Economic Challenges and Behavioral and Mental Health Risks for Overdose during the COVID-19 Pandemic among People Who Inject Drugs

Abstract

People who inject drugs (PWID) are a population that disproportionately struggles with economic and mental health challenges. However, despite numerous reports of people globally experiencing new or exacerbated economic and/or mental health challenges during the COVID-19 pandemic, the literature on the effect of the pandemic on PWID and their risk for harm (e.g., overdose) remains sparse. The present study will describe reported changes during the pandemic in risk factors for drug overdose (including changes in mental health symptoms and care access) among PWID in Chicago, and it will examine associations between such risk factor changes and the experience of economic challenges during the pandemic. Participants from an ongoing longitudinal study of young PWID from the Chicago suburbs and their injection risk network members (N = 138; mean age = 28.7 years) were interviewed about changes in their experiences, substance use behavior, and mental health since the start of the COVID-19 pandemic. Bivariate cross tabulations were computed of each “overdose risk factor” with experiences of economic challenges during the pandemic. Fisher’s Exact Tests were used to assess statistical significance. Adjusted logistic regression models were also conducted that controlled for sociodemographic characteristics, for time elapsed since the start of the pandemic, and for pre-pandemic income, homelessness, and injection frequency. Over half of our sample reported using alone more than usual during the pandemic, and over 40% reported using more than usual and/or buying drugs that were of a decreased purity or quality. Additionally, a large proportion of our sample (52.5% of those asked) reported more difficulty than usual accessing mental health care. Experiencing loss of a source of income during the pandemic was associated with using more drugs, using alone more, using a larger amount of drugs while using alone, wanting to stop using but being unable, and difficulty accessing mental health care. The preliminary associations found by the present study suggest that economic challenges or disruptions experienced during the pandemic are likely to increase risk for overdose among PWID experiencing such challenges, via changes in the above behaviors and/or conditions that are associated with risk for overdose. Intervention efforts should therefore be focused not only directly on overdose prevention, but also on assisting PWID with their economic challenges and helping them regain economic stability and access to services that may have been impeded by financial difficulty.

Perceptions of access to harm reduction services during the COVID-19 pandemic among people who inject drugs in Chicago

“…COIP provides services including syringe exchange, substance use counseling, and HCV and HIV testing and counseling as well as conducting research with PWID. The field sites are located in Chicago neighborhoods with high HIV, HCV, sexually transmitted infection incidence rates, and drug-related arrests (12). Informed consent was obtained from all study participants prior to data collection.…”

“…Along with complex medical comorbidities, vulnerability of PWID is further augmented by social factors such as homelessness, incarceration, poverty, and limited access to healthcare due to drug use stigma and discrimination (4)(5)(6)(7)(8)(9)(10). Collectively, these risk factors are compounded by economic hardships exacerbated by the COVID-19 pandemic, including food insecurity, housing insecurity, and substandard sanitation conditions (3,5,11,12). For these and other reasons, research specific to COVID-19 suggests that the pandemic escalated isolation, loss of social support, and mental health decline among PWID (5,13).…”

A Novel Index Measure of Housing-related Risk as a Predictor of Overdose among Young People Who Inject Drugs and Injection Networks

“…Recruitment was primarily conducted at two field sites of Community Outreach Intervention Projects (COIP), a center established in 1986 within University of Illinois at Chicago School of Public Health that currently (i) provides services (e.g., syringe service programs - SSPs, naloxone distribution, case management, and medication assisted treatment - MAT - services) and (ii) conducts research with PWID to better inform intervention efforts. These field sites are located in Chicago areas with higher-than-average rates of HIV, hepatitis C, sexually transmitted infections, and drug-related arrests ( 21 ). To diversify the pool of participants and target non-SSP-involved and suburban PWID, recruitment was also done directly in open outdoor drug market areas known from previous studies by our group to attract both urban and suburban PWID and though mobile unit outreach postings at community-based organizations serving PWID, as well as through social media platforms ( 48 ).…”

“…As a result, PWID who begin to experience housing instability often remain in a state of long-term, cyclical homelessness (12). Theoretically, housing instability can increase stress, depression, and anxiety, all of which are associated with increased risk for overdose (13)(14)(15)(16)(17)(18)(19)(20)(21). Housing instability is also directly associated with increased risk of overdose in some (5,9,14,(22)(23)(24)(25)(26)(27), but not all studies (28-30), perhaps partly due to the inconsistent conceptualizations of housing instability across studies.…”

Interrupted time series analysis of drug overdose fatalities in service-related industries versus non-service-related industries during the COVID-19 pandemic, 2018–2021

“…2 3 Reduction in work hours or loss of employment increased the risk of using substances alone and as self-medication for stress. [4][5][6] At the height of the pandemic, customary gathering places for recovery support services closed, and social distancing was enforced where gathering…”