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Rathore R, Rangrej SB, Carvalho V. Increased alcohol consumption during the COVID-19 pandemic: A cross-sectional study. World J Clin Cases 2024; 12:3410-3416. [DOI: 10.12998/wjcc.v12.i18.3410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/06/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted health, mental well-being, and societal functioning, particularly for individuals with psychiatric conditions and substance use disorders. Recent evidence highlights a concerning increase in alcohol consumption during the pandemic, with a study spanning 2015-2020 indicating heightened usage, especially among young and middle-aged adults, for relaxation and tension relief. Additionally, addressing challenges exacerbated by the pandemic, another study underscored persistent barriers to healthcare access, resulting in increased alcohol and tobacco use rates and limited healthcare options. These findings shed light on the unique vulnerabilities exposed by the pandemic, emphasizing the need to investigate further its impact on alcohol consumption in diverse non-urban American communities.
AIM To investigate the impact of the COVID-19 pandemic on alcohol abuse using socioeconomic and medical parameters in diverse non-urban community in America.
METHODS Based on a cross-sectional analysis of 416 participants the United States in 2021, the study utilized The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria to categorize alcohol consumption levels. Participants aged 21 years and above were surveyed through an online platform due to COVID-19 challenges. The survey was conducted from January 14 to January 31, 2022, recruiting participants via social media and ensuring anonymity. Informed consent was secured, emphasizing the voluntary nature of participation, and participants could only take the survey once.
RESULTS Out of 416 survey respondents, 396 met eligibility criteria, with 62.9% reporting increased alcohol consumption during COVID-19. Males (68.8%) and ages 21-29 years (34.6%) predominated. Low alcohol consumption decreased by 2.8% (P = 0.237), moderate by 21.4% (P < 0.001), and heavy increased by 14.9% (P < 0.001). Alcohol abuse rose by 6.5% (P = 0.0439), with a 7% increase in self-identified alcohol abusers/alcoholics. Seeking treatment during COVID-19 rose by 6.9%. Easier alcohol access (76.0%) was reported, while 80.7% found it harder to access medical care for alcohol-related issues. These findings highlight the pandemic's impact on alcohol consumption and healthcare access, emphasizing the need for targeted interventions during public health crises.
CONCLUSION The COVID-19 pandemic exacerbated alcoholism and abuse, with increased heavy consumption (P < 0.001) and abuse (P = 0.0439). Access to medical programs for addressing alcohol abuse declined, highlighting the need for targeted intervention.
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Affiliation(s)
- Rajni Rathore
- Department of Pharmacology and Therapeutics, Saint James School of Medicine, Arnos Vale VC0280, Saint Vincent and the Grenadines
| | - Shahid Bakhsh Rangrej
- Department of Anatomy and Research, Saint James School of Medicine, Arnos Vale VC0280, Saint Vincent and the Grenadines
| | - Victoria Carvalho
- Medical School Basic Sciences, Saint James School of Medicine, Arnos Vale VC0280, Saint Vincent and the Grenadines
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Schmidt RA, Everett K, Perez-Brumer A, Strike C, Rush B, Gomes T. A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy. Addiction 2024; 119:1111-1122. [PMID: 38476027 DOI: 10.1111/add.16459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND AIMS Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. DESIGN This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed. SETTING AND PARTICIPANTS The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period. MEASUREMENTS We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario. FINDINGS Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015). CONCLUSION Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.
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Affiliation(s)
- Rose A Schmidt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- ICES, Toronto, Canada
| | | | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Brian Rush
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Tara Gomes
- ICES, Toronto, Canada
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Management and Evaluation at the University of Toronto, Institute of Health Policy, Toronto, Ontario, Canada
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Beitari S, Yi S, Sharma S, Yung R, Conway B. Exploring COVID-19 vaccine uptake and hesitancy among vulnerable populations in inner city Vancouver, Canada: Insights into characteristics and clinical outcomes. Vaccine 2024:S0264-410X(24)00477-8. [PMID: 38637213 DOI: 10.1016/j.vaccine.2024.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
The COVID-19 pandemic is having a profound impact on the health, social and economic well-being of people in Canada and around the world. To address vaccine disparity among vulnerable populations facing social-structural challenges, it is crucial to provide evidence-based information on the importance of completion of the recommended vaccination schedule. In this study, we investigated vaccination rates and variables as facilitators or barriers to COVID-19 vaccination among vulnerable populations living in Vancouver's inner-city residents. On a weekly basis, a team (including health care providers [HCPs] and support staff) conducts a Community Pop-up Clinic (CPC) event at single room occupancy dwellings in Vancouver's inner city to provide COVID-19 vaccine and/or related information. Participants also completed a survey about their COVID-19 vaccination status and COVID knowledge, including knowledge about COVID vaccination. We collected data from 892 CPC participants between January 2021-August 2023. The median age at baseline was 45 (IQR 36-55) years, with 317 (35.5 %) female and 285 (31.9 %) self-identified as Indigenous. Within the population, 512 (57.4 %) reported unstable housing and 441 (49.5 %) were active injection drug users. Regarding COVID-19 vaccinations, 235 (26.3 %) were unvaccinated, 119 (13.3 %) had received one dose of the COVID-19 vaccine, 432 (48.4 %) had received 2 doses, and 106 (11.8 %) had received at least 3 doses. Variables such as age (AOR 2.28, 95 % CI 1.37-3.80, p < 0.001) and HCV seropositivity (AOR 1.91, 95 % CI 1.20-3.04, p = 0.005) were significantly associated with higher odds of vaccination uptake. Conversely, unstable housing was significantly associated with a lower odds of vaccination uptake (AOR 0.53, 95 % CI 0.35-0.79, p = 0.002). Results from this study suggest that targeted community focused initiatives are crucial to address vaccine disparity among vulnerable populations living in Vancouver's inner city facing unstable housing and drug use injection.
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Affiliation(s)
- Saina Beitari
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Shana Yi
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
| | - Shawn Sharma
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
| | - Rossitta Yung
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
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Graves RL, Shofer FS, Kayser JB, Perrone J. First-Year Medical Students' Perceptions of Stigma Toward People With Opioid Use Disorder Before and After an Educational Intervention. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241236302. [PMID: 38456439 DOI: 10.1177/29767342241236302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Stigma among medical trainees toward people with opioid use disorder (OUD) compounds the problems associated with opioid addiction. People with OUD who experience overt and implicit stigma from healthcare providers are less likely to seek and receive treatment, further restricting their access to already limited resources. The objective of our study was to assess an educational strategy to mitigate stigma toward people with OUD among first-year medical students. METHODS This study assessed perceptions of stigma toward people with OUD among first-year medical students using an adaptation of a brief, validated opioid stigma scale before and after an educational intervention. The intervention consisted primarily of a recorded panel in which people with a history of OUD shared their experiences with stigma followed by small group discussions. RESULTS After the educational intervention, students were more likely to respond that (1) they believed most people held negative beliefs about people with OUD and (2) they personally disagreed with negative statements about people with OUD. CONCLUSIONS Educational interventions addressing stigma toward people with OUD are potentially effective and should be integrated into medical curricula. Such interventions are a crucial part of the effort to improve the medical care of people with OUD.
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Affiliation(s)
- Rachel L Graves
- Department of Anesthesiology, Wake Forest University, Winston-Salem, NC, USA
| | - Frances S Shofer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua B Kayser
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanmarie Perrone
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Medicine Center for Addiction Medicine and Policy, Philadelphia, PA, USA
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Ramezani N, Taylor BG, Balawajder EF, MacLean K, Pollack HA, Schneider JA, Taxman FS. Predictors of mental health among U.S. adults during COVID-19 early pandemic, mid- pandemic, and post-vaccine eras. BMC Public Health 2024; 24:643. [PMID: 38424510 PMCID: PMC10902933 DOI: 10.1186/s12889-024-17781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND A collective trauma like COVID-19 impacts individuals differently due to socio-contextual and individual characteristics. Younger adults, minorities, affiliates of certain political parties, and residents of some regions of the United States reported experiencing poorer mental health during the pandemic. Being diagnosed with COVID-19, or losing a friend/family to it, was related to more adverse mental health symptoms. While the negative impact of COVID-19 on health outcomes has been studied, mental health changes during this pandemic need further exploration. METHODS In a study of 8,612 U.S. households, using three surveys collected from a nationally representative panel between May 2020 and October 2021, using a repeated cross-sectional design, a linear mixed effect regression model was performed to investigate factors associated with the mental health status, based on the Mental Health Inventory-5, of individuals throughout different phases of the COVID-19 pandemic, and whether an improvement over time, especially after vaccines became available, was observed. RESULTS An overall improvement in mental health was observed after vaccines became available. Individuals with no COVID-related death in their household, those not wearing masks, those identifying as members of the Republican Party, race/ethnicities other than Asian, men, older adults, and residents of the South were less likely than others to report mental health challenges. CONCLUSIONS Our results highlight the need for widespread mental health interventions and health promotion to address challenges during the COVID-19 pandemic and beyond. Due to the worse mental health observed among Asians, younger adults, women, low-income families, those with a higher level of concern for COVID-19, people who lost someone to COVID-19, and/or individuals with histories of opioid use disorder and criminal legal involvement, over the period of this study, targeted attention needs to be given to the mental health of these groups.
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Affiliation(s)
- Niloofar Ramezani
- Department of Biostatistics, Virginia Commonwealth University, Box 980032, One Capital Square, 830 East Main St, Richmond, VA, 23219, USA.
| | - Bruce G Taylor
- NORC at the University of Chicago, Public Health Department, 4350 East West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Elizabeth Flanagan Balawajder
- NORC at the University of Chicago, Public Health Department, 4350 East West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Kai MacLean
- NORC at the University of Chicago, Public Health Department, 4350 East West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, Department of Public Health Sciences, Urban Health Lab, University of Chicago, 969 E 60th St, Chicago, IL, 60637, USA
| | - John A Schneider
- Department of Medicine and Public Health Sciences, Crown Family School of Social Work, Policy, and Practice, University of Chicago, 5841 South Maryland Avenue MC 5065, Chicago, IL, 60637, USA
| | - Faye S Taxman
- Schar School of Policy and Government, George Mason University, 3351 Fairfax Drive Van Metre Hall, Arlington, VA, 22201, USA
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Ginther J, McNally G. CE: Reducing Bias Against People with Substance Use Disorders. Am J Nurs 2024; 124:28-37. [PMID: 38055841 DOI: 10.1097/01.naj.0000998224.71157.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
ABSTRACT Addiction is a highly misunderstood and stigmatized chronic illness frequently encountered by health care providers during routine medical care. People with substance use disorders, in particular, face extraordinary stigma and bias when interacting with health care providers, including nurses. Stigma associated with addiction contributes to health inequities and is recognized as a significant barrier to people seeking and receiving necessary health care. Since patients often spend the most time with nurses in the clinical setting, nurses are ideally positioned to address addiction stigma. However, many nurses lack knowledge about addiction, stigma, and the impact of the words they use, whether in conversation or in clinical documentation. This article reviews the consequences of addiction stigma (labeling, stereotyping, or discrimination) and the steps nurses can take to reduce biases related to substance use. A case scenario based on our experience will be used to guide a discussion of opportunities for nurses to intervene and improve care.
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Affiliation(s)
- Jane Ginther
- Jane Ginther is an NP on the trauma team in the Department of Orthopedic Surgery, The Ohio State University Wexner Medical Center, Columbus. Gretchen McNally is an NP at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH. The authors acknowledge Carlton Brown, PhD, RN, AOCN, nurse research consultant at Zenith Health Care Solutions, for editorial assistance. Contact author: Jane Ginther, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Abraham O, Koeberl CR, McCarthy TJ. MedSMA℞T Adventures in PharmaCity Game: Youth Experiences and Recommendation for Use in Opioid Safety Education. PHARMACY 2023; 11:143. [PMID: 37736915 PMCID: PMC10514865 DOI: 10.3390/pharmacy11050143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
Adolescents are often excluded from the creation of opioid safety interventions; therefore, it is crucial to design evidence-based interventions tailored for and with youth. Video games are ubiquitous and approachable to adolescents making them an accessible educational modality. MedSMA℞T: Adventures in PharmaCity is a serious game that educates adolescents and their families on the safe, appropriate, and responsible use of opioid prescriptions. The first objective of the study was to elucidate adolescents' experiences and perceptions of the game. The second objective was to elicit their recommendations for use and suggestions for improvement. Adolescents were recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Recruitment occurred between April 2021 and October 2021. Eligible adolescents played the game and completed a follow-up virtual semi-structured interview with a study team member. Interviews were transcribed verbatim and uploaded to NVivo for data analysis. A thematic content analysis was performed. A total of seventy-two adolescents participated. Analysis yielded four themes: prior gaming experience, educational salience, game design impressions, and recommendations for improvement. Most adolescents approached MedSMA℞T with prior gaming experience. The youth correctly identified the game's intended objective: the promotion of opioid medication safety. Adolescents had overarchingly positive impressions of the game's levels, characters, and graphics. Study participants suggested expanded game levels, improved controls, and more instructions for gameplay. In summary, adolescents had favorable experiences using the MedSMA℞T game which allude to the wide-spread acceptability of this intervention among young people.
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Affiliation(s)
- Olufunmilola Abraham
- Social and Administrative Sciences Division, Madison School of Pharmacy, University of Wisconsin, Madison, WI 53705, USA
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Walters SM, Kerr J, Cano M, Earnshaw V, Link B. Intersectional Stigma as a Fundamental Cause of Health Disparities: A case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time. STIGMA AND HEALTH 2023; 8:325-343. [PMID: 37744082 PMCID: PMC10516303 DOI: 10.1037/sah0000426] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Recent evidence points to racial and ethnic disparities in drug-related deaths and health conditions. Informed by stigma, intersectionality, intersectional stigma, and fundamental cause theories, we aimed to explore whether intersectional stigma was a fundamental cause of health. We document key events and policies over time and find that when progress is made new mechanisms emerge that negatively affect health outcomes for Black and Hispanic persons. We then focus on intersectional stigma targeting Black and Hispanic persons who use drugs. We document that when a person, or group of people, occupy multiple stigmatized identities the processes of stigmatization and scapegoating are particularly persistent and pernicious since people and groups can be stigmatized and scapegoated on varying intersections. We propose that an intersectional stigma framework allows for a better understanding of observed patterns over time, thereby providing a better guide for policies and interventions designed to reduce disparities. As a framework, intersectional stigma aims to recognize that when different sources of stigma collide, a new set of circumstances is created for those who reside in the intersection. We conclude that intersectional stigma is a fundamental cause of health inequities and provide policy recommendations aimed at dismantling intersectional stigma processes and mitigating the effects of intersectional stigmas to ultimately promote better health outcomes for Black and Hispanic persons who use drugs.
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Affiliation(s)
- Suzan M Walters
- School of Global Public Health, New York University, New York, NY
- Center for Drug Use and HIV/HCV Research, New York, NY
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY
| | - Manuel Cano
- Department of Social Work, University of Texas at San Antonio, San Antonio, TX
| | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE
| | - Bruce Link
- Department of Sociology, University of California Riverside, Riverside, CA
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Ali F, Kaura A, Russell C, Bonn M, Bruneau J, Dasgupta N, Imtiaz S, Martel-Laferrière V, Rehm J, Shahin R, Elton-Marshall T. Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study. Harm Reduct J 2023; 20:99. [PMID: 37516836 PMCID: PMC10387201 DOI: 10.1186/s12954-023-00826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. METHODS Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. RESULTS Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. CONCLUSION PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.
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Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada.
| | - Ashima Kaura
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul, Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Nabarun Dasgupta
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sameer Imtiaz
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, & Institute of Medical Science (IMS), Toronto, Canada
- 1 King's College Circle, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | | | - Tara Elton-Marshall
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Des Jarlais DC, Weng CA, Feelemyer J, McKnight C. COVID-19 vaccination and HIV transmission among persons who inject drugs during the first two years of the COVID-19 pandemic in New York City. Harm Reduct J 2023; 20:63. [PMID: 37138304 PMCID: PMC10156073 DOI: 10.1186/s12954-023-00791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/29/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND To examine COVID-19 vaccination and HIV transmission among persons who inject drugs (PWID) during the COVID-19 pandemic (2020-2022) in New York City (NYC). METHODS Two hundred and seventy five PWID were recruited from October 2021 to September 2022. A structured questionnaire was used to measure demographics, drug use behaviors, overdose experiences, substance use treatment history, COVID-19 infection, vaccination, and attitudes. Serum samples were collected for HIV, HCV, and SARS-CoV-2 (COVID-19) antibody testing. RESULTS Participants were: 71% male, the mean age was 49 (SD 11), 81% reported at least one COVID-19 immunization, 76% were fully vaccinated and 64% of the unvaccinated had antibodies for COVID-19. Self-reported injection risk behaviors were very low. HIV seroprevalence was 7%. Eighty-nine percent of the HIV seropositive respondents reported knowing they were HIV seropositive and being on antiretroviral therapy prior to the COVID-19 pandemic. There were two likely seroconversions in 518.83 person-years at risk from the March 2020 start of the pandemic to the times of interviews, for an estimated incidence rate of 0.39/100 person-years, 95% Poisson CI 0.05-1.39/100 person-years. CONCLUSIONS There is concern that the COVID-19 pandemic disruptions to HIV prevention services and the psychological stress of the pandemic may lead to increased risk behavior and increased HIV transmission. These data indicate adaptive/resilient behaviors in both obtaining COVID-19 vaccination and maintaining a low rate of HIV transmission among this sample of PWID during the first two years of the COVID-19 pandemic in NYC.
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Affiliation(s)
- Don C Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, 7th Floor, NY, 10003, New York, USA.
| | - Chenziheng Allen Weng
- School of Global Public Health, New York University, 708 Broadway, 7th Floor, NY, 10003, New York, USA
| | - Jonathan Feelemyer
- School of Global Public Health, New York University, 708 Broadway, 7th Floor, NY, 10003, New York, USA
| | - Courtney McKnight
- School of Global Public Health, New York University, 708 Broadway, 7th Floor, NY, 10003, New York, USA
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Rance J, Bryant J, Caruana T, Brener L. Practising care in a pandemic: Accounting for everyday life during COVID-19 among people who inject drugs. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:791-809. [PMID: 36738164 DOI: 10.1111/1467-9566.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 01/04/2023] [Indexed: 05/04/2023]
Abstract
From the outset of the COVID-19 pandemic, fears have been raised worldwide regarding the unique challenges facing socially marginalised people such as those who inject drugs. This article draws on in-depth interviews conducted during the first year of the pandemic with people who inject drugs living in urban and regional Australia. Perhaps the most surprising finding to emerge was the number of participants who reported minimal disruption to their everyday lives, even improved wellbeing in some instances. Attempting to make sense of this unanticipated finding, our analysis draws on the concept of 'care', not as a moral disposition or normative code but as something emergent, contingent and realised in practice. Working with Foucault's ethics and recent feminist insights on the politics of care from the field of Science and Technology Studies, we explore how care was enacted in the everyday lives of our participants. We examine how participants' daily routines became objects of care and changed practice in response to the pandemic; how their ongoing engagement with harm reduction services afforded not only clinical support but vital forms of social and affective connection; and how for some, care was realised through an ethos and practice of constrained sociality and solitude.
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Affiliation(s)
- Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
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Fast N, van Kessel R, Humphreys K, Ward NF, Roman-Urrestarazu A. The Evolution of Telepsychiatry for Substance Use Disorders During COVID-19: a Narrative Review. CURRENT ADDICTION REPORTS 2023; 10:187-197. [PMID: 37266192 PMCID: PMC10126560 DOI: 10.1007/s40429-023-00480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review This article aims to review and synthesize the current research evidence regarding the efficacy of telepsychiatry-delivered substance use disorder treatment using a narrative review with a focus on the effects of remote healthcare delivery within the substance abuse treatment space. Recent Findings The COVID-19 pandemic exerted substantial pressures on all levels of society. Social isolation, loss of employment, stress, physical illness, overburdened health services, unmet medical needs, and rapidly changing pandemic restrictions had particularly severe consequences for people with mental health issues and substance use disorders. Since the start of the pandemic, addiction treatment (and medical treatment overall) using remote health platforms has significantly expanded to different platforms and delivery systems. The USA, in particular, reported transformational policy developments to enable the delivery of telehealth during the COVID-19 pandemic. However, systemic barriers such as a widespread lack of internet access and insufficient patient and provider digital skills remain. Summary Overall, telepsychiatry is a promising approach for the treatment of substance use disorders, but more randomized controlled trials are needed in the future to assess the evidence base of available interventions.
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Affiliation(s)
- Noam Fast
- START Treatment & Recovery Centers, New York City, USA
- Addiction Psychiatry Fellowship Faculty, Department of Psychiatry, Columbia University, New York City, USA
| | - Robin van Kessel
- Department of Health Policy, London School of Economics and Political Science, LSE Health, London, UK
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Natalie Frances Ward
- Department of International Development Studies, University of Amsterdam, Amsterdam, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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Walters SM, Felsher M, Frank D, Jaiswal J, Townsend T, Muncan B, Bennett AS, Friedman SR, Jenkins W, Pho MT, Fletcher S, Ompad DC. I Don't Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1648. [PMID: 36674402 PMCID: PMC9864395 DOI: 10.3390/ijerph20021648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. METHODS Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods. RESULTS Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting and/or changing the route of transmission. Approximately half of persons who inject drugs sampled had heard of fentanyl test strips, however fentanyl test strip use was low. To reverse overdoses, participants reported using cold water baths. Use of naloxone to reverse overdose was low. Barriers to naloxone access and use included fear of arrest and opioid withdrawal. CONCLUSIONS People who inject drugs understood fentanyl to be a potential contaminant in their drug supply and actively engaged in harm reduction techniques to try to prevent overdose. Interventions to increase harm reduction education and information about and access to fentanyl test strips and naloxone would be beneficial.
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Affiliation(s)
- Suzan M. Walters
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
| | - Marisa Felsher
- College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - David Frank
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jessica Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Tarlise Townsend
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Brandon Muncan
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Alex S. Bennett
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Samuel R. Friedman
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Wiley Jenkins
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL 62702, USA
| | - Mai T. Pho
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | | | - Danielle C. Ompad
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
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14
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Lutgen C, Callen E, Robertson E, Clay T, Filippi MK. Implementation and Evaluation of Primary Care Team Participation in Opioid Use Disorder Learning Sessions. Subst Abus 2023; 44:51-61. [PMID: 37226899 DOI: 10.1177/08897077231174675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Previous studies show that some primary care clinicians do not feel equipped to treat patients with opioid use disorder (OUD). This study addressed the gaps in confidence and knowledge of primary care physicians and other participants (i.e., participants who were not physicians) in diagnosing, treating, prescribing, and educating patients with OUD through interactive learning sessions. METHODS The American Academy of Family Physicians National Research Network held monthly OUD learning sessions from September 2021 to March 2022 with physicians and other participants (n = 31) from 7 practices. Participants took baseline (n = 31), post-session (n = 11-20), and post-intervention (n = 21) surveys. Questions focused on confidence, knowledge, among others. We used non-parametric tests to compare individual responses pre-versus-post participation as well as to compare responses between groups. RESULTS All participants experienced significant changes in confidence and knowledge for most topics covered in the series. When comparing physicians to other participants, physicians had greater increases in confidence in dosing and monitoring for diversion (P = .047), but other participants had greater increases in confidence in the majority of topic areas. Physicians also had greater increases in knowledge than other participants in dosing and monitoring for safety (P = .033) and dosing and monitoring for diversion (P = .024), whereas other participants had greater increases in knowledge in most remaining topics. Participants agreed that sessions provided practical knowledge, except for relevancy of the case study portion of the session to current practice (P = .023) and the session improved participant ability to care for patients (P = .044). CONCLUSION Through participating in interactive OUD learning sessions, knowledge and confidence increased among physicians and other participants. These changes may impact participants' decisions to diagnose, treat, prescribe, and educate patients with OUD.
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Affiliation(s)
- Cory Lutgen
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Elisabeth Callen
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Elise Robertson
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Tarin Clay
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Melissa K Filippi
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
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Tomko C, Clouse E, Haney K, Galai N, Footer K, Ferryman K, Smith KC, Sherman SG. A study protocol to explore and implement community-based point-of-care COVID-19 testing for women who use drugs in Baltimore, Maryland: The CARE study. PLoS One 2022; 17:e0277605. [PMID: 36542613 PMCID: PMC9770432 DOI: 10.1371/journal.pone.0277605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022] Open
Abstract
Women who use drugs (WWUD) experience structural vulnerabilities (e.g., housing, food insecurities) and comorbidities that elevate their susceptibility to more severe COVID-19 symptoms or fatality compared to similarly-aged women who do not use illicit drugs. Testing is a cornerstone of effective COVID prevention, however, entrenched barriers to healthcare utilization means that WWUD may have diminished accessing to COVID testing. The CARE (COVID Action Research Engagement) study first examines predisposing and enabling factors that predict COVID testing uptake over six months (baseline, 3-, and 6-month follow-up) among a cohort of WWUD (N = 250) in Baltimore, Maryland, providing a nuanced and holistic understanding of how to meaningfully engage WWUD in COVID testing. Then, point-of-care COVID testing will be implemented on a mobile outreach van affiliated with a local community-based organization primarily serving WWUD; anonymous surveys of mobile outreach guests (N = 100) will assess feasibility and acceptability of this integrated testing. The study is grounded in the Behavioral Model for Vulnerable Populations and the Theoretical Framework of Acceptability. We hypothesize that point-of-care COVID testing integrated into a low-barrier harm reduction service, such as a mobile outreach program, will be an enabling environment for COVID testing uptake in part by reducing structural impediments to testing and will be highly feasible and acceptable to participants. Strengths, limitations, and plans for results dissemination are discussed.
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Affiliation(s)
- Catherine Tomko
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Emily Clouse
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Haney
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Footer
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kadija Ferryman
- Berman Institute of Bioethics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Clegg Smith
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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16
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Jordan AE, Izar R, Nicolas R, Beharie N, Harocopos A. Understanding Vaccine Perceptions and Willingness to Receive COVID-19 Vaccination: Opportunities to Strengthen Public Health Responses and COVID-19 Services for People Who Use Drugs. Vaccines (Basel) 2022; 10:vaccines10122044. [PMID: 36560454 PMCID: PMC9784169 DOI: 10.3390/vaccines10122044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background: People who use drugs (PWUD) are at high risk for COVID-19 infection, morbidity, and mortality. COVID-19 vaccines are safe and effective at reducing serious illness and death from COVID-19. There are sparse data on the perceptions and willingness of PWUD to receive COVID-19 vaccination. Materials and Methods: In order to assess the perceptions of, and willingness to receive, COVID-19 vaccination among PWUD, we conducted a rapid survey-based assessment of 100 PWUD in NYC (Spring 2021) who reported not having received COVID-19 vaccination and who reported past 30-day illicit drug use. Results: More than 80% of respondents agreed that personally receiving a COVID-19 vaccine was important for the health of others in the community, and endorsing this belief was significantly associated with COVID-19 vaccine willingness reflecting a high prevalence of altruistic beliefs (p-value: 0.01). Other reported perceptions that were significantly associated with COVID-19 vaccine willingness were believing that COVID-19 vaccines are safe for PWUD and trusting COVID-19 information from their healthcare providers (p-values < 0.05). That said, 62% reported being unwilling to receive a COVID-19 vaccine, and 70−83% had concerns about general vaccine safety/efficacy. Examining pairs of questions to explore potential ambivalence between vaccine endorsement and vaccine concerns identified that 56−65% simultaneously reported vaccine safety/efficacy concerns and beliefs that vaccination was an important intervention. Of the 75 respondents who reported past 30-day use of harm reduction and/or substance use disorder (SUD) programs, nearly 90% reported these programs as trusted sources of COVID-19 information. Conclusion: Most participants reported altruistic beliefs about the role of vaccines for community health, including COVID-19 vaccines, and this altruism was associated with willingness to be vaccinated against COVID-19. These findings suggest a complex relationship between beliefs about the role of vaccination in community health and the safety/efficacy of vaccines; this ambivalence suggests that COVID-19 vaccine willingness may not be firmly fixed, indicating potential opportunities to address questions and build vaccine confidence. Harm reduction and SUD programs could be leveraged to further engage PWUD in receipt of COVID-19 information and/or vaccination. Recognizing vaccine ambivalence, emphasizing collective and individual benefits of vaccination, and messaging from trusted sources may be promising approaches to increase vaccination in this population.
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17
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Rains A, York M, Bolinski R, Ezell J, Ouellet LJ, Jenkins WD, Pho MT. Attitudes toward harm reduction and low-threshold healthcare during the COVID-19 pandemic: qualitative interviews with people who use drugs in rural southern Illinois. Harm Reduct J 2022; 19:128. [PMID: 36403075 PMCID: PMC9675127 DOI: 10.1186/s12954-022-00710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Chronic health conditions associated with long-term drug use may pose additional risks to people who use drugs (PWUD) when coupled with COVID-19 infection. Despite this, PWUD, especially those living in rural areas, may be less likely to seek out health services. Previous research has highlighted the increased disease burden of COVID-19 among PWUD. Our manuscript supplements this literature by exploring unique attitudes of PWUD living in rural areas toward the pandemic, COVID-19 vaccination, and the role of harm reduction (HR) organizations in raising health awareness among PWUD. METHODS Semi-structured interviews were conducted with 20 PWUD living in rural southern Illinois. Audio recordings were professionally transcribed. A preliminary codebook was created based on interview domains. Two trained coders conducted iterative coding of the transcripts, and new codes were added through line-by-line coding and thematic grouping. RESULTS Twenty participants (45% female, mean age of 38) completed interviews between June and November 2021. Participants reported negative impacts of the pandemic on mental health, financial wellbeing, and drug quality. However, the health impacts of COVID-19 were often described as less concerning than its impacts on these other aspects of life. Many expressed doubt in the severity of COVID-19 infection. Among the 16 unvaccinated participants who reported receiving most of their information from the internet or word of mouth, uncertainty about vaccine contents and distrust of healthcare and government institutions engendered wariness of the vaccination. Distrust of healthcare providers was related to past stigmatization and judgement, but did not extend to the local HR organization, which was unanimously endorsed as a positive institution. Among participants who did not access services directly from the HR organization, secondary distribution of HR supplies by other PWUD was a universally cited form of health maintenance. Participants expressed interest in low-threshold healthcare, including COVID-19 vaccination, should it be offered in the local HR organization's office and mobile units. CONCLUSION COVID-19 and related public health measures have affected this community in numerous ways. Integrating healthcare services into harm reduction infrastructures and mobilizing secondary distributors of supplies may promote greater engagement with vaccination programs and other healthcare services. TRIAL NUMBER NCT04427202.
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Affiliation(s)
- Alex Rains
- Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - Mary York
- Department of Sociology, Southern Illinois University, Carbondale, IL, USA
| | - Rebecca Bolinski
- Department of Sociology, Southern Illinois University, Carbondale, IL, USA
| | - Jerel Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, USA
- Center for Cultural Humility, Cornell University, Ithaca, NY, USA
| | - Lawrence J Ouellet
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Wiley D Jenkins
- Department of Epidemiology and Biostatistics, SIU School of Medicine, Springfield, IL, USA
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, USA
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18
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Brener L, Horwitz R, Rance J, Caruana T, Bryant J. Health worker perceptions of the impact of COVID-19 on harm reduction services for people who inject drugs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2320-2329. [PMID: 35293054 PMCID: PMC9111390 DOI: 10.1111/hsc.13782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/19/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic has affected entire systems of health service provision globally, including health service closure, redeployment of staff and resources and implementation of infection prevention protocols. Harm reduction facilities face particular challenges responding to COVID-19, attempting to continue service provision to people who inject drugs with minimal service disruption whilst protecting their staff. This research assessed the impact of COVID-19 on staff working at harm reduction and alcohol and other drug (AOD) services in Australia in the first 9 months of the pandemic. The research employed mixed methods, using survey data to inform in-depth interviews. Surveys were completed by 207 participants working in the AOD sector and the harm reduction sector nationally. Interviews were conducted with 16 staff at three harm reduction sites in metropolitan Sydney and one regional NSW service. Staff felt able to respond to the trying circumstances of this pandemic, especially as practical messages around the COVID-19 response were similar to those already in place for clients in relation to blood-borne virus prevention. Staff felt that they were still able to provide core services to clients with some modifications in delivery. They were willing to take on additional responsibilities to ensure their own safety and that of clients, including conducting temperature checks and screening questions, whilst also adopting novel service provision strategies to reach clients during lockdowns such as postal services, outreach work and telehealth. NSP and AOD services were able to implement COVID-19 infection control strategies, whilst maintaining and expanding service access through remote and innovative strategies in a manner which supported both clients and service providers, during the first wave of the pandemic in 2020.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Robyn Horwitz
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Jake Rance
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Theresa Caruana
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Joanne Bryant
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
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19
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MacKinnon L, Kerman N, Socías ME, Brar R, Bardwell G. Primary care embedded within permanent supportive housing for people who use substances: A qualitative study examining healthcare access in Vancouver, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5062-e5073. [PMID: 35852403 PMCID: PMC9970158 DOI: 10.1111/hsc.13921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/09/2022] [Accepted: 07/08/2022] [Indexed: 05/11/2023]
Abstract
Marginally housed people who use drugs and alcohol (PWUD/A) face barriers in accessing healthcare services, which may be improved by providing healthcare in housing settings. This case study examines the experiences of healthcare access amongst PWUD/A who live in a permanent supportive housing model in Vancouver, Canada. This model has an embedded multidisciplinary clinic providing in-reach services. Thirty participants were recruited via posters placed throughout the building and semi-structured qualitative interviews were conducted remotely. Interviews were conducted with participants who accessed onsite care regularly (n = 15) and those who do not (n = 15). Data were analysed to identify both a priori and emerging themes. Participants who accessed the onsite clinic reported benefiting from stigma-free care. Close proximity and convenience of drop-in appointments enabled participants to engage with healthcare services more consistently, though hours of operation and privacy concerns were barriers for others. Participants who did not use the onsite clinic highlighted the importance of continuity of care with their pre-existing primary care team, particularly if their clinic was in close geographic proximity. However, they also described utilising these services for urgent health needs or as an occasional alternative source of care. Shared perspectives across all participants emphasised the importance of low-barrier services, including medication delivery, convenience and positive therapeutic relationships. Our findings suggest that embedding access to primary care within supportive housing benefits PWUD/A who have previously encountered barriers to healthcare access. This model could be implemented to prevent utilisation of acute healthcare resources and improve health outcomes amongst PWUD/A.
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Affiliation(s)
- Laura MacKinnon
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - M. Eugenia Socías
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Rupinder Brar
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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20
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Conway A, Treloar C, Crawford S, Grebely J, Marshall AD. People engaged in opioid agonist treatment as a counterpublic during the COVID-19 pandemic in Australia: A qualitative study. Drug Alcohol Rev 2022; 42:203-212. [PMID: 36054577 PMCID: PMC9538012 DOI: 10.1111/dar.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 06/08/2022] [Accepted: 07/31/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION People receiving opioid agonist treatment (OAT) are at higher risk of comorbidities, poverty and discrimination, which Big Events like the COVID-19 pandemic may exacerbate. The behaviours of people receiving OAT do not always align with normative behaviours as conceived by ruling institutions and laws, and so the group becomes a counterpublic, not imagined in mainstream public discourse. The aim of this study was to understand how people receiving OAT, as a counterpublic, implemented practises of care to mitigate negative health outcomes during COVID-19. METHODS Participants were recruited via eight peer-led organisations across Australia. In-depth, semi-structured interviews were completed between August and December 2020 with 40 people receiving OAT. The analysis centres practises of care, allowing interactions that influence the health of participants, to be understood in their unique contexts. RESULTS Aspects of the COVID-19 state response were designed for an idealised public, demonstrated by the increased policing that accompanied enforcement of restrictions which was detrimental to the wellbeing of people receiving OAT. Counterpublic health strategies employed by people receiving OAT were disrupted, but participants were often able to adapt to the changing context. DISCUSSION AND CONCLUSION This study elucidates how practises of care among people receiving OAT are enacted and disrupted during a Big Event, with implications beyond the COVID-19 pandemic for future Big Events. The study findings evidence the need for policies that mitigate the impact of Big Events such as supporting re-groupment within the counterpublic, legitimising counterpublic health strategies and stopping the criminalisation of people who use drugs.
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Affiliation(s)
- Anna Conway
- The Kirby InstituteUNSW SydneySydneyAustralia,Centre for Social Research in HealthUNSW SydneySydneyAustralia
| | - Carla Treloar
- Centre for Social Research in HealthUNSW SydneySydneyAustralia
| | | | | | - Alison D. Marshall
- The Kirby InstituteUNSW SydneySydneyAustralia,Centre for Social Research in HealthUNSW SydneySydneyAustralia
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21
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Kavanagh K, Tallian K, Sepulveda JA, Rojas S, Martin S, Sikand H. Do buprenorphine doses and ratios matter in medication assisted treatment adherence? Ment Health Clin 2022; 12:241-246. [PMID: 36071736 PMCID: PMC9405633 DOI: 10.9740/mhc.2022.08.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Buprenorphine (BUP), generally prescribed as buprenorphine/naloxone, is a key component of medication-assisted treatment (MAT) to manage opioid use disorder. Studies suggest higher doses of BUP increase treatment adherence. Routine urine drug screens (UDS) assist in monitoring MAT adherence via measurement of excreted BUP and its metabolite, norbuprenorphine (NBP). The clinical significance between BUP/NBP concentrations and their ratios for assessing adherence and substance use is not well-described. Methods We conducted a single-center, retrospective chart review of 195 clients age ≥18 years enrolled in a local MAT program from August 2017 to February 2021. Demographics, BUP doses, prescription history, and UDS results were collected. Participants were divided based on MAT adherence (<80% vs ≥80%) and median total daily dose (TDD) of BUP (≥16 mg vs <16 mg) in addition to pre- and post-COVID-19 cohorts. Results Median BUP/NBP urinary concentrations were significantly correlated with MAT adherence (P < .0001 for each) and a reduced percentage of positive UDS for opioids (P = .0004 and P < .0001, respectively) but not their ratios. Median TDD of BUP ≥16 mg (n = 126) vs <16 mg (n = 68) was not correlated with MAT adherence (P = .107) or incidence of nonprescription use (P = .117). A significantly higher incidence of UDS positive for opiates (P = .049) and alcohol (P = .035) was observed post-COVID-19. Discussion Clients appearing adherent to MAT who had higher concentrations of urinary BUP/NBP demonstrated a reduced incidence of opioid-positive UDS independent of the BUP dose prescribed. An increase in opioid- and alcohol-positive UDSs were observed during the COVID-19 pandemic.
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Affiliation(s)
- Kevin Kavanagh
- 1 Clinical Psychiatric Pharmacist, Health and human Services Agency Pharmacy, San Diego County Psychiatry Hospital, San Diego, California
| | | | - Joe A. Sepulveda
- 3 Chief of Psychiatry and Medical Director, Substance Use Disorder Services, Family Health Centers of San Diego, San Diego, California
| | - Sarah Rojas
- 4 Family Medicine Specialist, Family Health Centers of San Diego, San Diego, California
| | - Shedrick Martin
- 5 Clinical Pharmacist Specialist, Department of Pharmacy, Santa Rosa Memorial Hospital, Santa Rosa, California
| | - Harminder Sikand
- 6 Director of Clinical Services and Residency Programs, Department of Pharmacy, Scripps Mercy Hospital, San Diego, California
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22
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Harcey SR, Gauthier R, Markowski KL, Smith JA. Short Take: Collecting Data from a Vulnerable Population during the COVID-19 Pandemic. FIELD METHODS 2022; 34:265-271. [PMID: 37379443 PMCID: PMC8968433 DOI: 10.1177/1525822x221077398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Conducting field research with a vulnerable population is difficult under the most auspicious conditions, and these difficulties only increase during a pandemic. Here, we describe the practical challenges and ethical considerations surrounding a recent data collection effort with a high-risk population during the COVID-19 pandemic. We detail our strategies related to research design, site selection, and ethical review.
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Affiliation(s)
- Sela R. Harcey
- Department of Sociology, University of
Nebraska-Lincoln, Lincoln, NE, USA
- Military Workplace Climate
Research, Fors Marsh Group, Arlington, VA, USA
| | - Robin Gauthier
- Department of Sociology, University of
Nebraska-Lincoln, Lincoln, NE, USA
| | - Kelly L. Markowski
- Ohio Colleges of Medicine
Government Resource Center, The Ohio State University Wexner
Medical Center, Columbus, OH, USA
- Rural Drug Addiction Research
(RDAR) Center, University of
Nebraska-Lincoln, Lincoln, NE, USA
| | - Jeffrey A. Smith
- Department of Sociology, University of
Nebraska-Lincoln, Lincoln, NE, USA
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23
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Jenkins RA, Whitney BM, Nance RM, Allen TM, Cooper HLF, Feinberg J, Fredericksen R, Friedmann PD, Go VF, Jenkins WD, Korthuis PT, Miller WC, Pho MT, Rudolph AE, Seal DW, Smith GS, Stopka TJ, Westergaard RP, Young AM, Zule WA, Delaney JAC, Tsui JI, Crane HM. The Rural Opioid Initiative Consortium description: providing evidence to Understand the Fourth Wave of the Opioid Crisis. Addict Sci Clin Pract 2022; 17:38. [PMID: 35883197 PMCID: PMC9321271 DOI: 10.1186/s13722-022-00322-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To characterize and address the opioid crisis disproportionately impacting rural U.S. regions. METHODS The Rural Opioid Initiative (ROI) is a two-phase project to collect and harmonize quantitative and qualitative data and develop tailored interventions to address rural opioid use. The baseline quantitative survey data from people who use drugs (PWUD) characterizes the current opioid epidemic (2018-2020) in eight geographically diverse regions. RESULTS Among 3,084 PWUD, 92% reported ever injecting drugs, 86% reported using opioids (most often heroin) and 74% reported using methamphetamine to get high in the past 30 days; 53% experienced homelessness in the prior 6 months; and 49% had ever overdosed. Syringe service program use varied by region and 53% had ever received an overdose kit or naloxone prescription. Less than half (48%) ever received medication for opioid use disorder (MOUD). CONCLUSIONS The ROI combines data across eight rural regions to better understand drug use including drivers and potential interventions in rural areas with limited resources. Baseline ROI data demonstrate extensive overlap between opioid and methamphetamine use, high homelessness rates, inadequate access to MOUD, and other unmet needs among PWUD in the rural U.S. By combining data across studies, the ROI provides much greater statistical power to address research questions and better understand the syndemic of infectious diseases and drug use in rural settings including unmet treatment needs.
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Affiliation(s)
- Richard A. Jenkins
- Prevention Research Branch, National Institute on Drug Abuse, 3WFN MSC 6024, 301 North Stonestreet Ave, Bethesda, MD 20892 USA
| | - Bridget M. Whitney
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - Robin M. Nance
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - Todd M. Allen
- Ragon Institute of MGH, MIT and Harvard, Rm 764 400 Technology Square, Cambridge, MA 02139 USA
| | - Hannah L. F. Cooper
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building 1518 Clifton Road, Atlanta, GA 30322 USA
| | - Judith Feinberg
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505 USA
| | - Rob Fredericksen
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - Peter D. Friedmann
- Baystate Medical Center—University of Massachusetts, Office of Research, UMass Chan Medical School - Baystate, 3601 Main Street, 3rd Floor, Springfield, MA 01199 USA
| | - Vivian F. Go
- University of North Carolina—Chapel Hill, 363 Rosenau Hall CB# 7440, Chapel Hill, NC 27599 USA
| | - Wiley D. Jenkins
- Southern Illinois University, 201 E Madison Street, Springfield, IL 62702 USA
| | - P. Todd Korthuis
- Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR 97239 USA
| | - William C. Miller
- The Ohio State University, 302 Cunz Hall 1841 Neil Ave, Columbus, OH 43210 USA
| | - Mai T. Pho
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
| | - Abby E. Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA USA
| | - David W. Seal
- Tulane University, 1440 Canal Street, Suite 2210, New Orleans, LA 70112 USA
| | - Gordon S. Smith
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505 USA
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Ave. W, Winnipeg, MB R3E 0T5 Canada
| | - Thomas J. Stopka
- Tufts University School of Medicine Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Ryan P. Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI 53705-2281 USA
| | - April M. Young
- University of Kentucky, 760 Press Avenue Suite 280, Lexington, KY 40536 USA
| | - William A. Zule
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 2709-2194 USA
| | - Joseph A. C. Delaney
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Ave. W, Winnipeg, MB R3E 0T5 Canada
| | - Judith I. Tsui
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - Heidi M. Crane
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - the Rural Opioid Initiative
- Prevention Research Branch, National Institute on Drug Abuse, 3WFN MSC 6024, 301 North Stonestreet Ave, Bethesda, MD 20892 USA
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
- Ragon Institute of MGH, MIT and Harvard, Rm 764 400 Technology Square, Cambridge, MA 02139 USA
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building 1518 Clifton Road, Atlanta, GA 30322 USA
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505 USA
- Baystate Medical Center—University of Massachusetts, Office of Research, UMass Chan Medical School - Baystate, 3601 Main Street, 3rd Floor, Springfield, MA 01199 USA
- University of North Carolina—Chapel Hill, 363 Rosenau Hall CB# 7440, Chapel Hill, NC 27599 USA
- Southern Illinois University, 201 E Madison Street, Springfield, IL 62702 USA
- Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR 97239 USA
- The Ohio State University, 302 Cunz Hall 1841 Neil Ave, Columbus, OH 43210 USA
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA USA
- Tulane University, 1440 Canal Street, Suite 2210, New Orleans, LA 70112 USA
- Tufts University School of Medicine Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI 53705-2281 USA
- University of Kentucky, 760 Press Avenue Suite 280, Lexington, KY 40536 USA
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 2709-2194 USA
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Ave. W, Winnipeg, MB R3E 0T5 Canada
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24
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Textor L, Ventricelli D, Aronowitz SV. 'Red Flags' and 'Red Tape': Telehealth and pharmacy-level barriers to buprenorphine in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103703. [PMID: 35561484 PMCID: PMC10962060 DOI: 10.1016/j.drugpo.2022.103703] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Structural vulnerabilities for people who use drugs (PWUD) were exacerbated by the COVID-19 pandemic. In this context, federal lawmakers in the United States (U.S.) invoked an exemption to the 2008 Ryan Haight Act requiring in-person evaluation to prescribe buprenorphine for treatment of opioid use disorder (OUD), which allowed for the initiation and maintenance of buprenorphine via telehealth. Despite the potential for telehealth to address some of the geographic disparities in OUD treatment access, recent research has suggested that significant barriers to buprenorphine also exist at the pharmacy level. The purpose of this study was to qualitatively assess how efforts to increase access to buprenorphine via telehealth are implemented by prescribers and pharmacists and experienced by patients. METHODS Participant observation and semi-structured interviews focused on telehealth for OUD treatment and buprenorphine prescribing and dispensing were conducted with patients (n = 19), prescribers and clinic staff (n = 24), and pharmacists (n = 10) in Pennsylvania and California between May 2020 - May 2021. FINDINGS While participants stated that telehealth for OUD treatment was a welcome option, pharmacy-level barriers to buprenorphine persisted. Geographical distance from patient to provider or pharmacist continued to serve as "red flags" for pharmacists, leading to pharmacy-level "red tape:" gatekeeping measures including geographic restrictions, telephone prescription "confirmations," prescription cancellations and refusals. Patients' unmet expectations of buprenorphine access in some cases led to unanticipated risks including a return to injection drug use. CONCLUSION Challenges to increasing buprenorphine access persist in the U.S. even in settings where telehealth is implemented, and telehealth may inadvertently produce new barriers for some patients. Despite national support for policies aimed at increasing access to treatment for substance use disorders rather than punishment, policy shifts from punishment to treatment have not permeated evenly across all geographic areas and populations. Perceived threats of Drug Enforcement Administration (DEA) enforcement, and self-defensive institutional practices in pharmacies, reinforce ideologies of drug law enforcement, leading to poor patient outcomes including lack of buprenorphine access.
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Affiliation(s)
- Lauren Textor
- David Geffen School of Medicine and Department of Anthropology, University of California, Los Angeles, United States of America.
| | - Daniel Ventricelli
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, United States of America
| | - Shoshana V Aronowitz
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, United States of America
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25
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Eapen-John D, Mohiuddin AG, Kennedy JL. A potential paradigm shift in opioid crisis management: The role of pharmacogenomics. World J Biol Psychiatry 2022; 23:411-423. [PMID: 34854362 DOI: 10.1080/15622975.2021.2012397] [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: 10/19/2022]
Abstract
Pharmacogenetic investigations into the opioid crisis suggest genetic variation could be a significant cause of opioid-related morbidity and mortality. Variability in opioid system genes, including single nucleotide polymorphisms, manifest after pharmacogenetic testing, as previously invisible risk factors for addiction and overdose. Pharmacodynamic genes regulate opioid-sensitive brain networks and neural reward circuitry. Pharmacokinetic genes expressed in drug metabolic pathways regulate blood levels of active vs. inactive opioid metabolites. Elucidating the complex interplay of genetic variations in pharmacokinetic and pharmacodynamic pathways will shed new light on the addictive and toxic properties of opioids. This narrative review serves to promote understanding of key genetic mechanisms affecting the metabolism and actions of opioids, and to explore causes of the recent surge in opioid-related mortality associated with COVID-19. Personalised treatment plans centred around an individual's genetic makeup could make opioid-based pain management and opioid use disorder (OUD) treatments safer and more effective at both the individual and system levels.
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Affiliation(s)
- David Eapen-John
- Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ayeshah G Mohiuddin
- Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James L Kennedy
- Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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26
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Abstract
In recent decades, the United States has seen a substantial increase in the number of people diagnosed with substance use disorder (SUD). Both SUDs and COVID-19 separately have had, and continue to have, a widespread impact on our society. While they are two distinct entities, they are intricately related and have been shown to influence one another. Lockdown mandates intended to enhance public safety produced unintended consequences for people with SUDs by decreasing access to treatment and disrupting their current care. Telehealth could offer a solution to this disruption as its utilization expands the provider’s reach and increases access to treatment in underserved populations, including those with SUDs. The use of telemedicine seems to result in higher rates of patient satisfaction, compliance, and treatment retention rates while maintaining the need for social distancing. Even when pandemic restrictions resolve, telehealth can continue to provide invaluable benefits to individuals with addiction, particularly those in rural America. In summary, ongoing research regarding telehealth delivery and the expansion of telehealth is a byproduct of the pandemic and can advance the American healthcare system beyond the days of COVID-19. This manuscript will review studies regarding the use of telehealth in SUD with the hope that further research within and beyond the COVID-19 pandemic will lead to the increased use of telehealth by those involved in and those receiving care for SUDs.
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27
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Walters SM, Bolinski RS, Almirol E, Grundy S, Fletcher S, Schneider J, Friedman SR, Ouellet LJ, Ompad DC, Jenkins W, Pho MT. Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis. Addict Sci Clin Pract 2022; 17:24. [PMID: 35468860 PMCID: PMC9037978 DOI: 10.1186/s13722-022-00303-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Drug overdose rates in the United States have been steadily increasing, particularly in rural areas. The COVID-19 pandemic and associated mitigation strategies may have increased overdose risk for people who use drugs by impacting social, community, and structural factors. METHODS The study included a quantitative survey focused on COVID-19 administered to 50 people who use drugs and semi-structured qualitative interviews with 17 people who use drugs, 12 of whom also participated in the quantitative survey. Descriptive statistics were run for the quantitative data. Qualitative coding was line-by-line then grouped thematically. Quantitative and qualitative data were integrated during analysis. RESULTS Findings demonstrate how COVID-19 disruptions at the structural and community level affected outcomes related to mental health and drug use at the individual level. Themes that emerged from the qualitative interviews were (1) lack of employment opportunities, (2) food and housing insecurity, (3) community stigma impacting health service use, (4) mental health strains, and (5) drug market disruptions. Structural and community changes increased anxiety, depression, and loneliness on the individual level, as well as changes in drug use patterns, all of which are likely to increase overdose risk. CONCLUSION The COVID-19 pandemic, and mitigation strategies aimed at curbing infection, disrupted communities and lives of people who use drugs. These disruptions altered individual drug use and mental health outcomes, which could increase risk for overdose. We recommend addressing structural and community factors, including developing multi-level interventions, to combat overdose. Trial registration Clinicaltrails.gov: NCT04427202. Registered June 11, 2020: https://clinicaltrials.gov/ct2/show/NCT04427202?term=pho+mai&draw=2&rank=3.
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Affiliation(s)
- Suzan M Walters
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA.
- Center for Drug Use and HIV/HCV Research, New York, NY, USA.
| | - Rebecca S Bolinski
- Department of Sociology, Southern Illinois University, Carbondale, IL, USA
| | - Ellen Almirol
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Stacy Grundy
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, USA
| | | | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Samuel R Friedman
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Lawrence J Ouellet
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Danielle C Ompad
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Wiley Jenkins
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, USA
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, USA
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28
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Jenkins WD, Rose J, Molina Y, Lee M, Bolinski R, Luckey G, Van Ham B. Cancer Screening among Rural People Who Use Drugs: Colliding Risks and Barriers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084555. [PMID: 35457423 PMCID: PMC9026855 DOI: 10.3390/ijerph19084555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/27/2023]
Abstract
Rural cancer disparities are associated with lesser healthcare access and screening adherence. The opioid epidemic may increase disparities as people who use drugs (PWUD) frequently experience healthcare-associated stigmatizing experiences which discourage seeking routine care. Rural PWUD were recruited to complete surveys and interviews exploring cancer (cervical, breast, colorectal, lung) risk, screening history, and healthcare experiences. From July 2020–July 2021 we collected 37 surveys and 8 interviews. Participants were 24.3% male, 86.5% White race, and had a mean age of 44.8 years. Females were less likely to report seeing a primary care provider on a regular basis, and more likely to report stigmatizing healthcare experiences. A majority of females reporting receiving recommendations and screens for cervical and breast cancer, but only a minority were adherent. Similarly, only a minority of males and females reported receiving screening tests for colorectal and lung cancer. Screening rates for all cancers were substantially below those for the US generally and rural areas specifically. Interviews confirmed stigmatizing healthcare experiences and suggested screening barriers and possible solutions. The opioid epidemic involves millions of individuals and is disproportionately experienced in rural communities. To avoid exacerbating existing rural cancer disparities, methods to engage PWUD in cancer screening need to be developed.
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Affiliation(s)
- Wiley D. Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL 62794, USA;
- Correspondence:
| | - Jennifer Rose
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA; (J.R.); (G.L.)
| | - Yamile Molina
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA;
| | - Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL 62794, USA;
- Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL 62702, USA
| | - Rebecca Bolinski
- Department of Sociology, Southern Illinois University, Carbondale, IL 62901, USA;
| | - Georgia Luckey
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA; (J.R.); (G.L.)
| | - Brent Van Ham
- Center for Rural Health and Social Services Development, Southern Illinois University, Carbondale, IL 62901, USA;
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29
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Walters SM, Frank D, Van Ham B, Jaiswal J, Muncan B, Earnshaw V, Schneider J, Friedman SR, Ompad DC. PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure. AIDS Behav 2022; 26:1308-1320. [PMID: 34626265 PMCID: PMC8501360 DOI: 10.1007/s10461-021-03488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.
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30
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Watson DP, Staton MD, Grella CE, Scott CK, Dennis ML. Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic. Subst Abuse Treat Prev Policy 2022; 17:22. [PMID: 35303913 PMCID: PMC8931576 DOI: 10.1186/s13011-022-00449-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.
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Affiliation(s)
- Dennis P. Watson
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Monte D. Staton
- grid.185648.60000 0001 2175 0319Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL 60613 USA
| | - Christine E. Grella
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Christy K. Scott
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Michael L. Dennis
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761 USA
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31
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Bolinski RS, Walters S, Salisbury-Afshar E, Ouellet LJ, Jenkins WD, Almirol E, Van Ham B, Fletcher S, Johnson C, Schneider JA, Ompad D, Pho MT. The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2230. [PMID: 35206421 PMCID: PMC8872091 DOI: 10.3390/ijerph19042230] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. METHODS We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. RESULTS Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated "beans" and "buttons". Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. CONCLUSIONS The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.
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Affiliation(s)
- Rebecca S. Bolinski
- Department of Sociology, Southern Illinois University, 475 Clocktower Drive, Room 323A, Carbondale, IL 62901, USA
| | - Suzan Walters
- Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY 10003, USA; (S.W.); (D.O.)
| | - Elizabeth Salisbury-Afshar
- Department of Family Medicine and Community Health, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA;
| | - Lawrence J. Ouellet
- Division of Epidemiology and Biostatistics/COIP (MC 923), School of Public Health, University of Illinois Chicago, 1603 W. Taylor, Chicago, IL 60607, USA;
| | - Wiley D. Jenkins
- Epidemiology and Biostatistics, Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL 62794, USA;
| | - Ellen Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA;
| | - Brent Van Ham
- Center for Rural Health and Social Service Development, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA;
| | - Scott Fletcher
- The Community Action Place, Inc., 1400 N. Wood Road Suite 7, Murphysboro, IL 62966, USA;
| | - Christian Johnson
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA; (C.J.); (J.A.S.); (M.T.P.)
| | - John A. Schneider
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA; (C.J.); (J.A.S.); (M.T.P.)
| | - Danielle Ompad
- Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY 10003, USA; (S.W.); (D.O.)
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Mai T. Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA; (C.J.); (J.A.S.); (M.T.P.)
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Roux P, Donadille C, Girard G, Spire B, Protière C, Velter A. Impact of COVID-19 Pandemic on Men Who Have Sex With Men That Practice Chemsex in France: Results From the National ERAS Web Survey. Am J Mens Health 2022; 16:15579883211073225. [PMID: 35156425 PMCID: PMC8848067 DOI: 10.1177/15579883211073225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chemsex-the use of drugs in a sexual context-has been associated with more at-risk sexual practices and substance-related complications in men who have sex with men (MSM). To date, no study has focused on the impact of France's first coronavirus disease 2019 (COVID-19)-related lockdown on the mental health and drug/alcohol use of MSM who practice chemsex. We implemented a web-based survey of 9,488 MSM living in France in June 2020 (after the country's first COVID-19 lockdown). Specifically, we first compared the subpopulation of MSM who self-reported practicing chemsex during their most recent sexual intercourse (defined as "chemsexers") with other MSM, using five outcomes: increased 1/tobacco use, 2/alcohol use, and 3/other psychoactive drug use. 4/using psychotropic medication during the lockdown, and finally 5/psychological distress. We then analyzed the outcomes' associations with the main explanatory variable "chemsexer," after adjusting for all relevant variables. Among 7,195 MSM who had sexual intercourse with a man during the previous 6 months, 359 participants (5%) were identified as "chemsexers." Multivariable analyses showed that during the first lockdown period, chemsexers were significantly more likely than non-chemsexers to have increased their use of tobacco, alcohol, and other psychoactive substances. Chemsexers were also more likely to have used psychotropic medication and to have experienced psychological distress during the previous month. Given the ongoing COVID-19 pandemic in France and worldwide, this finding highlights the need to develop psychosocial interventions and harm reduction services for MSM chemsexers, potentially via mobile health.
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Affiliation(s)
- Perrine Roux
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Cécile Donadille
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Gabriel Girard
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Bruno Spire
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Christel Protière
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
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Delisle-Reda S, Bruneau J, Martel-Laferrière V. Telehealth for people who inject drugs: An acceptable method of treatment but challenging to access. J Addict Dis 2022; 40:514-517. [PMID: 35133229 DOI: 10.1080/10550887.2022.2035166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND While telemedicine is seen as an emerging practice that will outlast the COVID-19 pandemic, it can reduce health services for those with limited internet and technological devices access or sufficient literacy. OBJECTIVE(S) The aim of this study was to explore the feasibility of using telehealth with people who inject drugs (PWID). METHODS A survey on availability and accessibility of different methods of communication was administered to a sample of PWID from an ongoing longitudinal cohort in Montréal, Canada. RESULTS Among the 96 respondents, phone calls were generally considered acceptable (89.6%) although availability was low (50%). Acceptability and availability of social media were 26% and 41.7%, respectively. Internet-based communication applications were considered acceptable to use for telehealth in 28.1% of participants, even if not frequently available (8.3%). CONCLUSIONS Telehealth is an acceptable form of treatment for PWID, but may be challenging due to low availability of phone or internet access.
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Affiliation(s)
| | - Julie Bruneau
- Université de Montréal, Montréal, Québec, Canada.,Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Valérie Martel-Laferrière
- Université de Montréal, Montréal, Québec, Canada.,Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Walters SM, Perlman DC, Guarino H, Mateu-Gelabert P, Frank D. Lessons from the First Wave of COVID-19 for Improved Medications for Opioid Use Disorder (MOUD) Treatment: Benefits of Easier Access, Extended Take Homes, and New Delivery Modalities. Subst Use Misuse 2022; 57:1144-1153. [PMID: 35443862 PMCID: PMC9709780 DOI: 10.1080/10826084.2022.2064509] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Medications for Opioid Use Disorder (MOUD) are associated with important public health benefits. Program changes implemented in response to COVID-19 hold promise as ongoing strategies to improve MOUD treatment. Methods: MOUD patients on buprenorphine or methadone, providers, government regulators, and persons who use drugs not in MOUD were recruited in the Northeast region of the United States between June and October of 2020 via advertisements, fliers, and word of mouth. Semi-structured qualitative interviews were conducted. Interviews were professionally transcribed and thematically coded by two independent coders. Results: We conducted interviews with 13 people currently on buprenorphine, 11 currently on methadone, 3 previously on buprenorphine, 4 previously on methadone, and 6 who used drugs but had never been on MOUD. In addition, we interviewed MOUD providers, clinic staff, and government officials at agencies that regulate MOUD. Most participants found increased take-home doses, home medication delivery, and telehealth implemented during COVID-19 to be favorable, reporting that these program changes reduced travel time to clinics, facilitated retention in care, and reduced stigma associated with clinic attendance. However, some participants reported negative consequences of COVID-19, most notably, decreased access to basic resources, such as food, clothing, and harm reduction materials that had previously been distributed at some MOUD clinics. Conclusion: Access to and retention in MOUD can be lifesaving for persons using drugs. COVID-19-impelled program changes, including increased take-home doses, home medication delivery, and telehealth generally improved participants' experiences with MOUD. Making these permanent could improve retention in care.
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Affiliation(s)
- Suzan M Walters
- School of Global Public Health, New York University, New York, New York, USA.,Center for Drug Use and HIV/HCV Research, NYU School of Global Public Health, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV/HCV Research, NYU School of Global Public Health, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Honoria Guarino
- Center for Drug Use and HIV/HCV Research, NYU School of Global Public Health, New York, New York, USA.,Graduate School of Public Health & Health Policy, City University of New York, New York, New York, USA
| | - Pedro Mateu-Gelabert
- Center for Drug Use and HIV/HCV Research, NYU School of Global Public Health, New York, New York, USA.,Graduate School of Public Health & Health Policy, City University of New York, New York, New York, USA
| | - David Frank
- School of Global Public Health, New York University, New York, New York, USA.,Center for Drug Use and HIV/HCV Research, NYU School of Global Public Health, New York, New York, USA
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Friedman SR, Williams LD, Guarino H, Mateu-Gelabert P, Krawczyk N, Hamilton L, Walters SM, Ezell JM, Khan M, Di Iorio J, Yang LH, Earnshaw VA. The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:385-408. [PMID: 34115390 PMCID: PMC8664901 DOI: 10.1002/jcop.22581] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 05/26/2023]
Abstract
Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the "stigma system" as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.
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Affiliation(s)
- Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Leslie D Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Pedro Mateu-Gelabert
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Noa Krawczyk
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Leah Hamilton
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Suzan M Walters
- NYU Rory Meyers College of Nursing, Interdisciplinary Research Training Institute on Hispanic Drug Abuse, University of Southern California, Los Angeles, California, USA
| | - Jerel M Ezell
- Department of Sociology, University of Chicago, Chicago, Illinois, USA
- Department of Medicine, Section on Global Health and Infectious Diseases, University of Chicago, Chicago, Illinois, USA
| | - Maria Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jorgelina Di Iorio
- Faculty of Psychology and Intercambios Civil Association, CONICET/Buenos Aires University, Buenos Aires, Argentina
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
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Sun T, Aroke H, Kogut S, Katenka N, Bratberg J, Buchanan A. Early buprenorphine-naloxone initiation for opioid use disorder reduces opioid overdose, emergency room visits and healthcare cost compare to late initiation. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 48:217-225. [PMID: 34780312 DOI: 10.1080/00952990.2021.1981358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although the effectiveness of buprenorphine-naloxone (BUP-NX) has been established, real-world evidence on the benefits of early treatment initiation is limited. OBJECTIVE To evaluate the association between early BUP-NX initiation and health-related outcomes among insured adults with opioid use disorder (OUD). METHODS We conducted a cross-sectional analysis using the Optum's de-identified Clinformatics® Data Mart Database from 2010 to 2018. Patients who initiated BUP-NX within 30 days of OUD diagnosis were classified as early initiators. Patients who initiated BUP-NX later, but within the one-year follow-up, were defined as late initiators. Outcomes included opioid overdose, opioid overdose-related emergency department (ED) visits, and all-cause healthcare cost during the year after OUD diagnosis. We employed generalized linear models to compare outcomes between early and late initiators, adjusting for baseline covariates and accounting for missing information for covariates using multiple imputation. RESULTS A total of 8,388 patients with OUD were identified; mean age was 39.9 years; 36% were female; and 67.6% were early initiators. Early initiators had an estimated 42% lower rate of opioid overdose (adjusted rate ratio (aRR) = 0.58; 95% confidence interval (CI): 0.52, 0.64); 51% lower rate of opioid overdose-related ED visits (aRR = 0.49; 95% CI: 0.44, 0.55); and 31% lower total healthcare cost (adjusted cost ratio = 0.69; 95% CI: 0.66, 0.72), compared to late initiators. CONCLUSION Compared to late BUP-NX initiation, early initiation was associated with a lower risk of opioid overdose and opioid overdose-related ED visits, and reduced total healthcare cost among insured adult patients with OUD.
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Affiliation(s)
- Tianyu Sun
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Hilary Aroke
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Stephen Kogut
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Natallia Katenka
- Department of Computer Science and Statistics, College of Art and Science, University of Rhode Island, Kingston, Rhode Island, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Ashley Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
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Cerdá M, Jalali MS, Hamilton AD, DiGennaro C, Hyder A, Santaella-Tenorio J, Kaur N, Wang C, Keyes KM. A Systematic Review of Simulation Models to Track and Address the Opioid Crisis. Epidemiol Rev 2021; 43:147-165. [PMID: 34791110 DOI: 10.1093/epirev/mxab013] [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] [Received: 11/16/2020] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 01/04/2023] Open
Abstract
The opioid overdose crisis is driven by an intersecting set of social, structural, and economic forces. Simulation models offer a tool to help us understand and address this complex, dynamic, and nonlinear social phenomenon. We conducted a systematic review of the literature on simulation models of opioid use and overdose up to September 2019. We extracted modeling types, target populations, interventions, and findings. Further, we created a database of model parameters used for model calibration, and evaluated study transparency and reproducibility. Of the 1,398 articles screened, we identified 88 eligible articles. The most frequent types of models were compartmental (36%), Markov (20%), system dynamics (16%), and Agent-Based models (16%). Over a third evaluated intervention cost-effectiveness (40%), and another third (39%) focused on treatment and harm reduction services for people with opioid use disorder (OUD). More than half (61%) discussed calibrating their models to empirical data, and 31% discussed validation approaches used in their modeling process. From the 63 studies that provided model parameters, we extracted the data sources on opioid use, OUD, OUD treatment, cessation/relapse, emergency medical services, and mortality parameters. This database offers a tool that future modelers can use to identify potential model inputs and evaluate comparability of their models to prior work. Future applications of simulation models to this field should actively tackle key methodological challenges, including the potential for bias in the choice of parameter inputs, investment in model calibration and validation, and transparency in the assumptions and mechanics of simulation models to facilitate reproducibility.
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Affiliation(s)
- Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | | | - Ava D Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Ayaz Hyder
- Division of Environmental Health Sciences, College of Public Health, and Translational Data Analytics Institute, The Ohio State University, Columbus, Ohio
| | - Julian Santaella-Tenorio
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Navdep Kaur
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Christina Wang
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Dennelly L, Sousa C, Roberts K. Shaping the Future of Social Work Practice in Healthcare: Addressing COVID-19 Needs through Integrated Primary Care. SOCIAL WORK 2021; 67:swab046. [PMID: 34791472 DOI: 10.1093/sw/swab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/01/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
COVID-19 has illustrated the urgency of promoting integrated healthcare as the model of the future, with social workers not only supporting the physical and mental health of providers and patients, but also leading efforts to transform systems, policies, and social work education. Primary care, where the role of social workers is continuing to grow, is a central location for integrating the treatment of medical, social, and behavioral problems. In these settings, social workers can take the lead to meet community needs, assist in public health efforts, and bolster the frontline medical workforce. The following article reflects upon what we as social workers have learned a year into the global pandemic and how we can apply this knowledge to shaping the future of social work in primary care. Authors consider how the multiple medical and psychosocial needs of patients affected by COVID-19 are addressed in primary care through three core functions of social work: providing behavioral healthcare, coordinating care, and undertaking population health-based interventions. Article ends with a discussion about how social work can respond to the urgent task of transforming health within the context of social work practice, policy, and education for the next generation of healthcare social workers.
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Schneider JA, Taylor BG, Hotton AL, Lamuda PA, Ozik J, Lin Q, Flanagan E, Tuyet Pho M, Kolak M, Brewer R, Pagkas-Bather J, Pollack HA. National variability in Americans' COVID-19 protective behaviors: Implications for vaccine roll-out. PLoS One 2021; 16:e0259257. [PMID: 34739498 PMCID: PMC8570526 DOI: 10.1371/journal.pone.0259257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022] Open
Abstract
Protective behaviors such as mask wearing and physical distancing are critical to slow the spread of COVID-19, even in the context of vaccine scale-up. Understanding the variation in self-reported COVID-19 protective behaviors is critical to developing public health messaging. The purpose of the study is to provide nationally representative estimates of five self-reported COVID-19 protective behaviors and correlates of such behaviors. In this cross-sectional survey study of US adults, surveys were administered via internet and telephone. Adults were surveyed from April 30-May 4, 2020, a time of peaking COVID-19 incidence within the US. Participants were recruited from the probability-based AmeriSpeak® national panel. Brief surveys were completed by 994 adults, with 73.0% of respondents reported mask wearing, 82.7% reported physical distancing, 75.1% reported crowd avoidance, 89.8% reported increased hand-washing, and 7.7% reported having prior COVID-19 testing. Multivariate analysis (p critical value .05) indicates that women were more likely to report protective behaviors than men, as were those over age 60. Respondents who self-identified as having low incomes, histories of criminal justice involvement, and Republican Party affiliation, were less likely to report four protective behaviors, though Republicans and individuals with criminal justice histories were more likely to report having received COVID-19 testing. The majority of Americans engaged in COVID-19 protective behaviors, with low-income Americans, those with histories of criminal justice involvement, and self-identified Republicans less likely to engage in these preventive behaviors. Culturally competent public health messaging and interventions might focus on these latter groups to prevent future infections. These findings will remain highly relevant even with vaccines widely available, given the complementarities between vaccines and protective behaviors, as well as the many challenges in delivering vaccines.
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Affiliation(s)
- John A Schneider
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | | | - Anna L Hotton
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | | | - Jonathan Ozik
- Argonne National Laboratory, Chicago, Illinois, United States of America
| | - Qinyun Lin
- Center for Spatial Data Science, University of Chicago, Chicago, Illinois, United States of America
| | - Elizabeth Flanagan
- Argonne National Laboratory, Chicago, Illinois, United States of America
| | - Mai Tuyet Pho
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, Chicago, Illinois, United States of America
| | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Jade Pagkas-Bather
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, Illinois, United States of America
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Ellis MS, Kasper ZA, Cicero TJ. Polysubstance use trends and variability among individuals with opioid use disorder in rural versus urban settings. Prev Med 2021; 152:106729. [PMID: 34293380 DOI: 10.1016/j.ypmed.2021.106729] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 01/20/2023]
Abstract
Rural areas of the United States have been disproportionately impacted by the opioid epidemic, exacerbated by COVID-19-related economic upheavals. While polysubstance use is an important determinant of overdose risk, variability in polysubstance use as a result of numerous factors (e.g., access, preference) has yet to be described, particularly among rural persons with opioid use disorder (PWOUD). Survey data on past-month use of prescription and illicit opioids and 12 non-opioid psychoactive drug classes were analyzed from a national sample of rural (n = 3872) and urban (n = 8153) residents entering treatment for OUD from 2012 to 2019. Trend analyses for opioid and stimulant use were compared between rural and urban PWOUD. Latent class analyses assessed substance use trends through identified typologies of rural/urban PWOUD, which then underwent comparative analyses. By 2019, prescription opioid use remained greater in rural versus urban PWOUD, and methamphetamine use showed greater growth in rural, compared to urban areas. Latent class analyses identified variability in polysubstance use, with five identical subgroups in rural/urban PWOD: high polysubstance, polyprescription, prescription opioid-focused, prescription opioid-focused with polysubstance use, and illicit opioid-focused. Polyprescription was highest in rural areas, with illicit opioid-focused use highest in urban areas. Demographic characteristics, co-morbid conditions and healthcare coverage were all associated with between-group differences. There is significant variability in polysubstance use that may identify specific prevention and treatment needs for subpopulations of OUD patients: interventions focused on reducing opioid prescriptions, early engagement with mental health resources, wider distribution of naloxone, and screening/treatment plans that take into account the use of multiple substances.
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Affiliation(s)
- Matthew S Ellis
- Washington University in St. Louis School of Medicine, Department of Psychiatry, Campus Box 8134, 660 S. Euclid Avenue, St. Louis, MO 63110, United States.
| | - Zachary A Kasper
- Washington University in St. Louis School of Medicine, Department of Psychiatry, Campus Box 8134, 660 S. Euclid Avenue, St. Louis, MO 63110, United States
| | - Theodore J Cicero
- Washington University in St. Louis School of Medicine, Department of Psychiatry, Campus Box 8134, 660 S. Euclid Avenue, St. Louis, MO 63110, United States
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Lung Disease in Central Appalachia: It's More than Coal Dust that Drives Disparities. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:477-486. [PMID: 34602885 PMCID: PMC8461577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The population living in Central Appalachia is disproportionately impacted by lung disease. This is driven, in part, by occupational hazards and environmental exposures. However, it is more than coal dust that is driving the ongoing disparity of lung disease in the region. This review describes how the decline of the coal mine industry and subsequent rise of unemployment, poverty, and educational disparities have increased risk for worse pulmonary health outcomes in the region. Additional challenges related to healthcare access, substance use, cultural characteristics, and social capital are highlighted in their relation to pulmonary health within Central Appalachia. Lastly, the review describes strategies that hold promise to reduce regional health disparities. Several healthcare and community-centered initiatives are highlighted as successful examples of collaborative efforts working towards improving pulmonary health outcomes in the region. However, significant challenges related to social, economic, and environmental factors remain. Addressing these social determinants of health must be a paramount concern for healthcare, community and political leaders seeking to impact change and improve the health and well-being of this vulnerable population.
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Mumba MN, Jaiswal J, Langner-Smith N, Mugoya GT, Brown W, Davis LL. COVID-19 and opioid use disorder: Expanding treatment access in rural settings. Nursing 2021; 51:44-47. [PMID: 34633996 DOI: 10.1097/01.nurse.0000798204.89531.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Substance use treatment inequities among rural populations are well documented and the COVID-19 pandemic has exacerbated these inequalities, forcing healthcare providers to be creative in the delivery of treatment. Systematic reviews on the use of telehealth to treat patients with substance use disorder indicate that it is a promising alternative to in-person services. This article examines the evidence supporting the use of telehealth in treating patients with opioid use disorder and explores other promising options that can help overcome pandemic-related barriers to treatment.
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Affiliation(s)
- Mercy Ngosa Mumba
- Mercy Ngosa Mumba is an associate professor at the University of Alabama Capstone College of Nursing in Tuscaloosa, Ala. Also at the University of Alabama in Tuscaloosa, Jessica Jaiswal is an assistant professor, Natalia Langner-Smith is a graduate research assistant, George Mugoya is an associate professor, and Whitnee Brown is a clinical instructor. Lori Davis is the associate chief of staff for research at the Tuscaloosa VA Medical Center
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Abstract
The United States is experiencing an evolving and worsening drug overdose epidemic. Although the rate of drug use among workers has remained relatively stable, the risk of overdose and death among drug users has not, as illicit drugs have increased in potency and lethality. The cumulative impacts of COVID-19 and the opioid crisis increase the likelihood of illness and death among workers with opioid use disorder. Workplaces represent a critical point of contact for people living in the United States who are struggling with or recovering from a substance use disorder, and employment is a vital source of recovery "capital." The benefits of addressing substance use in the workplace, supporting treatment, and employing workers in recovery are evident. The National Institute for Occupational Safety and Health has published research to inform policy and practice toward prevention efforts and has developed accessible resources and toolkits to support workers, employers, and workplaces in combatting the opioid overdose crisis and creating safer, healthier communities.
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Affiliation(s)
- Jamie C Osborne
- National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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Henderson R, McInnes A, Mackey L, Bruised Head M, Crowshoe L, Hann J, Hayward J, Holroyd BR, Lang E, Larson B, Leonard AJ, Persaud S, Raghavji K, Sarin C, Virani H, Wadsworth IW, Whitman S, McLane P. Opioid use disorder treatment disruptions during the early COVID-19 pandemic and other emergent disasters: a scoping review addressing dual public health emergencies. BMC Public Health 2021; 21:1471. [PMID: 34320954 PMCID: PMC8318046 DOI: 10.1186/s12889-021-11495-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background During public health emergencies, people with opioid use disorder (PWOUD) may be particularly impacted. Emergent disasters such as the COVID-19 pandemic disrupt already-strained harm reduction efforts and treatment availability. This study aims to answer three research questions. How do public health emergencies impact PWOUD? How can health systems respond to novel public health emergencies to serve PWOUD? How can the results of this scoping review be contextualized to the province of Alberta to inform local stakeholder responses to the pandemic? Methods We conducted a scoping review using the 6-stage Arksey and O’Malley framework to analyse early-pandemic and pre-pandemic disaster literature. The results of the scoping review were contextualized to the local pandemic response, through a Nominal Group Technique (NGT) process with frontline providers and stakeholders in Alberta, Canada. Results Sixty one scientific journal articles and 72 grey literature resources were included after full-text screening. Forty sources pertained to early COVID-19 responses, and 21 focused on OUD treatment during other disasters. PWOUD may be more impacted than the general population by common COVID-19 stressors including loss of income, isolation, lack of rewarding activities, housing instability, as well as fear and anxiety. They may also face unique challenges including threats to drug supplies, stigma, difficulty accessing clean substance use supplies, and closure of substance use treatment centres. All of these impacts put PWOUD at risk of negative outcomes including fatal overdose. Two NGT groups were held. One group (n = 7) represented voices from urban services, and the other (n = 4) Indigenous contexts. Stakeholders suggested that simultaneous attention to multiple crises, with adequate resources to allow attention to both social and health systems issues, can prepare a system to serve PWOUD during disasters. Conclusion This scoping review and NGT study uncovers how disasters impact PWOUD and offers suggestions for better serving PWOUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11495-0.
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Affiliation(s)
- Rita Henderson
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Ashley McInnes
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Leslee Mackey
- Department of Emergency Medicine, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | | | - Lindsay Crowshoe
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Jessica Hann
- Department of Emergency Medicine, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada.,Addiction Recovery and Community Health (ARCH) Team, Royal Alexandra Hospital, 10240 Kingsway NW, Edmonton, AB, T5H 3V9, Canada
| | - Jake Hayward
- Department of Emergency Medicine, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Brian R Holroyd
- Department of Emergency Medicine, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada.,Emergency Strategic Clinical Network, Alberta Health Services, 10030 - 107 St NW, Edmonton, AB, T5J 3E4, Canada
| | - Eddy Lang
- Emergency Strategic Clinical Network, Alberta Health Services, 10030 - 107 St NW, Edmonton, AB, T5J 3E4, Canada.,Department of Emergency Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Bonnie Larson
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Ashley Jane Leonard
- Knowledge Resource Service, Alberta Health Services, 10030 - 107 St NW, Edmonton, AB, T5J 3E4, Canada
| | - Steven Persaud
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Khalil Raghavji
- Metro City Medical Clinic, 150 - 909 5 Ave SW, Calgary, AB, T2P 3G5, Canada
| | - Chris Sarin
- Indigenous Services Canada, Suite 730, 9700 Jasper Avenue, Edmonton, AB, T5J 4C3, Canada.,Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Hakique Virani
- Metro City Medical Clinic, 150 - 909 5 Ave SW, Calgary, AB, T2P 3G5, Canada.,Department of Medicine, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Iskotoahka William Wadsworth
- Blood Tribe, Stand Off, Canada.,Treaty 7 Chiefs Alliance, 206 - 8408 Elbow Drive SW, Calgary, Alberta, T2V 1K7, Canada
| | - Stacey Whitman
- Addiction and Mental Health, Alberta Health Services, 10030 - 107 St NW, Edmonton, AB, T5J 3E4, Canada
| | - Patrick McLane
- Department of Emergency Medicine, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada.,Emergency Strategic Clinical Network, Alberta Health Services, 10030 - 107 St NW, Edmonton, AB, T5J 3E4, Canada
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Holtz L. Creating a pronation therapy team: One hospital's journey. Nursing 2021; 51:58-61. [PMID: 34157004 DOI: 10.1097/01.nurse.0000753988.30717.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Prone positioning is a recommended therapy for patients with COVID-19 who develop acute respiratory distress syndrome. This article describes the creation, operation, and evolution of the pronation therapy team at the author's Veterans Affairs facility.
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Affiliation(s)
- Louella Holtz
- Louella Holtz is a nurse educator at Veterans Affairs New Jersey Health Care System in East Orange, N.J
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46
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Qeadan F, Mensah NA, Tingey B, Bern R, Rees T, Madden EF, Porucznik CA, English K, Honda T. The association between opioids, environmental, demographic, and socioeconomic indicators and COVID-19 mortality rates in the United States: an ecological study at the county level. ACTA ACUST UNITED AC 2021; 79:101. [PMID: 34130741 PMCID: PMC8204068 DOI: 10.1186/s13690-021-00626-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/01/2021] [Indexed: 01/08/2023]
Abstract
Background The spread of the COVID-19 pandemic throughout the world presents an unprecedented challenge to public health inequities. People who use opioids may be a vulnerable group disproportionately impacted by the current pandemic, however, the limited prior research in this area makes it unclear whether COVID-19 and opioid use outcomes may be related, and whether other environmental and socioeconomic factors might play a role in explaining COVID-19 mortality. The objective of this study is to evaluate the association between opioid-related mortality and COVID-19 mortality across U.S. counties. Methods Data from 3142 counties across the U.S. were used to model the cumulative count of deaths due to COVID-19 up to June 2, 2020. A multivariable negative-binomial regression model was employed to evaluate the adjusted COVID-19 mortality rate ratios (aMRR). Results After controlling for covariates, counties with higher rates of opioid-related mortality per 100,000 persons were found to be significantly associated with higher rates of COVID-19 mortality (aMRR: 1.0134; 95% CI [1.0054, 1.0214]; P = 0.001). Counties with higher average daily Particulate Matter (PM2.5) exposure also saw significantly higher rates of COVID-19 mortality. Analyses revealed rural counties, counties with higher percentages of non-Hispanic whites, and counties with increased average maximum temperatures are significantly associated with lower mortality rates from COVID-19. Conclusions This study indicates need for public health efforts in hard hit COVID-19 regions to also focus prevention efforts on overdose risk among people who use opioids. Future studies using individual-level data are needed to allow for detailed inferences.
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Affiliation(s)
- Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Nana Akofua Mensah
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Benjamin Tingey
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Rona Bern
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Tracy Rees
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Erin Fanning Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA
| | - Christina A Porucznik
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | - Trenton Honda
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
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Cerdá M, Krawczyk N, Hamilton L, Rudolph KE, Friedman SR, Keyes KM. A Critical Review of the Social and Behavioral Contributions to the Overdose Epidemic. Annu Rev Public Health 2021; 42:95-114. [PMID: 33256535 PMCID: PMC8675278 DOI: 10.1146/annurev-publhealth-090419-102727] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
More than 750,000 people in the United States died from an overdose between 1999 and 2018; two-thirds of those deaths involved an opioid. In this review, we present trends in opioid overdose rates during this period and discuss how the proliferation of opioid prescribing to treat chronic pain, changes in the heroin and illegally manufactured opioid synthetics markets, and social factors, including deindustrialization and concentrated poverty, contributed to the rise of the overdose epidemic. We also examine how current policies implemented to address the overdose epidemic may have contributed to reducing prescription opioid overdoses but increased overdoses involving illegal opioids. Finally, we identify new directions for research to understand the causes and solutions to this critical public health problem, including research on heterogeneous policy effects across social groups, effective approaches to reduce overdoses of illegal opioids, and the role of social contexts in shaping policy implementation and impact.
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Affiliation(s)
- Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA; , , ,
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA; , , ,
| | - Leah Hamilton
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA; , , ,
| | - Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10027, USA; ,
| | - Samuel R Friedman
- Center for Opioid Epidemiology and Policy, Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA; , , ,
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10027, USA; ,
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48
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Levitt A, Mermin J, Jones CM, See I, Butler JC. Infectious Diseases and Injection Drug Use: Public Health Burden and Response. J Infect Dis 2021; 222:S213-S217. [PMID: 32877539 DOI: 10.1093/infdis/jiaa432] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Alexandra Levitt
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Mermin
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Isaac See
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jay C Butler
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Muncan B, Jordan AE, Perlman DC, Frank D, Ompad DC, Walters SM. Acceptability and Effectiveness of Hepatitis C Care at Syringe Service Programs for People Who Inject Drugs in New York City. Subst Use Misuse 2021; 56:728-737. [PMID: 33682610 PMCID: PMC8514132 DOI: 10.1080/10826084.2021.1892142] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction/Objectives: The incidence of hepatitis C (HCV) infection is rising among people who inject drugs (PWID). Even in the context of known HCV prevention and treatment strategies, some PWID remain unengaged in HCV care. This study aimed to identify and characterize experiences and perceptions of PWID regarding the acceptability and effectiveness of HCV testing and treatment at a local syringe service program (SSP). Methods: A total of 36 PWID participated in semi-structured interviews at an SSP in New York City. Interviews were audio-recorded, transcribed, and coded by three coders, following a constructivist grounded theory approach. Relevant themes were identified as they emerged from the data. Results: Interviews with PWID revealed three themes related to the impact of SSPs on HCV care: (1) non-stigmatizing SSP environments, (2) the role of SSPs in improving HCV knowledge, and (3) acceptability of SSPs as sites for HCV care among PWID. Discussion: This paper contributes to the ongoing understanding that SSPs provide a well-accepted source of HCV services for PWID. Participants believed that SSPs are accessible and effective sites for HCV care, and suggested that stigma among PWID continues to affect receipt of HCV care in traditional settings. Conclusions: Understanding attitudes and beliefs of PWID regarding the effectiveness of SSPs as sites for HCV care is crucial for the development of focused strategies to reduce HCV transmission, and to ultimately achieve HCV elimination. Given this, further research is warranted investigating how best to improve HCV care at harm reduction sites such as SSPs.
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Affiliation(s)
- Brandon Muncan
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Ashly E. Jordan
- Behavioral Science Training Program in Drug Abuse Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - David C. Perlman
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Frank
- Behavioral Science Training Program in Drug Abuse Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Danielle C. Ompad
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Suzan M. Walters
- Behavioral Science Training Program in Drug Abuse Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
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50
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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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