Lisbon’s COVID 19 response: harm reduction interventions for people who use alcohol and other drugs in emergency shelters

Fuertes, Ricardo; Belo, Elsa; Merendeiro, Cristiana; Curado, Adriana; D, Gautier; Neto, Ana; Taylor, Hannah

doi:10.1186/s12954-021-00463-x

Cited by 19 publications

(12 citation statements)

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“…Descriptions of harm reduction practices in COVID-19 isolation shelters have been reported from Toronto (49) and Hamilton (50,51), Canada; Boston (49,52) and San Francisco (53,54), USA; Lisbon, Portugal (55); and Tshwane, South Africa (56). The other Canadian harm reduction programs are most like the one described in our study.…”

Section: Discussionsupporting

confidence: 56%

“…In Lisbon, harm reduction organizations provided support, sterile injecting equipment, naloxone, and a mobile drug consumption room to shelter residents. Residents had access to benzodiazepines for alcohol withdrawal management, but no safe supply or managed alcohol program was provided (55). In Tshwane, prescribers provided methadone in the stadium-based emergency shelter.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Brothers¹,

Leaman²,

Bonn³

et al. 2022

Preprint

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Background: During a COVID-19 outbreak in the congregate shelter system in Halifax, Nova Scotia, Canada, a multidisciplinary health care team provided an emergency safe supply of pharmaceutical-grade medications and beverage-grade alcohol to facilitate isolation in COVID-19 hotel shelters for residents who are dependent on these substances. We aimed to evaluate (a) substances and dosages provided, and (b) effectiveness and safety of the program. Methods: We retrospectively reviewed medical records of all COVID-19 isolation hotel shelter residents during May 2021. We extracted data on medication and alcohol dosages provided each day. The primary outcome was residents prematurely leaving isolation against public health orders. Adverse events included (a) overdose; (b) intoxication; and (c) diversion, selling, or sharing of medications or alcohol. Results: Over 25 days, 77 isolation hotel residents were assessed (mean age 42 +/- 14 years; 24% women). Sixty-two (81%) residents were provided medications, alcohol, or cigarettes. Seventeen residents (22%) received opioid agonist treatment medications (methadone, buprenorphine, or slow-release oral morphine) and 27 (35%) received hydromorphone tablets. Thirty-one (40%) residents received stimulant tablets with methylphenidate (27; 35%), dextroamphetamine (8; 10%), or lisdexamfetamine (2; 3%). Six residents (8%) received benzodiazepines. Forty-two (55%) residents received alcohol, including 41 (53%) with strong beer, three (3%) with wine, and one (1%) with hard liquor. Over 14 days in isolation, mean daily dosages increased of hydromorphone (45 +/- 32 to 57 +/- 42mg), methylphenidate (51 +/- 28 to 77 +/- 37mg), dextroamphetamine (33 +/- 16 to 46 +/- 13mg), and alcohol (12.3 +/- 7.6 to 13.0 +/- 6.9 standard drinks). Six residents (8%) left isolation prematurely, but four of those residents returned. Over 1,059 person-days in isolation, there were zero overdoses. Documented concerns regarding intoxication occurred six times (0.005 events/person-day) and medication diversion or sharing three times (0.003 events/person-day). Conclusions: An emergency safe supply and managed alcohol program, paired with housing, was associated with low rates of adverse events and high rates of successful completion of the 14-day isolation period in COVID-19 isolation hotel shelters. This supports the effectiveness and safety of emergency safe supply prescribing and managed alcohol in this setting.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Brothers¹,

Leaman²,

Bonn³

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…Managed alcohol programs (MAPs) are evidence-based alcohol harm reduction approaches specifically developed for those experiencing the dual challenges of AUD and homelessness. Initially developed in Canada in the late 1990s, they have grown in prominence in recent years and now exist in Ireland, with plans to develop MAPs in Australia (Ezard et al, 2018;Holmes, 2019), Scotland (Carver et al, 2021;Scottish Housing News, 2020), and Portugal (Fuertes et al, 2021). Within MAPs alcohol is provided in measured, regular doses throughout the day, along with other supports, such as housing, healthcare, and community activities (Pauly et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

‘It’s like a safety haven’: considerations for the implementation of managed alcohol programs in Scotland

Parkes

Carver

Matheson

et al. 2021

Drugs: Education, Prevention and Policy

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Alcohol use disorders (AUDs) are not equitably spread across the population, with some groups, such as people who are experiencing homelessness, being more vulnerable to AUDs due to social inequalities, stigma, and complex social and structural processes. Managed alcohol programs (MAPs) are a harm reduction approach first developed in Canada for those experiencing AUDs and homelessness with positive results. This study aimed to describe the factors that should be considered when implementing MAPs in Scotland. Qualitative data were collected in Scotland via semi-structured interviews with 29 individuals in a range of roles, including strategic informants (n ¼ 12), service staff (n ¼ 8), and potential beneficiaries (n ¼ 9). Vignettes were used to support data collection. Data were analysed using Framework in NVivo. Participants highlighted six considerations to inform the implementation of MAPs in Scotland: the importance of individualized care; provision of alcohol; holistic care and a focus on well-being; types of settings and service models; staffing; and autonomy and rules. Future research should focus on piloting MAPs in a range of service contexts, using different models of care and settings, to develop an enhanced understanding of their effectiveness in addressing harms and promoting well-being for those experiencing AUDs and homelessness.

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“…It helped to mitigate harms related to the reduction and restriction of services including supervised consumption facilities, harm reduction supplies, and substance use care. Fuertes et al demonstrated that mobile drug consumption rooms were highly utilized in Lisbon’s response to the COVID-19 shelter-response and mobile consumption may be an area of further research needed when addressing overdose response in Canadian shelters [ 14 ]. Similarly, in South Africa’s response to homelessness in a large urban center, primary care practitioners prioritized the provision of methadone to reduce withdrawal [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of an integrated safer use space and safer supply program on non-fatal overdose among emergency shelter residents during a COVID-19 outbreak: a case study

et al. 2022

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Background Opioid-related harms, including fatal and non-fatal overdoses, rose dramatically during the COVID-19 pandemic and presented unique challenges during outbreaks in congregate settings such as shelters. People who are deprived of permanent housing have a high prevalence of substance use and substance use disorders, and need nimble, rapid, and portable harm reduction interventions to address the harms of criminalized substance use in an evidence-based manner. Case study In February 2021, a COVID-19 outbreak was declared at an emergency men’s shelter in Hamilton, Ontario, Canada. Building on pre-existing relationships, community and hospital-based addictions medicine providers and a local harm reduction group collaborated to establish a shelter-based opioid agonist treatment and safer supply program, and a volunteer run safer drug use space that also distributed harm reduction supplies. In the 4 weeks preceding the program, the rate of non-fatal overdoses was 0.93 per 100 nights of shelter bed occupancy. During the 26 days of program operation, there were no overdoses in the safer use space and the rate of non-fatal overdoses in the shelter was 0.17 per 100 nights of shelter bed occupancy. The odds ratio of non-fatal overdose pre-intervention to during intervention was 5.5 (95% CI 1.63–18.55, p = 0.0059). We were not able to evaluate the impact of providing harm reduction supplies and did not evaluate the impact of the program on facilitating adherence to public health isolation and quarantine orders. The program ended as the outbreak waned, as per the direction from the shelter operator. Conclusions There was a significant reduction in the non-fatal overdose rate after the safer drug use and safer supply harm reduction program was introduced. Pre-existing relationships between shelter providers, harm reduction groups, and healthcare providers were critical to implementing the program. This is a promising approach to reducing harms from the criminalization of substance use in congregate settings, particularly in populations with a higher prevalence of substance use and substance use disorders.

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Lisbon’s COVID 19 response: harm reduction interventions for people who use alcohol and other drugs in emergency shelters

Cited by 19 publications

References 0 publications

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

‘It’s like a safety haven’: considerations for the implementation of managed alcohol programs in Scotland

The impact of an integrated safer use space and safer supply program on non-fatal overdose among emergency shelter residents during a COVID-19 outbreak: a case study

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