Harm Reduction, By Mail: the Next Step in Promoting the Health of People Who Use Drugs

Hayes, Benjamin T.; Favaro, Jamie; Davis, Corey S.; Gonsalves, Gregg; Beletsky, Leo; Vlahov, David; Heimer, Robert; Fox, Aaron D.

doi:10.1007/s11524-021-00534-1

Cited by 11 publications

(6 citation statements)

References 29 publications

(22 reference statements)

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“…These services are particularly important for rural areas where distance is a barrier to SSP use [17]. Mail delivery of equipment has shown promise in other areas of the USA, however funding and state-level policy changes may be necessary for expansion [45]. Similar to our findings, others have described how mobile SSP units reduce needle sharing and reuse of needles, facilitate referrals to treatment, while also providing essential services [46].…”

Section: Discussionsupporting

confidence: 81%

The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in a rural American state

et al. 2022

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Background The impact of public health policies during the COVID-19 pandemic on people who inject drugs (PWID) has varied across regions. In other countries, recent research has shown that PWID access to harm reduction services, despite rapid adaptations, has been negatively impacted. Our study describes these impacts in a rural state. Methods We conducted semi-structured interviews with PWID, community partners, and healthcare providers in the rural state of Maine (USA). We explored how changes made during the pandemic impacted access to harm reduction services, including basic services (i.e., shelter), syringe service programs, safe drug supply, low barrier treatment, and peer support. Interviews were analyzed using the framework method to apply Penchansky’s model of access, with Saurman’s modification, which includes six dimensions of access—accessibility, availability, acceptability, affordability, accommodation, awareness. Results We interviewed thirty-six stakeholders (N = 9 community partners, N = 9 healthcare providers, N = 18 PWID). Policies such as mobile outreach expansion, mail delivery of equipment, and relaxed telemedicine regulations facilitated accessibility to syringe service programs and low barrier buprenorphine treatment. Public health policies, such as social distancing and screening policies, reduced contact, which subsequently reduced acceptability and awareness of many services. Elimination of the one-for-one needle exchange in some areas increased, acceptability (i.e., perception of service), and affordability for PWID. However, some areas actually began enforcing a one-for-one needle exchange policy, which reduced affordability, acceptability, and awareness of services. Conclusions Changes resulting from the COVID-19 pandemic have impacted all dimensions of access to harm reduction services among PWID. While some barriers to harm reduction services were unavoidable during the pandemic, we found that specific policy decisions mitigated service barriers, while other policies exacerbated them. Relaxing needle exchange policies were particularly helpful in facilitating access to harm reduction services by giving community organizations flexibility to adapt to the evolving needs of PWID. These results can inform policies and service delivery to optimally mitigate the negative impacts on PWID during, and beyond, the pandemic.

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Section: Discussionsupporting

confidence: 81%

The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in a rural American state

et al. 2022

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“…Significant disruption in access to sterile syringes underscores the need for disaster preparedness and alternative mechanisms to deliver sterile syringes to people who need them under emergency conditions. Addressing disruptions in the ability of participants to access sterile syringes is critical ( Bartholomew, Nakamura, Metsch, & Tookes, 2020 ) a gap that may be best filled by mail delivery models of harm reduction ( Hayes et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

The COVID-19 pandemic and the health of people who use illicit opioids in New York City, the first 12 months

Bennett

Townsend

Elliott

2022

International Journal of Drug Policy

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“…Vicissitudes in fentanyls’ supply are correlated with mortality and real-time surveillance may be exploited as part of an early warning system [14 ▪▪ ]. Given the vicissitudes and increasing unknowns of the street drug supply, calls for improved surveillance [14 ▪▪ ,91 ▪▪ ], advanced harm reduction [92 ▪ ] including remote access [93 ▪ ], drug checking [94,95 ▪ ,96 ▪ ,97 ▪ ] and supervised consumption spaces are growing in chorus [15 ▪ ].…”

Section: Treatment Issuesmentioning

confidence: 99%

The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis

Ciccarone¹

2021

Current Opinion in Psychiatry

453

247

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Purpose of review This review provides an update on recently published literature on the rise of illicit fentanyls, risks for overdose, combinations with other substances, e.g. stimulants, consequences, and treatment. Recent findings Overdose due to illicit synthetic opioids (e.g. fentanyl and fentanyl analogs) continues to rise in the US both preceding and during the COVID-19 pandemic. Fentanyl-related overdose is rising in new geographic areas e.g. the western USA. Stimulant-related overdose is also increasing nationwide driven by methamphetamine and cocaine. Polysubstance use, e.g. the use of a stimulant along with an opioid is driving stimulant-related overdose. Other medical consequences of injection drug use are rising including HIV and hepatitis C infections. Medication approaches to treating opioid use disorder remain the standard of care and there are new promising pharmacological approaches to treating methamphetamine use disorder. Summary A ‘fourth wave’ of high mortality involving methamphetamine and cocaine use has been gathering force in the USA. Availability and use of illicit fentanyls are still the major drivers of overdose deaths and the current rise in stimulant-related deaths appears entwined with the ongoing opioid epidemic.

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Harm Reduction, By Mail: the Next Step in Promoting the Health of People Who Use Drugs

Cited by 11 publications

References 29 publications

The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in a rural American state

The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in a rural American state

The COVID-19 pandemic and the health of people who use illicit opioids in New York City, the first 12 months

The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis

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