Impact of changes to the delivery of opioid agonist treatment, introduced during the COVID-19 pandemic, on treatment access and dropout in Ireland: An interrupted time series analysis

Durand, Louise; Boland, Fiona; Harnedy, Norma; Delargy, Ide; Scully, Mike; Bourke, Margaret; Ebbitt, William; Vázquez, María Otero; Keenan, Eamon; Cousins, Gráinne

doi:10.1016/j.josat.2023.209029

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…In the current study, the number of individuals using the service did decline in 2020, coinciding with COVID-19, which does suggest that lockdown restrictions may have played a role in declining patterns of usage. During COVID-19, a home delivery needle and syringe service was established [ 32 ], along with increased provision of OAT services [ 33 ], which may also have meant that fewer people would have needed to attend a needle exchange. Since 2020, patterns have only recovered to 2015 levels, which suggests that COVID-19 may have had an enduring impact on behaviour patterns.…”

Section: Discussionmentioning

confidence: 99%

Community Pharmacy Needle Exchange Programme: What Can Analysis of the Data Tell Us about the Changing Drug Market in Ireland?

Evans,

Harnedy,

Keenan

2024

IJERPH

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Community Pharmacy Needle Exchanges are a harm reduction measure that have been established in a number of countries to provide access to sterile injecting equipment for people who inject drugs (PWID). To ensure that they are meeting needs, it is important to monitor the use of the services. This study aimed to determine patterns of needle distribution and return in community pharmacies in Ireland over time. The number of pharmacies, needle packs, clean needles and returned packs was obtained from the Health Service Executive (HSE) Planning and Business Information Unit (PBI). Yearly totals were calculated to show patterns from 2015 to 2022. There has been an 18% decline in the number of pharmacies providing the service since 2015, with a 19% decline in the number of packs provided and a 21% decline in the number of packs returned. The proportion of packs returned was 23% in 2015 and 18% in 2022. There has been a 16% decline in the number of sterile needles provided and a 6% reduction in the average number of needles per individual since 2017. Declining needle use and low rates of used needle return (against a backdrop of large numbers of PWID that have not significantly reduced over time) suggest that there is a need to investigate if community pharmacies in Ireland have the scope to improve their harm reduction impact. This raises questions in terms of the need to both improve and adapt the service against a backdrop of changing drug markets. Key recommendations include the need to review the harm reduction services employed by participating pharmacies when providing new equipment and organising the return of used equipment.

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Section: Discussionmentioning

confidence: 99%

Community Pharmacy Needle Exchange Programme: What Can Analysis of the Data Tell Us about the Changing Drug Market in Ireland?

Evans,

Harnedy,

Keenan

2024

IJERPH

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“…In response to pandemic shifts in health care delivery, a number of changes in the delivery of care may have affected access to OAT. Some studies in Canada and in other jurisdictions have demonstrated increased access to OAT related to implementation of virtual care services for OUD, increase in take-home doses and home delivery of medications, and reduced urine drug screening requirements, among other measures. Some of these pandemic-related changes were also associated with lower rates of treatment interruption and discontinuation .…”

Section: Discussionmentioning

confidence: 99%

Trends in Rates of Opioid Agonist Treatment and Opioid-Related Deaths for Youths in Ontario, Canada, 2013-2021

et al. 2023

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ImportanceData suggest that the opioid crisis in North America has recently been reflected in opioid-related mortality among youths. Despite recommendation for its use, youths encounter barriers to accessing OAT, including stigma, burden of witnessed dosing, and lack of availability of youth-oriented services and prescribers comfortable treating this population.ObjectiveTo compare rates of opioid agonist treatment (OAT) and opioid-related mortality between youths aged 15 to 24 years and adults aged 25 to 44 years in Ontario, Canada, over time.Design, Setting, and ParticipantsThis cross-sectional analysis of rates of OAT and opioid-related deaths between 2013 and 2021 used data obtained from the Ontario Drug Policy Research Network, Public Health Ontario, and Statistics Canada. Individuals included in the analysis were aged 15 to 44 years and residing in Ontario, the most populous province in Canada.ExposuresYouths aged 15 to 24 years compared with adults aged 25 to 44 years.Main Outcomes and MeasuresOAT (methadone, buprenorphine, and slow-release oral morphine) per 1000 population and opioid-related deaths per 100 000 population.ResultsBetween 2013 and 2021, 1021 youths aged 15 to 24 years died from opioid toxicity; 710 were male (69.5%). In the final year of the study period, 225 youths (146 male [64.9%]) died from opioid toxicity, and 2717 (1494 male [55.0%]) were dispensed OAT. Over the study period, the rate of opioid-related deaths among youths in Ontario increased 369.2% from 2.6 to 12.2 per 100 000 population (48 to 225 total deaths) and the rate of OAT use decreased 55.9% from 3.4 to 1.5 per 1000 (6236 to 2717 individuals). For adults aged 25 to 44 years, the rate of opioid-related deaths increased 371.8% from 7.8 to 36.8 per 100 000 (283 to 1502 deaths), and the rate of OAT increased 27.8% from 7.9 to 10.1 per 1000 population (28 667 to 41 200 individuals). Trends for youths and adults persisted across both sexes.Conclusions and RelevanceThe findings of this study suggest that opioid-related deaths are increasing among youths while OAT use is paradoxically declining. The reasons for these observed trends require further investigation, including a consideration of changing trends in opioid use and opioid use disorder among youths, barriers to OAT, and opportunities to optimize care and reduce harms for youths who use substances.

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“…Despite the introduction of pharmacotherapy policy changes to support physical distancing, such as greater access to unsupervised dosing, dispensing to third parties and extending prescription durations, we found no evidence of increased harms that might be associated with the diversion or extra-medical use of OAT medications. There is now a growing body of literature from multiple settings showing that more flexible prescribing and dispensing policies introduced in the early stages of the pandemic increased OAT initiation [30,31], reduced treatment interruption and discontinuation [32] and were not associated with increased substance use or opioidrelated overdoses [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Opioid‐related ambulance attendances during the first 2 years of the COVID‐19 pandemic in Victoria, Australia

McGrath,

Stare,

Chua

et al. 2023

Addiction

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Background and AimsPublic health measures introduced to contain the spread of the SARS‐CoV‐2 virus likely affected opioid supply and demand, as well as the patterns and contexts of opioid use. We measured opioid‐related harms during the first 2 years of COVID‐19 restrictions in Victoria, Australia.DesignWe adopted an interrupted time series analysis design using interventional autoregressive integrated moving average (ARIMA) models. Opioid‐related ambulance attendance data between January 2015 and March 2022 were extracted from the National Ambulance Surveillance System.SettingVictoria, Australia.ParticipantsPatients (≥15 years) attended to by an ambulance for opioid‐related harms.MeasurementsMonthly opioid‐related ambulance attendances for three drug types: heroin, prescription opioids and opioid agonist therapy (OAT) medications.FindingsThe monthly rate of heroin‐related attendances fell by 26% immediately after the introduction of COVID‐19 restrictions. A reduced rate of heroin‐related attendances was observed during COVID‐19 restrictions, resulting in 2578 averted heroin‐related attendances. There was no change in the rate of attendances for extra‐medical OAT medications or prescription opioids.ConclusionsStrict COVID‐19 restrictions in Victoria, Australia appear to have resulted in a substantial reduction in heroin‐related ambulance attendances, perhaps because of border closures and restrictions on movement affecting supply, changing patterns of drug consumption, and efforts to improve access to OAT. Despite policy changes allowing longer OAT prescriptions and an increased number of unsupervised doses, we found no evidence of increased harms related to the extra‐medical use of these medications.

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Impact of changes to the delivery of opioid agonist treatment, introduced during the COVID-19 pandemic, on treatment access and dropout in Ireland: An interrupted time series analysis

Cited by 5 publications

References 22 publications

Community Pharmacy Needle Exchange Programme: What Can Analysis of the Data Tell Us about the Changing Drug Market in Ireland?

Community Pharmacy Needle Exchange Programme: What Can Analysis of the Data Tell Us about the Changing Drug Market in Ireland?

Trends in Rates of Opioid Agonist Treatment and Opioid-Related Deaths for Youths in Ontario, Canada, 2013-2021

Opioid‐related ambulance attendances during the first 2 years of the COVID‐19 pandemic in Victoria, Australia

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