Preliminary indications of the burden of COVID-19 among people who inject drugs in England and Northern Ireland and the impact on access to health and harm reduction services

Croxford, Sara; Emanuel, Eva; Ibitoye, A. Z.; Njoroge, Jacquelyn; Edmundson, Claire; Bardsley, Megan; Heinsbroek, Ellen; Hope, Vivian; Phipps, Emily

doi:10.1016/j.puhe.2021.01.004

Cited by 38 publications

(37 citation statements)

References 5 publications

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“…The public health measures and social disruption of the COVID-19 pandemic impacted upon drug use, with instability, boredom and isolation all identified as drivers of change; however, the extent to which these changes will sustain as public health measures ease is unknown. Other UK and Canadian studies observed COVID-19 measures influenced drug use ( Ali et al, 2021 ; Croxford et al, 2021 ; Public Health England, 2020 ; Public Health England et al, 2020 ; Schofield et al, 2021 ; Scott et al, 2020 ), and in the US COVID-19 related stressors were linked to relapse ( Hurley et al, 2021 ). Consequently, the issues with supply and changes in substance use during COVID-19 appear to have affected PWID globally.…”

Section: Discussionmentioning

confidence: 98%

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

Kesten¹,

Holland²,

Linton³

et al. 2021

International Journal of Drug Policy

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Background : People who inject drugs (PWID) are a high-risk group for COVID-19 transmission and serious health consequences. Restrictions imposed in the UK in response to the pandemic led to rapid health and housing service alterations. We aimed to examine PWID experiences of: 1) challenges relating to the COVID-19 public health measures; 2) changes to opioid substitution therapy (OST) and harm reduction services; and 3) perceived effects of COVID-19 on drug use patterns and risk behaviour. Methods : Telephone semi-structured interviews were conducted with 28 PWID in Bristol, Southwest of England. Analysis followed a reflexive thematic analysis. Results : Concern about COVID-19 and adherence to public health guidance varied. Efforts made by services to continue providing support during the pandemic were appreciated and some changes were preferred, such as less frequent OST collection, relaxation of supervised consumption and needle and syringe programmes (NSP) home delivery. However, remote forms of contact were highlighted as less beneficial and more difficult to engage with than in-person contact. Public health guidance advising people to ‘stay home’ led to increased isolation, boredom, and time to ruminate which impacted negatively on mental health. Lockdown restrictions directly impacted on sources of income and routine. Changes in drug use were explained as a consequence of isolation and fewer interactions with peers, problems accessing drugs, reduced drug purity and reduced financial resources. Conclusion : This study captures the significant impacts and challenges of the COVID-19 pandemic on the lives of PWID. While rapid adaptations to service delivery to help mitigate the risks of COVID-19 were appreciated and some changes such as relaxation of supervised daily OST consumption were viewed positively, barriers to access need further attention. Going forwards there may be opportunities to harness the positive aspects of some changes to services.

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Section: Discussionmentioning

confidence: 98%

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

Kesten¹,

Holland²,

Linton³

et al. 2021

International Journal of Drug Policy

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“…There are an estimated 15.6 million people who inject drugs (PWID) worldwide, the global prevalence of HIV among PWID is 18%, and localized HIV outbreaks among PWID have been observed in numerous settings [4,5]. Colliding syndemics of IDU, HIV, HCV and overdose have been further exacerbated by social and economic harms caused by the COVID-19 pandemic and mitigation strategies [6][7][8][9]. Resultant shifts in drug distribution and consumption patterns, in addition to augmented barriers to health and social services, make access to essential care for PWID a timely priority [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Colliding syndemics of IDU, HIV, HCV and overdose have been further exacerbated by social and economic harms caused by the COVID-19 pandemic and mitigation strategies [6][7][8][9]. Resultant shifts in drug distribution and consumption patterns, in addition to augmented barriers to health and social services, make access to essential care for PWID a timely priority [6][7][8][9]. While the global burdens of substance use and related risk remain high, effective evidence-based public health interventions exist to reduce drug-related harms among people who inject drugs (PWID) [10].…”

Section: Introductionmentioning

confidence: 99%

Municipal police support for harm reduction services in officer-led referrals of people who inject drugs in Tijuana, Mexico

et al. 2021

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Background Police constitute a structural determinant of health and HIV risk of people who inject drugs (PWID), and negative encounters with law enforcement present significant barriers to PWID access to harm reduction services. Conversely, police may facilitate access via officer-led referrals, potentiating prevention of HIV, overdose, and drug-related harms. We aimed to identify police characteristics associated with support for officer-led referrals to addiction treatment services and syringe service programs (SSP). We hypothesized that officers who believe harm reduction services are contradictory to policing priorities in terms of safety and crime reduction will be less likely to support police referrals. Methods Between January and June 2018, police officers (n = 305) in Tijuana, Mexico, completed self-administered surveys about referrals to harm reduction services during the 24-month follow-up visit as part of the SHIELD police training and longitudinal cohort study. Log-binomial regression was used to estimate adjusted prevalence ratios and model policing characteristics and attitudes related to officers’ support for including addiction treatment and SSP in referrals. Results Respondents were primarily male (89%), patrol officers (86%) with a median age of 38 years (IQR 33–43). Overall, 89% endorsed referral to addiction services, whereas 53% endorsed SSP as acceptable targets of referrals. Officers endorsing addiction services were less likely to be assigned to high drug use districts (adjusted prevalence ratio [APR] = 0.50, 95% CI 0.24, 1.08) and more likely to agree that methadone programs reduce crime (APR = 4.66, 95% CI 2.05, 9.18) than officers who did not support addiction services. Officers endorsing SSPs were younger (adjusted prevalence ratio [APR] = 0.96 95% CI 0.93, 0.98), less likely to be assigned to high drug use districts (APR = 0.50, 95% CI 0.29, 0.87), more likely to believe that methadone programs reduce crime (APR = 2.43, 95% CI 1.30, 4.55), and less likely to believe that SSPs increase risk of needlestick injury for police (APR = 0.44, 0.27, 0.71). Conclusions Beliefs related to the occupational impact of harm reduction services in terms of officer safety and crime reduction are associated with support for referral to related harm reduction services. Efforts to deflect PWID from carceral systems toward harm reduction by frontline police should include measures to improve officer knowledge and attitudes about harm reduction services as they relate to occupational safety and law enforcement priorities. Trial Registration: NCT02444403.

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“… 3 , 4 Recent UK and US studies indicate a low incidence of COVID-19 in people who use drugs including, but not confined to, patients treated with opioid substitution treatment. 5 , 6 , 7 A US retrospective study concluded that patients with recent opioid use disorder were at higher risk for COVID-19 and that methadone, buprenorphine and naltrexone did not alter that risk. 8 However, detailed examination of this study does not provide strong evidence for this.…”

mentioning

confidence: 99%

“… An unexpectedly low incidence of COVID-19 has been observed in patients treated for opioid dependency with the long-acting opioid drugs methadone and buprenorphine. 1 , 2 , 7 , 4 , 5 , 6 , 7 , 8 , 9 , 10 2. Opioids have drug-specific and varied systemic immunomodulatory effects that may influence the response to the virus.…”

mentioning

confidence: 99%

Therapeutic potential of long-acting opioids and opioid antagonists for SARS-CoV-2 infection

Eagleton¹,

Stokes²,

Fenton³

et al. 2021

British Journal of Anaesthesia

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Preliminary indications of the burden of COVID-19 among people who inject drugs in England and Northern Ireland and the impact on access to health and harm reduction services

Cited by 38 publications

References 5 publications

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

Municipal police support for harm reduction services in officer-led referrals of people who inject drugs in Tijuana, Mexico

Therapeutic potential of long-acting opioids and opioid antagonists for SARS-CoV-2 infection

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