Background : People who inject drugs (PWID) are a high-risk group for COVID-19 transmission and serious health consequences. Restrictions imposed in the UK in response to the pandemic led to rapid health and housing service alterations. We aimed to examine PWID experiences of: 1) challenges relating to the COVID-19 public health measures; 2) changes to opioid substitution therapy (OST) and harm reduction services; and 3) perceived effects of COVID-19 on drug use patterns and risk behaviour. Methods : Telephone semi-structured interviews were conducted with 28 PWID in Bristol, Southwest of England. Analysis followed a reflexive thematic analysis. Results : Concern about COVID-19 and adherence to public health guidance varied. Efforts made by services to continue providing support during the pandemic were appreciated and some changes were preferred, such as less frequent OST collection, relaxation of supervised consumption and needle and syringe programmes (NSP) home delivery. However, remote forms of contact were highlighted as less beneficial and more difficult to engage with than in-person contact. Public health guidance advising people to ‘stay home’ led to increased isolation, boredom, and time to ruminate which impacted negatively on mental health. Lockdown restrictions directly impacted on sources of income and routine. Changes in drug use were explained as a consequence of isolation and fewer interactions with peers, problems accessing drugs, reduced drug purity and reduced financial resources. Conclusion : This study captures the significant impacts and challenges of the COVID-19 pandemic on the lives of PWID. While rapid adaptations to service delivery to help mitigate the risks of COVID-19 were appreciated and some changes such as relaxation of supervised daily OST consumption were viewed positively, barriers to access need further attention. Going forwards there may be opportunities to harness the positive aspects of some changes to services.

Background People who inject drugs are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. Methods A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic-type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. Results In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly; for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. Conclusions This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.

Background In many countries, the average age of people who use illicit opioids, such as heroin, is increasing. This has been suggested to be a reason for increasing numbers of opioid-related deaths seen in surveillance data. We aimed to describe causes of death among people who use illicit opioids in England, how causes of death have changed over time, and how they change with age. MethodsIn this matched cohort study, we studied patients in the Clinical Practice Research Datalink with recorded illicit opioid use (defined as aged 18-64 years, with prescriptions or clinical observations that indicate use of illicit opioids) in England between Jan 1, 2001, and Oct 30, 2018. We also included a comparison group, matched (1:3) for age, sex, and general practice with no records of illicit opioid use before cohort entry. Dates and causes of death were obtained from the UK Office for National Statistics. The cohort exit date was the earliest of date of death or Oct 30, 2018. We described rates of death and calculated cause-specific standardised mortality ratios. We used Poisson regression to estimate associations between age, calendar year, and cause-specific death. Findings We collected data for 106 789 participants with a history of illicit opioid use, with a median follow-up of 8•7 years (IQR 4•3-13•5), and 320 367 matched controls with a median follow-up of 9•5 years (5•0-14•4). 13 209 (12•4%) of 106 789 participants in the exposed cohort had died, with a standardised mortality ratio of 7•72 (95% CI 7•47-7•97). The most common causes of death were drug poisoning (4375 [33•1%] of 13 209), liver disease (1272 [9•6%]), chronic obstructive pulmonary disease (COPD; 681 [5•2%]), and suicide (645 [4•9%]). Participants with a history of illicit opioid use had higher mortality rates than the comparison group for all causes of death analysed, with highest standardised mortality ratios being seen for viral hepatitis (103•5 [95% CI 61•7-242•6]), HIV (16•7 [9•5-34•9]), and COPD (14•8 [12•6-17•6]). In the exposed cohort, at age 20 years, the rate of fatal drug poisonings was 271 (95% CI 230-313) per 100 000 person-years, accounting for 59•9% of deaths at this age, whereas the mortality rate due to non-communicable diseases was 31 (16-45) per 100 000 person-years, accounting for 6•8% of deaths at this age. Deaths due to non-communicable diseases increased more rapidly with age (1155 [95% CI 880-1431] deaths per 100 000 person-years at age 50 years; accounting for 52•0% of deaths at this age) than did deaths due to drug poisoning (507 (95% CI 452-562) per 100 000 person-years at age 50 years; accounting for 22•8% of deaths at this age). Mirroring national surveillance data, the rate of fatal drug poisonings in the exposed cohort increased from 345 (95% CI 299-391) deaths per 100 000 person-years in 2010-12 to 534 (468-600) per 100 000 person-years in 2016-18; an increase of 55%, a trend that was not explained by ageing of participants.Interpretation People who use illicit opioids have excess risk of death across all major causes of ...

Chalcogenide perovskites have been recently proposed as novel absorber materials for photovoltaic applications. BaZrS3, the most investigated compound of this family, shows a high absorption coefficient, a bandgap of around 1.8 eV, and excellent stability. In addition to the 3D perovskite BaZrS3, the Ba–Zr–S compositional space contains various 2D Ruddlesden–Popper phases Ban + 1ZrnS3n + 1 (with n = 1, 2, 3) which have recently been reported. Herein, it is shown that at high temperature the Gibbs free energies of 3D and 2D perovskites are very close, suggesting that 2D phases can be easily formed at high temperatures. The product of the BaS and ZrS2 solid‐state reaction, in different stoichiometric conditions, presents a mixture of BaZrS3 and Ba4Zr3S10. To carefully resolve the composition, X‐ray diffraction, scanning electron microscopy, and energy‐dispersive X‐ray spectroscopy analysis are complemented with Raman spectroscopy. For this purpose, the phonon dispersions, and the consequent Raman spectra, are calculated for the 3D and 2D chalcogenide perovskites, as well as for the binary precursors. This thorough characterization demonstrates the thermodynamic limitations and experimental difficulties in forming phase‐pure chalcogenide perovskites through solid‐state synthesis and the importance of using multiple techniques to soundly resolve the composition of these materials.