A real-world ten-week follow-up of the COVID outbreak in an outpatient drug clinic in Salamanca (Spain)

Abstract

Objective To compare over ten weeks the number of relapses, hospital admissions, calls made, admissions to therapeutic communities, face-to-face visits, treatment adjustment, number of injectables administered, and number of emergencies attended due to emotional and behavioral alterations and/or substance use disorder, and to describe and quantify social emergencies in an outpatient drug clinic (ODC) in Salamanca (Spain) from March 16, 2020, to May 22, 2020. Methods This is an ecological study of the COVID pandemic over ten weeks. The study examines the set of alcohol or other drug-dependent or dual disorder patients in the population of Salamanca, Spain. The measurements were: professionals; calls made; percentage of successful calls; face-to-face visits; first visits made; reviews made; techniques; injectable treatments; other treatments; evolution; relapses. The ODC includes about 375 new patients each year and another 650 other patients annually. Results The study found the number of relapses to be greater in the last five weeks of the 10-week study period. Patients' psychopathological instability also increased, and face-to-face visits were necessary. The most frequent psychopathology that required face-to-face intervention was depressive disorder. The number of interventions with patients increased. In parallel, social workers' efforts were greater after the seventh week. There was a decrease in response to calls. Throughout this time, the ODC attended to patients who needed to be treated for the first time. Conclusions Confinement due to the coronavirus pandemic generated maladaptive emotional responses and other behaviors, such as excessive alcohol consumption. The number of face-to-face consultations, admissions, and referrals to therapeutic communities increased. Patients under stress and in social isolation resorted more often to substance use. The ODC had to adopt a flexible approach to evaluate patients with more serious problems, by using face-to-face assessments.

A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe

“…PPE [ 26 ] and masks [ 86 ] were also reported as being worn during interviews for two studies. Additional studies noted that facemasks were enforced during health check-ups [ 20 ] or in public [ 42 ], and encouraged while awaiting test results and in general patient areas of a health facility [ 51 ]. Rodriguez et al [ 12 ] described difficulties enforcing masks among PEH in shelters, with some giving up and only requiring them to be worn by staff.…”

“…Reluctance to follow and ambivalence regarding the importance of social distancing among PEH was noted in four studies [ 12 , 23 , 25 , 93 ]. Physical distancing was enforced among some PEH accessing homeless support services in the U.S. [ 97 ], during health check-ups in Salamanca [ 20 ], and during interviews for a study in Spain [ 26 ] and encouraged among patients accessing a psychiatric emergency room in Los Angeles [ 51 ] and shelter residents in Washington State [ 55 ]. One study in Ireland reported accommodation services were expanded to support social distancing [ 101 ].…”

“…Active substance use among PEH during the pandemic was noted in 36 studies [ 8 , 11 , 12 , 13 , 20 , 23 , 25 , 26 , 38 , 47 , 51 , 61 , 62 , 68 , 72 , 76 , 81 , 82 , 84 , 88 , 89 , 92 , 94 , 96 , 99 , 101 , 102 , 103 , 104 , 107 , 108 , 110 , 113 , 114 , 115 ]. Substances used included alcohol [ 8 , 13 , 23 , 25 , 26 , 47 , 61 , 62 , 68 , 72 , 82 , 84 , 88 , 89 , 94 , 99 , 101 , 102 , 108 , 110 …”

“…An additional four studies noted general opioid use [ 26 , 72 , 108 , 113 ], and 17 reported current substance use without further specification [ 11 , 12 , 13 , 20 , 25 , 38 , 47 , 61 , 68 , 76 , 92 , 96 , 101 , 102 , 103 , 107 , 110 , 114 ]. Increased use of substances was reported in four studies [ 20 , 23 , 88 , 104 ]. Increased use of marijuana (28%), tobacco (20%), and alcohol (20%) during the pandemic was reported by some young PEH (18–25 years old) in Los Angeles [ 88 ].…”

“…In some cases, harm reduction, treatment, and support services for PEH were closed, limited, or inaccessible due to commute barriers [ 16 , 17 , 18 , 19 ]. These new challenges have exacerbated existing mental health issues; studies have reported increased rates of self-harm, depression, and anxiety among PEH [ 20 , 21 ], as well as increased difficulties in accessing mental health services [ 13 ].…”