Addressing the Syndemic of HIV, Hepatitis C, Overdose, and COVID-19 Among People Who Use Drugs: The Potential Roles for Decriminalization and Safe Supply

Bonn, Matthew; Palayew, Adam; Bartlett, Sofia; Touesnard, Natasha; Tyndall, Mark

doi:10.15288/jsad.2020.81.556

Cited by 107 publications

(98 citation statements)

References 18 publications

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“…The COVID-19 pandemic also led to discontinuation of previously available services that addressed some of these barriers specific to rural syringe access, such as home peer outreach and mobile syringe exchange. While discontinuation of these services may have been a reasonable early response, as the pandemic continues programs will need to reconsider outreach services to balance risk posed by COVID-19 infection with increasing overdose and HIV/HCV transmission [ 3 – 8 , 22 ]. We also found that, as experienced by the participants, state guidelines allowing for needs-based syringe distribution were not uniformly realized during the study period, further limiting harm reduction engagement in the context of a rapidly changing pandemic.…”

Section: Discussionmentioning

confidence: 99%

Harm Reduction and Adaptations Among PWUD in Rural Oregon During COVID-19

Seaman

Leichtling²,

Stack³

et al. 2021

AIDS Behav

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Coronavirus Disease 2019 (COVID-19) may influence HIV/HCV transmission risk behaviors in rural communities. We conducted semi-structured qualitative interviews with people who use drugs (PWUD) in five rural Oregon counties and asked about COVID-19 impact on substance use and harm reduction practices and their advice for improving public health responses. Participants (n = 36) reported using only methamphetamine (52.8%), only heroin (16.7%), or both (30.6%); 75% of participants reported recent injection. Three thematic categories emerged: SSP adaptations and accessibility, PWUD harm reduction practices, and policy suggestions. Participants noted the importance of SSPs to COVID-19 prevention and wellbeing, though some experienced increased barriers, leading to increased risky injection practices. Participants suggested need-based rather than one-for-one exchange, increasing syringe delivery services, encouraging secondary exchange by PWUD, and peers as trusted voices for information exchange. Rapid implementation of policy and practice changes are urgently required to improve SSP access, reinforce safer use, and prevent HIV/HCV and COVID-19 transmission.

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Section: Discussionmentioning

confidence: 99%

Harm Reduction and Adaptations Among PWUD in Rural Oregon During COVID-19

Seaman

Leichtling²,

Stack³

et al. 2021

AIDS Behav

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“…Similar measures were implemented elsewhere [ 34 , 35 ]. Additional measures were also proposed, such as improving addiction treatment access using telehealth encounters for OAT induction [ 36 , 37 ], substance use decriminalization [ 38 ], and safe supply of opioid [ 39 ] and other substances, including stimulants [ 40 ]. Further research should investigate their potential impact on substance use behaviours, substance use disorder outcomes, treatment retention, intoxications, and mortality, as well as long-term physical, mental, and social outcomes.…”

Section: Discussionmentioning

confidence: 99%

Evolution of the Illegal Substances Market and Substance Users’ Social Situation and Health during the COVID-19 Pandemic

Gaume

Schmutz

Daeppen

et al. 2021

IJERPH

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The outbreak of the COVID-19 pandemic and the measures taken for tackling it had the potential to lead to deep modifications in the supply of illegal drugs and to impact substance users’ health and social situation. To investigate this, we used mixed methods, i.e., quantitative data collected with a brief questionnaire from substance users receiving opioid agonist treatment in a treatment centre in Switzerland (N = 49), and qualitative data obtained using semi-structured phone interviews among a sub-group of participants (N = 17). We repeated data collection twice over four weeks to investigate trends over time (N = 51 and 14 at wave 2). Findings consistently showed the limited impact of the COVID-19 outbreak on the illegal substance market. Over the two waves, the supply, price and purity of three main illegal substances did not significantly vary. Substance use was estimated as usual by most, trending toward a decrease. The impact of the pandemic on participants’ social situation and health was appraised as low to medium. Nevertheless, a minority of participants reported higher impact and multivariate analyses showed a more important impact for those who were female, younger, and not using multiple substances. This process was implemented quickly and provided an understanding of the short-term impact of the pandemic on drug markets and users.

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“…The SARS-CoV-2 epidemics overlaps with endemic diseases [NCD, malaria, schistosomiasis, tuberculosis, hepatitis C, HIV, dengue and other neglected tropical diseases (NTD)] and with seasonal diseases (such as influenza and other respiratory diseases), a host of cultural and social determinants (fear, stigmatization, racism, gender, economic inequalities, mis-information, risk behaviors, food and nutrition insecurity, occupation, climate, exposure to different types of pollution, supply of health and social care services, health care seeking behavior and violence, supply of drugs and addictive behaviors) and climate and environment [ 31 , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] ] ( Fig. 1 ).…”

Section: Evidence Of the Syndemic Nature Of The Sars-cov-2 Pandemicmentioning

confidence: 99%

The SARS-CoV-2 pandemic: A syndemic perspective

et al. 2021

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The SARS-CoV-2 pandemic has affected communities, populations, and countries throughout the world. As the SARS-CoV-2 pandemic developed, the extent to which the disease interacted with already existing endemic, non-communicable and infectious diseases became evident, hence deeply influencing health outcomes. Additionally, a synergistic effect has been demonstrated also with socio-economic, cultural, and contextual determinants of health which seem to contribute to poorer health and accumulating social disadvantages. In this essay, using as a starting point the syndemic theory that translates the cumulative and intertwined factors between different epidemics, we argue that the SARS-CoV-2 is a one health issue of a syndemic nature and that the failure to acknowledge this contributes to weakened policy-making processes and public health responses and ineffective health policies and programs.

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Addressing the Syndemic of HIV, Hepatitis C, Overdose, and COVID-19 Among People Who Use Drugs: The Potential Roles for Decriminalization and Safe Supply

Cited by 107 publications

References 18 publications

Harm Reduction and Adaptations Among PWUD in Rural Oregon During COVID-19

Harm Reduction and Adaptations Among PWUD in Rural Oregon During COVID-19

Evolution of the Illegal Substances Market and Substance Users’ Social Situation and Health during the COVID-19 Pandemic

The SARS-CoV-2 pandemic: A syndemic perspective

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