Understanding the impact of the SARS-COV-2 pandemic on hospitalized patients with substance use disorder

Abstract

Background The SARS-COV-2 pandemic rapidly shifted dynamics around hospitalization for many communities. This study aimed to evaluate how the pandemic altered the experience of healthcare, acute illness, and care transitions among hospitalized patients with substance use disorder (SUD). Methods We performed a qualitative study at an academic medical center in Portland, Oregon, in Spring 2020. We conducted semi-structured interviews, and conducted a thematic analysis, using an inductive approach, at a semantic level. Results We enrolled 27 participants, and identified four main themes: 1) shuttered community resources threatened patients’ basic survival adaptations; 2) changes in outpatient care increased reliance on hospitals as safety nets; 3) hospital policy changes made staying in the hospital harder than usual; and, 4) care transitions out of the hospital were highly uncertain. Discussion Hospitalized adults with SUD were further marginalized during the SARS-COV-2 pandemic. Systems must address the needs of marginalized patients in future disruptive events.

“No home to take methadone to”: Experiences with addiction services during the COVID-19 pandemic among survivors of opioid overdose in Boston

“…Namely, unhoused participants described an inability to meet their daily needs with the closure of public spaces and increases in policing, which reduced access to things like harm reduction supplies, clean water, and bathrooms. These findings are in line with other studies that similarly found shuttering of community resources exacerbated inequities experienced by unhoused people who use drugs ( King et al, 2021 ; Parkes et al, 2021 ). Policy makers must consider the risks associated with increased surveillance or policing and reducing access to public services for structurally marginalized populations while designing policies to protect other, less marginalized, community members ( Grebely et al, 2020 ; Perri et al, 2020 ).…”

“…Importantly, our findings build on others that show community-based addiction services for people who use drugs or those experiencing housing insecurity were multi-purpose spaces that offered more than harm reduction and social services ( King et al, 2021 ). Before their closing, these brick-and-mortar institutions offered safe places for people who use drugs to be and connect with their community daily.…”

“…Additionally, changes in access to harm reduction and substance use treatment services, which have historically relied on in-person interactions, may also be contributing to increased overdose rates ( EMCDDA, 2020 ). People with opioid use disorder (OUD) and a history of overdose, many of whom have co-morbid physical and mental health conditions, may be particularly vulnerable to the effects of the COVID-19 pandemic ( King et al, 2021 ; Larochelle et al, 2019 ; Leece et al, 2015 ; Weiner et al, 2017 ). One effective opioid overdose prevention strategy is treatment with medications for opioid use disorder (MOUD), which have been historically highly regulated in the United States ( Larochelle et al, 2019 ; Pearce et al, 2020 ; Sordo et al, 2017 ).…”

Impact of the COVID-19 Pandemic on the Experiences of Hospitalized Patients: A Scoping Review

“…Regarding the identification of feelings experienced during hospitalization , 71.9% (n = 23) of the articles indicated that the patients and family members experienced difficult moments 47 during the hospitalization period, with feelings of loneliness 16 , 17 , 21 , 31 and isolation 16 , 17 , 21 , 29 , 31 , 40 , 41 due to the restrictions regarding visits and companions and a lack of contact between professionals and patients. 20 Feelings such as sadness, 23 , 26 , 46 fear, 17 , 18 , 20 , 22 , 24 – 29 , 32 , 33 , 46 anxiety, 17 , 22 , 28 , 38 , 41 , 46 worry, 17 , 20 – 24 , 32 , 33 , 46 nervousness, 22 guilt, 26 , 46 anger, 23 , 26 tiredness, 24 hopelessness, 46 frustration, 43 discrimination, 18 , 22 vulnerability, 29 , 32 , 46 and uncertainty 22 were also reported, associated with lack of knowledge about the disease and with the situation in which they found themselves.…”

“…17 Thus, the importance of implementing strategies that alleviate psychological distress during hospitalization in isolation is highlighted, with an emphasis on people-and familycentered care. 21,50 Regarding the team's empathetic stance during the hospitalization period, the importance of the support by the care team was evidenced. However, the isolation measures hindered the patientprofessional interaction.…”