The impact of COVID-19 on people who inject drugs in New York City: increased risk and decreased access to services

Aponte-Meléndez, Yesenia; Mateu‐Gelabert, Pedro; Fong, Chunki; Eckhardt, Benjamin; Kapadia, Shashi N; Marks, Kristen

doi:10.1186/s12954-021-00568-3

Cited by 44 publications

(60 citation statements)

References 51 publications

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“…The morbidity and mortality associated with the ongoing overdose crisis have continued to increase over the past decade. The COVID-19 pandemic further compounded the impact of the overdose crisis by reducing access to SSPs and other harm reduction services and exacerbating underlying mental health issues [ 38 – 40 ]. Harm reduction programs offer a powerful and patient-centered tool to mitigate the negative consequences of substance use [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

et al. 2022

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Background Community-based harm reduction programs reduce morbidity and mortality associated with drug use. While hospital-based inpatient addiction consult services can also improve outcomes for patients using drugs, inpatient clinical care is often focused on acute withdrawal and the medical management of substance use disorders. There has been limited exploration of the integration of community-based harm reduction programs into the hospital setting. We conducted a qualitative study to describe provider perspectives on the implementation of a harm reduction in-reach program. Methods We conducted 24 semi-structured interviews with providers from three different primary work sites within a safety net hospital in Boston, MA, in 2021. Interviews explored perceived facilitators and barriers to the implementation of the harm reduction in-reach program in the hospital setting and solicited recommendations for potential improvements to the harm reduction in-reach program. Interviews were analyzed using an inductive approach that incorporated principles of grounded theory methodology to identify prevailing themes. Results Twenty-four participants were interviewed from the harm reduction in-reach program, inpatient addiction consult service, and the hospital observation unit. Thematic analysis revealed seven major themes and multiple facilitators and barriers to the implementation of the harm reduction in-reach program. Participants highlighted the impact of power differences within the medical hierarchy on inter-team communication and clinical care, the persistence of addiction-related stigma, the importance of coordination and role delineation between care team members, and the benefits of a streamlined referral process. Conclusions Harm reduction programs offer accessible, patient-centered, low-barrier care to patients using drugs. The integration of community-based harm reduction programs into the inpatient setting is a unique opportunity to bridge inpatient and outpatient care and expand the provision of harm reduction services. Trial registration: Not applicable.

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Section: Discussionmentioning

confidence: 99%

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

et al. 2022

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“…For individuals experiencing homelessness, the initiatives introduced during COVID-19 focused on preventing disease transmission and providing temporary accommodation to house individuals sleeping rough [ 48 ]. Low substance use treatment rates coupled with high drug related deaths during COVID-19 suggests initiatives did not address the substance use needs of people experiencing homelessness [ 49 ]. This suggests that the health system was likely ill-prepared/equipped to meet these needs of people experiencing homelessness during the pandemic.…”

Section: Introductionmentioning

confidence: 99%

“…This suggests that the health system was likely ill-prepared/equipped to meet these needs of people experiencing homelessness during the pandemic. Recent COVID-19 studies have highlighted a gap in understanding the depth of experiences for those who were dealing with mental health and substance use and particularly among people experiencing homelessness [ 45 , 46 , 49 , 50 ].…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19

Adams

Parker²,

Jablonski³

et al. 2022

IJERPH

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People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.

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“…To help mitigate the negative consequences of COVID‐19 restrictions, the introduction of disaster relief planning as a collaborative effort between NSPs, advocacy services for people who inject drugs, drug treatment organisations and government authorities, should be considered. Providing clear and concise information regarding access to health and support services has been shown to be a vital factor in informing decision‐making processes for both clients and service providers in other settings [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Health service utilisation and access for people who inject drugs during COVID‐19

Efunnuga

Higgs

Walker

et al. 2022

Drug and Alcohol Review

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Introduction The wide‐spread implementation of interventions to limit transmission and public health consequences of COVID‐19 in the Australian state of Victoria had flow‐on consequences for people who use and inject drugs. Consequences included the interruption of illicit drug supply and drug procurement, and the disruption to the delivery of health services. To inform strategies that can minimise the adverse outcomes of similar future disruptive events, this study explored how COVID‐19 restrictions impacted access to harm reduction and drug treatment services for people who inject drugs in Melbourne, Victoria. Methods Qualitative semi‐structured interviews were conducted via an online calling app, with 11 participants of a broader cohort study (the SuperMIX study) in April 2020. Interviews were focused on participants experiences of accessing and using harm reduction and drug treatment services. Data were thematically analysed using a process of blended coding. Results Findings revealed how disruptions in the delivery of harm reduction and drug treatment services—in response to COVID‐19 restrictions—created barriers accessing sterile injecting equipment, increased risk of arrest by police and exacerbated social isolation. Participants reported difficulties adapting to changes in services access, with some increases in injecting risk behaviours. However, improvements in opioid agonist therapy prescriptions were noted as a beneficial outcome. Discussion By examining the impacts of COVID‐19 and the resultant restrictions on people who inject drugs' access to health services in Melbourne, Victoria, findings provide guidance for future responses to the unanticipated large‐scale effects of the COVID‐19 pandemic, and similar disruptive events.

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The impact of COVID-19 on people who inject drugs in New York City: increased risk and decreased access to services

Cited by 44 publications

References 51 publications

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19

Health service utilisation and access for people who inject drugs during COVID‐19

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