shannon Mountain-Ray
- Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Deborah Finnell
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Payel Roy
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca Northup
- Association for Multidisciplinary Education and Research in Substance use and Addiction, Cranston, Rhode Island, USA
| | - Doreen MacLane-Baeder
- Association for Multidisciplinary Education and Research in Substance use and Addiction, Cranston, Rhode Island, USA
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Lynch M, O'Leary AC. COVID-19 related regulatory change for pharmacists - The case for its retention post the pandemic. Res Social Adm Pharm 2021; 17:1913-1919. [PMID: 32893134 PMCID: PMC7442579 DOI: 10.1016/j.sapharm.2020.07.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 11/24/2022]
Abstract
The delivery of healthcare including the provision of pharmacy services globally is highly regulated internationally in order to protect public health and welfare. However, the onset of the COVID-19 pandemic has precipitated the need internationally to amend the model of regulation in order to ensure that people were able to continue to access a range of healthcare services in a timely and effective manner. Many of the changes introduced to the regulation of pharmacy services in Ireland have been replicated in other countries. These include the introduction of electronic means to transmit prescriptions and other orders for medications, relaxing the legal restrictions in place controlling the emergency supply of prescription only medicines and more fully utilizing the professional competency of pharmacists by empowering them to use their expertise and judgment to support their patients accessing the healthcare services that they need. Many of the regulatory changes that have been introduced to support the COVID-19 public health emergency effort are ones that pharmacists have previously sought to enable them provide a more effective and expanded model of pharmaceutical care to their patients. Accordingly, many pharmacists will want these regulatory changes to be retained and further expanded in the aftermath of the COVID-19 public health emergency in order to extend their scope of practice and support them in the care of their patients.
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Affiliation(s)
- Matthew Lynch
- School of Pharmacy & Biomolecular Sciences, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | - Aisling C O'Leary
- School of Pharmacy & Biomolecular Sciences, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland; National Centre for Pharmacoeconomics, St. James's Hospital, James's St., Dublin 8, Ireland
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Nobles AL, Johnson DC, Leas EC, Goodman-Meza D, Zúñiga ML, Ziedonis D, Strathdee SA, Ayers JW. Characterizing Self-Reports of Self-Identified Patient Experiences with Methadone Maintenance Treatment on an Online Community during COVID-19. Subst Use Misuse 2021; 56:2134-2140. [PMID: 34486471 PMCID: PMC8820092 DOI: 10.1080/10826084.2021.1972317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: The coronavirus disease (COVID-19) pandemic has impacted patients receiving methadone maintenance treatment (MMT) through opioid treatment programs (OTPs), especially because of the unique challenges of the care delivery model. Previously, documentation of patient experiences during emergencies often comes years after the fact, in part because there is a substantial data void in real-time. Methods: We extracted 308 posts that mention COVID-19 keywords on r/methadone, an online community for patients receiving MMT to share information, on Reddit occurring between January 31, 2020 and September 30, 2020. 215 of these posts self-report an impact to their MMT. Using qualitative content analysis, we characterized the impacts described in these posts and identified four emergent themes describing patients' experience of impacts to MMT during COVID-19. Results: The themes included (1) 54.4% of posts reporting impediments to accessing their methadone, (2) 28.4% reporting impediments to accessing physicial OTPs, (3) 19.5% reporting having to self-manage their care, and (4) 4.7% reporting impediments to accessing OTP providers and staff. Conclusions: Patients described unanticipated consequences to one-size-fits-all policies that are unevenly applied resulting in suboptimal dosing, increased perceived risk of acquiring COVID-19 at OTPs, and reduced interaction with OTP providers and staff. While preliminary, these results are formative for follow-up surveillance metrics for patients of OTPs as well as digitally-mediated resource needs for this online community. This study serves as a model of how social media can be employed during and after emergencies to hear the lived experiences of patients for informed emergency preparedness and response.
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Affiliation(s)
- Alicia L Nobles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Derek C Johnson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Douglas Ziedonis
- University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - John W Ayers
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
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Farhoudian A, Radfar SR, Mohaddes Ardabili H, Rafei P, Ebrahimi M, Khojasteh Zonoozi A, De Jong CAJ, Vahidi M, Yunesian M, Kouimtsidis C, Arunogiri S, Hansen H, Brady KT, Potenza MN, Baldacchino AM, Ekhtiari H. A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic. Front Psychiatry 2021; 12:646206. [PMID: 34421664 PMCID: PMC8377291 DOI: 10.3389/fpsyt.2021.646206] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background and Aims: COVID-19 has infected more than 77 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing, and "lockdown" measures have affected drug and alcohol supply chains and subsequently their availability, price, and use patterns, with possible downstream effects on presentations of SUDs and demand for treatment. Given the lack of multicentric epidemiologic studies, we conducted a rapid global survey within the International Society of Addiction Medicine (ISAM) network in order to understand the status of substance-use patterns during the current pandemic. Design: Cross-sectional survey. Setting: Worldwide. Participants: Starting on April 4, 2020 during a 5-week period, the survey received 185 responses from 77 countries. Measurements: To assess addiction medicine professionals' perceived changes in drug and alcohol supply, price, use pattern, and related complications during the COVID-19 pandemic. Findings: Participants reported (among who answered "decreased" or "increased") a decrease in drug supply (69.0%) and at the same time an increase in price (95.3%) globally. With respect to changes in use patterns, an increase in alcohol (71.7%), cannabis (63.0%), prescription opioids (70.9%), and sedative/hypnotics (84.6%) use was reported, while the use of amphetamines (59.7%), cocaine (67.5%), and opiates (58.2%) was reported to decrease overall. Conclusions: The global report on changes in the availability, use patterns, and complications of alcohol and drugs during the COVID-19 pandemic should be considered in making new policies and in developing mitigating measures and guidelines during the current pandemic (and probable future ones) in order to minimize risks to people with SUD.
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Affiliation(s)
- Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ramin Radfar
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran.,Integrated Substance Abuse Programs Department, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hossein Mohaddes Ardabili
- Psychiatry and Behavioral Sciences Research Center, Faculty of Medicine, Ibn-e-Sina Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parnian Rafei
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ebrahimi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Khojasteh Zonoozi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehrnoosh Vahidi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Christos Kouimtsidis
- Surrey and Borders Partnership National Health Service Foundation Trust, Leatherhead, United Kingdom
| | | | - Helena Hansen
- Departments of Anthropology and Psychiatry, New York University, New York, NY, United States
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | | | - Marc N Potenza
- Yale School of Medicine, Connecticut Council on Problem Gambling and Connecticut Mental Health Center, New Haven, CT, United States
| | - Alexander Mario Baldacchino
- Division of Population and Behavior Sciences, Medical School, University of St Andrews, St Andrews, United Kingdom
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, OK, United States
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Althobaiti YS, Alzahrani MA, Alsharif NA, Alrobaie NS, Alsaab HO, Uddin MN. The Possible Relationship between the Abuse of Tobacco, Opioid, or Alcohol with COVID-19. Healthcare (Basel) 2020; 9:healthcare9010002. [PMID: 33375144 PMCID: PMC7822153 DOI: 10.3390/healthcare9010002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction: Substance use disorder has been frequently reported to increase the risk of infectious diseases, which might be owing to the sharing of contaminated inhalation, smoking, vaping, or injection equipment. Aim: This review analyzes the recent literature with the aim to put in light the possible relationship between the abuse of different substances (Tobacco, opioid, and Alcohol) with coronavirus disease (COVID-19). Tobacco: Multiple studies confirmed that cigarette smoking affects the respiratory system by increasing the expression of angiotensin-converting enzyme-2 (ACE2) receptors, which have a significant association with COVID-19 infection rate and disease severity. Opioid: Studies conducted regarding the association of opioid use disorder (OUD) and COVID-19 infection severity are limited; however, opioids can lead to both respiratory depression and kidney injuries, causing poor prognosis for those with COVID-19 infections. Alcohol: People with alcohol use disorders are at risk of developing acute lung injury and severe COVID-19 infection. Alcohol consumption during the COVID-19 pandemic has two possible scenarios: either increased or decreased based on situations. Conclusion: SUD has been frequently reported to have a positive relationship with COVID-19 severity Further studies are needed to understand the effects of opioids and alcohol abuse on COVID-19.
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Affiliation(s)
- Yusuf S. Althobaiti
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
- Department of Pharmacology and Toxicology, Health Science Campus, College of Pharmacy, Taif University, Taif 21974, Saudi Arabia
- General Directorate of Narcotics Control, General Administration for Precursors and Laboratories, Ministry of Interior, Riyadh 11134, Saudi Arabia
- Correspondence: ; Tel.: +966-545-736-200
| | - Maram A. Alzahrani
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
| | - Norah A. Alsharif
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
| | - Nawal S. Alrobaie
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
| | - Hashem O. Alsaab
- Department of Pharmaceutics and Pharmaceutical Technology, Taif University, Taif 21944, Saudi Arabia;
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Pagano A, Hosakote S, Kapiteni K, Straus ER, Wong J, Guydish JR. Impacts of COVID-19 on residential treatment programs for substance use disorder. J Subst Abuse Treat 2020; 123:108255. [PMID: 33375986 DOI: 10.1016/j.jsat.2020.108255] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/19/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The COVID-19 pandemic may present special challenges for residential substance use disorder (SUD) treatment facilities, which may lack infrastructure and support to implement infection control protocols while maintaining on-site treatment services. However, little is known about how residential SUD treatment programs are impacted by the COVID-19 pandemic. METHODS The research team conducted semi-structured interviews with 17 directors of 20 residential SUD treatment programs across California during the state's shelter-in-place order. The researchers then analyzed qualitative interview data thematically and coded them using ATLAS.ti software. FINDINGS Thematic analyses identified six major themes: program-level impacts, staff impacts, client impacts, use of telehealth, program needs, and positive effects. "Program-level impacts" were decreased revenue from diminished client censuses and insufficient resources to implement infection control measures. "Staff impacts" included layoffs, furloughs, and increased physical and emotional fatigue. "Client impacts" were delayed treatment initiation; receipt of fewer services while in treatment; lower retention; and economic and psychosocial barriers to community re-entry. "Use of telehealth" included technical and interpersonal challenges associated with telehealth visits. "Program needs" were personal protective equipment (PPE), stimulus funding, hazard pay, and consistent public health guidance. "Positive effects" of the pandemic response included increased attention to hygiene and health, telehealth expansion, operational improvements, and official recognition of SUD treatment as an essential health care service. CONCLUSION Study findings highlight COVID-related threats to the survival of residential SUD treatment programs; retention of the SUD treatment workforce; and clients' SUD treatment outcomes. These findings also identify opportunities to improve SUD service delivery and suggest avenues of support for residential SUD treatment facilities during and after the COVID-19 pandemic.
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Affiliation(s)
- Anna Pagano
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America.
| | - Sindhu Hosakote
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
| | - Kwinoja Kapiteni
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
| | - Elana R Straus
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
| | - Jessie Wong
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
| | - Joseph R Guydish
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
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75
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Wilkinson R, Hines L, Holland A, Mandal S, Phipps E. Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID-19 response. Harm Reduct J 2020; 17:95. [PMID: 33261636 PMCID: PMC7705852 DOI: 10.1186/s12954-020-00445-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND People who inject drugs are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. METHODS A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic-type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. RESULTS In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly; for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. CONCLUSIONS This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.
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Affiliation(s)
- Rebecca Wilkinson
- Rebecca Wilkinson, Public Health Registrar, School of Primary Care, Population Sciences and Medical Education, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - Lindsey Hines
- Lindsey Hines, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Holland
- Adam Holland Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sema Mandal
- Sema Mandal Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
| | - Emily Phipps
- Emily Phipps Blood Safety, Hepatitis, STI and HIV Division, National Infection Service, Public Health England, London, UK
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76
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Dunn KE, Brooner RK, Stoller KB. Technology-assisted methadone take-home dosing for dispensing methadone to persons with opioid use disorder during the Covid-19 pandemic. J Subst Abuse Treat 2020; 121:108197. [PMID: 33357606 PMCID: PMC7834258 DOI: 10.1016/j.jsat.2020.108197] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/23/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Covid-19 confers substantial risk for the >400,000 patients who receive methadone for the treatment of opioid use disorder (OUD) and methods for safely dispensing large quantities of methadone to patients are lacking. METHODS This study evaluated the MedMinder "Jon", an electronic and cellular-enabled pillbox that provides real-time monitoring to remotely manage take-home doses of methadone using a 12-week, within-subject, Phase II (NCT03254043) trial. We transitioned all participants from liquid to tablet methadone one week prior to randomization. Participants completed both treatment-as-usual and electronic pillbox conditions before choosing a condition in a final "choice phase". We assessed feasibility, satisfaction, and safety outcomes during the exit interview. RESULTS Overall, we randomized 25 participants, 24 (96.0%) completed >1 study session, and 21 (84.0%) completed the exit interview. We dispensed 167.92 g (1,974 doses) of methadone. Participants would use the pillbox again (86.3%) and recommend it to others (95.4%). Overall, 52.4% selected the pillbox in the choice condition and those who did not cited issues related to study requirements. Less than 1% of pillbox alerts were for medication being consumed outside the dosing window and we observed no evidence of actual or attempted methadone diversion. DISCUSSION We were able to adequately manage patients who would not otherwise qualify for large quantities of take-home methadone when we dispensed methadone tablets via a secure pillbox. The integration of a commercially available pillbox into routine clinic operations increases opportunity for dispensing medication. Our data support remote monitoring of methadone take-home doses and may inform clinic practices related to Covid-19.
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Affiliation(s)
- Kelly E Dunn
- Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, United States of America.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, United States of America.
| | - Kenneth B Stoller
- Johns Hopkins University School of Medicine, 911 North Broadway, Baltimore, MD 21205, United States of America.
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77
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Sinawi HA, Al Balushi N, Al-Mahrouqi T, Al Ghailani A, McCall RK, Sultan A, Al Sabti H, Al Maniri A, Murthi Panchatcharam S, Al-Alawi M. Predictors of psychological distress among the public in Oman amid coronavirus disease 2019 pandemic: a cross-sectional analytical study. PSYCHOL HEALTH MED 2020; 26:131-144. [PMID: 33151748 DOI: 10.1080/13548506.2020.1842473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a global, virulent pandemic disease that emerged in December 2019, with both short- and long-term psychological repercussions being inevitable. This study aimed to investigate the prevalence and predictors of psychological distress, defined by the presence of either depression or anxiety, among the public in Oman during the COVID-19 pandemic. This was a web-based, cross-sectional study conducted using governmental and private institutional e-mail systems and social media platforms. Anxiety and depression were assessed using both the Generalized Anxiety Disorder-7 Scale and the Patient Health Questionnaire-9. Logistic regression analysis was used to assess the independent predictors. There were a total of 1538 participants in this study (75% female). The prevalence of psychological distress was 30%. Being female, having financial instability, being treated for mental illness and self-medication for coping with stress were independent predictors of psychological distress among the study sample (Odds ratio [OR] = 1.69, confidence interval [CI] = 1.24-2.29; OR = 2.05, CI = 1.54-2.74; OR = 5.35, CI = 3.50-8.18; OR = 7.23, CI = 3.06-17.09, respectively). The results from this study will help public health officials in Oman to plan for and mitigate psychological repercussions of the current and future pandemics.
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Affiliation(s)
- Hamed Al Sinawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital , Muscat, Sultanate of Oman
| | - Naser Al Balushi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital , Muscat, Sultanate of Oman
| | | | | | | | - Alya Sultan
- Al Harub Medical Center , Muscat, Sultanate of Oman
| | - Hilal Al Sabti
- Oman Medical Specialty Board , Muscat, Sultanate of Oman
| | | | | | - Mohammed Al-Alawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital , Muscat, Sultanate of Oman
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78
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Cioffi CC, Leve LD. Substance use disorder treatment, parenting, and COVID-19. J Subst Abuse Treat 2020; 119:108148. [PMID: 33138931 DOI: 10.1016/j.jsat.2020.108148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/23/2020] [Accepted: 09/21/2020] [Indexed: 12/31/2022]
Abstract
Prior to COVID-19, options for parenting support while receiving substance use disorder (SUD) treatment were limited. The transition to using mobile technology for SUD treatment due to physical distancing during the pandemic may make parenting resources for people with SUDs even more limited. The rapid integration of parenting supports into telehealth and web-based treatment delivery is essential for improving long-term outcomes for families affected by substance use.
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Affiliation(s)
- Camille C Cioffi
- Prevention Science Institute, University of Oregon, 1600 Millrace Dr., Eugene, OR 97403, United States of America.
| | - Leslie D Leve
- Prevention Science Institute, University of Oregon, 1600 Millrace Dr., Eugene, OR 97403, United States of America
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79
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Gustavson AM, Gordon AJ, Kenny ME, McHenry H, Gronek J, Ackland PE, Hagedorn HJ. Response to coronavirus 2019 in Veterans Health Administration facilities participating in an implementation initiative to enhance access to medication for opioid use disorder. Subst Abus 2020; 41:413-418. [PMID: 32936695 PMCID: PMC8667808 DOI: 10.1080/08897077.2020.1809609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The actions needed to mitigate the spread of the coronavirus 2019 (COVID-19) have forged rapid paradigm shifts across healthcare delivery. In a time of crisis, continued access to and delivery of medication for opioid use disorder (M-OUD) is essential to save lives. However, prior to COVID-19, large variability in M-OUD adoption existed across the Veteran Health Administration (VHA) and it is unknown whether the COVID-19 pandemic exacerbated this divide. For the past two years, our team worked with eight VHA facilities to enhance adoption of M-OUD through a multi-component implementation intervention. This commentary explores these providers' responses to COVID-19 and the subsequent impact on their progress toward increasing adoption of M-OUD. Briefly, the loosening of regulatory restrictions fostered accelerated adoption of M-OUD, rapid support for telehealth offered a mechanism to increase M-OUD access, and reevaluation of current practices surrounding M-OUD strengthened adoption. Overall, during the COVID-19 crisis, facilities and providers responded positively to the call for increased access to M-OUD and appropriate care of patients with OUD. The VHA providers' responses and continued progress in enhancing M-OUD amidst a crisis may, in part, be attributable to their participation in an implementation effort prior to COVID-19 that established resources, expert support, and a community of practice. We anticipate the themes presented are generalizable to other healthcare systems grappling to deliver care to patients with OUD during a crisis. We propose areas of future research and quality improvement to continue to provide access and high quality, life-saving care to patients with OUD.
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Affiliation(s)
- Allison M. Gustavson
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Adam J. Gordon
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marie E. Kenny
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Haley McHenry
- Department of Pharmacy, Veterans Affairs Health System, Cheyenne, WY, USA
| | - Julie Gronek
- Veterans Affairs Health System, Battle Creek, MI, USA
| | - Princess E. Ackland
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Hildi J. Hagedorn
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA
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80
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Caring for Patients With Opioid Use Disorder in the Midst of a Pandemic: A Call to Action for All Nurses. J Addict Nurs 2020; 31:141-143. [PMID: 32868604 DOI: 10.1097/jan.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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81
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Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, Cannon M, Correll CU, Byrne L, Carr S, Chen EYH, Gorwood P, Johnson S, Kärkkäinen H, Krystal JH, Lee J, Lieberman J, López-Jaramillo C, Männikkö M, Phillips MR, Uchida H, Vieta E, Vita A, Arango C. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry 2020; 7:813-824. [PMID: 32682460 PMCID: PMC7365642 DOI: 10.1016/s2215-0366(20)30307-2] [Citation(s) in RCA: 872] [Impact Index Per Article: 218.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023]
Abstract
The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.
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Affiliation(s)
- Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Merete Nordentoft
- CORE-Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region, Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Crossley
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nev Jones
- Department of Psychiatry, University of South Florida, Tampa, FL, USA
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Louise Byrne
- School of Management, College of Business, RMIT University, Melbourne, VIC, Australia; Program for Recovery and Community Health, School of Medicine, Yale, New Haven, CT, USA; School of Medicine, Yale, New Haven, CT, USA
| | - Sarah Carr
- School of Social Policy and Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Eric Y H Chen
- Department of Psychiatry and State Key Laboratory on Cognitive and Brain Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris, University of Paris, INSERM U1266, Paris, France; GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, Paris, France
| | - Sonia Johnson
- Division of Psychiatry (National Insitute for Health Research Mental Health Policy Research Unit), University College London, London, UK
| | - Hilkka Kärkkäinen
- Global Alliance of Mental Illness Advocacy Networks-Europe, Brussels, Belgium
| | - John H Krystal
- Department of Psychiatry, School of Medicine, Yale, New Haven, CT, USA; Yale New Haven Hospital, New Haven, CT, USA
| | - Jimmy Lee
- North Region and Department of Psychosis, Institute of Mental Health, Singapore; Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jeffrey Lieberman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, NY, USA
| | - Carlos López-Jaramillo
- Department of Psychiatry, School of Medicine, University of Antioquia, Medellín, Colombia
| | | | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
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82
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Cochran G, Bruneau J, Cox N, Gordon AJ. Medication treatment for opioid use disorder and community pharmacy: Expanding care during a national epidemic and global pandemic. Subst Abus 2020; 41:269-274. [PMID: 32697171 DOI: 10.1080/08897077.2020.1787300] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, are effective strategies for treatment of opioid use disorder (OUD) and reducing overdose risk. MOUD treatment rates continue to be low across the US, and currently, some evidence suggests access to evidence-based treatment is becoming increasingly difficult for those with OUD as a result of the 2019 novel corona virus (COVID-19). A major underutilized source to address these serious challenges in the US is community pharmacy given the specialized training of pharmacists, high levels of consumer trust, and general availability for accessing these service settings. Canadian, Australian, and European pharmacists have made important contributions to the treatment and care of those with OUD over the past decades. Unfortunately, US pharmacists are not permitted to prescribe MOUD and are only currently allowed to dispense methadone for the treatment of pain, not OUD. US policymakers, regulators, and practitioners must work to facilitate this advancement of community pharmacy-based through research, education, practice, and industry. Advancing community pharmacy-based MOUD for leading clinical management of OUD and dispensation of treatment medications will afford the US a critical innovation for addressing the opioid epidemic, fallout from COVID-19, and getting individuals the care they need.
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Affiliation(s)
- Gerald Cochran
- Greater Intermountain Node, a NIH NIDA Clinical Trial Network node and Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Julie Bruneau
- Department of family medicine and emergency medicine, Université de Montréal, Montréal, Canada
| | - Nicholas Cox
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Adam J Gordon
- Greater Intermountain Node, a NIH NIDA Clinical Trial Network node and Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS Center), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
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83
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Melamed OC, Hauck TS, Buckley L, Selby P, Mulsant BH. COVID-19 and persons with substance use disorders: Inequities and mitigation strategies. Subst Abus 2020; 41:286-291. [PMID: 32697172 DOI: 10.1080/08897077.2020.1784363] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The COVID-19 pandemic disproportionately disrupts the daily lives of marginalized populations. Persons with substance use disorders are a particularly vulnerable population because of their unique social and health care needs. They face significant harm from both the pandemic itself and its social and economic consequences, including marginalization in health care and social systems. Hence, we discuss: (1) why persons with substance use disorders are at increased risk for infection with COVID-19 and a severe illness course; (2) anticipated adverse consequences of COVID-19 in persons with substance use disorders; (3) challenges to health care delivery and substance use treatment programs during and after the COVID-19 pandemic; and (4) the potential impact on clinical research in substance use disorders. We offer recommendations for clinical, public health, and social policies to mitigate these challenges and to prevent negative outcomes.
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Affiliation(s)
- Osnat C Melamed
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tanya S Hauck
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Buckley
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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84
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Chiappini S, Guirguis A, John A, Corkery JM, Schifano F. COVID-19: The Hidden Impact on Mental Health and Drug Addiction. Front Psychiatry 2020; 11:767. [PMID: 32848937 PMCID: PMC7403495 DOI: 10.3389/fpsyt.2020.00767] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Stefania Chiappini
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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85
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Wei Y, Shah R. Substance Use Disorder in the COVID-19 Pandemic: A Systematic Review of Vulnerabilities and Complications. Pharmaceuticals (Basel) 2020; 13:E155. [PMID: 32708495 PMCID: PMC7407364 DOI: 10.3390/ph13070155] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/18/2023] Open
Abstract
As the world endures the coronavirus disease 2019 (COVID-19) pandemic, the conditions of 35 million vulnerable individuals struggling with substance use disorders (SUDs) worldwide have not received sufficient attention for their special health and medical needs. Many of these individuals are complicated by underlying health conditions, such as cardiovascular and lung diseases and undermined immune systems. During the pandemic, access to the healthcare systems and support groups is greatly diminished. Current research on COVID-19 has not addressed the unique challenges facing individuals with SUDs, including the heightened vulnerability and susceptibility to the disease. In this systematic review, we will discuss the pathogenesis and pathology of COVID-19, and highlight potential risk factors and complications to these individuals. We will also provide insights and considerations for COVID-19 treatment and prevention in patients with SUDs.
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Affiliation(s)
- Yufeng Wei
- Department of Chemistry, New Jersey City University, Jersey City, NJ 07305, USA;
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Roncero C, Vicente-Hernández B, Casado-Espada NM, Aguilar L, Gamonal-Limcaoco S, Garzón MA, Martínez-González F, Llanes-Álvarez C, Martínez R, Franco-Martín M, Álvarez-Navares A. The Impact of COVID-19 Pandemic on the Castile and Leon Addiction Treatment Network: A Real-Word Experience. Front Psychiatry 2020; 11:575755. [PMID: 33324254 PMCID: PMC7723843 DOI: 10.3389/fpsyt.2020.575755] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/29/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Patients suffering from addiction are a vulnerable group in the midst of COVID-19, so their healthcare is considered essential. In this paper, the measures and responses of the Drug Addiction Assistance Network of Castile and Leon (DAACYL) in Spain during the first 6 weeks of the COVID-19 pandemic are explained. The aim is that this experience could be useful in places where this problem will continue and could help future interventions. Methods: A telephone survey was carried out as the main methodology, to collect information for the subsequent organization and repercussion on professionals and patients. This was carried out by the heads of the 18 DAACYL units. Among the interventions applied, the following stand out: implantation of telemedicine techniques, restriction of daily methadone dispensing, suspension of urine controls and initiation of care programs for the homeless. Results: As a result of these interventions, the professionals observed that patients are less demanding and mostly stable, with a low percentage of relapses. An increase in the consumption of alcohol and benzodiazepines have been reported as more common among people who relapse. Furthermore, the prevalence of COVID-19 infection in the sample is minimal; therefore, different hypotheses should be considered as an explanation (infra-diagnosis, immune system used to aggression, possible anti-inflammatory effect of some psychotropic drugs and a greater perception of danger against infection than the general population). Conclusions: The rapid adaptation and successful implementation of DAACYL have had satisfactory results. On the other hand, the prevention of the possible increase in the development of behavioral addictions and the use of homemade drugs should be considered.
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Affiliation(s)
- Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatry Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Begoña Vicente-Hernández
- Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
| | - Nerea M Casado-Espada
- Psychiatry Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatry Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Lourdes Aguilar
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatry Unit, School of Medicine, University of Salamanca, Salamanca, Spain.,Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
| | | | - María A Garzón
- Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
| | - Fernando Martínez-González
- Regional Commissioner for Drugs, Social Services Management, Castile and Leon Regional Government, Valladolid, Spain
| | | | - Ruth Martínez
- Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
| | - Manuel Franco-Martín
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatry Service, Zamora Health Care Complex, Zamora, Spain.,Psychiatry Service, Rio Hortega University Hospital, Valladolid, Spain
| | - Ana Álvarez-Navares
- Addictions and Dual Disorders Unit, Psychiatry Service, Salamanca University Health Care Complex, Salamanca, Spain
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87
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Martinotti G, Alessi MC, Di Natale C, Sociali A, Ceci F, Lucidi L, Picutti E, Di Carlo F, Corbo M, Vellante F, Fiori F, Tourjansky G, Catalano G, Carenti ML, Incerti CC, Bartoletti L, Barlati S, Romeo VM, Verrastro V, De Giorgio F, Valchera A, Sepede G, Casella P, Pettorruso M, di Giannantonio M. Psychopathological Burden and Quality of Life in Substance Users During the COVID-19 Lockdown Period in Italy. Front Psychiatry 2020; 11:572245. [PMID: 33101086 PMCID: PMC7497905 DOI: 10.3389/fpsyt.2020.572245] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Following the development of the COVID-19 pandemic, a rigid public health strategy of reduced social contact and shelter-in-place has been adopted by the Italian Government to reduce the spread of the virus. In this paper, we aim at evaluating the impact that the COVID-19 pandemic, and the relative containment measures, have had on a real-life sample of patients suffering from substance use disorders (SUDs) and/or behavioral addictions. METHODS An anonymous questionnaire was filled out by 153 addicted patients, both outpatients and residential inpatients, recruited across Italy and highly representative of the current Italian population suffering from addictions. Psychopathological burden (anxiety and depressive symptomatology, somatization, irritability, and post-traumatic symptoms), quality of life, and craving changes in daily habits were assessed. RESULTS In our sample, we found moderate rates of depression (22.9%), anxiety (30.1%), irritability (31.6%), and post-traumatic stress (5.4%) symptoms. Psychopathological burden was globally higher among residential patients. Reported levels of craving were generally low. DISCUSSION This study is the first attempt to collect Italian data regarding the effects of the rigid quarantine period, during the COVID-19 pandemic, on patients suffering from a SUD and/or behavioral addictions. The presence of a moderate psychopathological burden correlated to poor quality of life and low craving scores represented the main outcomes. Long-term studies, with follow-up after the end of the restrictive measures, should be considered to implement our findings.
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Affiliation(s)
- Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy.,Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Herts, United Kingdom
| | - Maria Chiara Alessi
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Chiara Di Natale
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Antonella Sociali
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Franca Ceci
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Lorenza Lucidi
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Elena Picutti
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Francesco Di Carlo
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mariangela Corbo
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Federica Vellante
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Federica Fiori
- Department of Mental Health, ASL Lanciano-Vasto-Chieti, Chieti, Italy
| | - Gaia Tourjansky
- Pathological Addictions Treatment Division, La Promessa o.n.l.u.s., Rome, Italy
| | - Gabriella Catalano
- Department of Mental Health and Addiction Services, ASL RM1, Rome, Italy
| | | | | | - Luigi Bartoletti
- Department of Mental Health and Addiction Services, ASL Alessandria, Alessandria, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vincenzo Maria Romeo
- Faculty of Psychological Sciences and Techniques, Dante Alighieri University, Reggio Calabria, Italy
| | - Valeria Verrastro
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Fabio De Giorgio
- Division of Legal Medicine, Institute of Public Health, Catholic University of Sacred Hearth, Rome, Italy
| | - Alessandro Valchera
- Pathological Addictions Service, Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Gianna Sepede
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Pietro Casella
- Department of Mental Health and Addiction Services, ASL RM1, Rome, Italy
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Massimo di Giannantonio
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Chieti, Italy
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