A rapid review of the impacts of “Big Events ” on risks, harms, and service delivery among people who use drugs: Implications for responding to COVID-19

Zolopa, Camille; Høj, Stine Bordier; Bruneau, Julie; Meeson, Julie-Soleil; Minoyan, Nanor; Raynault, Marie-France; Makarenko, Iuliia; Larney, Sarah

doi:10.1016/j.drugpo.2021.103127

Cited by 58 publications

(62 citation statements)

References 60 publications

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“…PWID are considered at high risk of COVID-19 infection and more severe health outcomes due to their susceptibility to infectious diseases, and cardiac and respiratory diseases ( Benzano et al, 2021 ; Jacka et al, 2020 ). Additional risks to PWID can be identified from a recent review of previous “Big Events” (including natural disasters and heroin shortages), which found these caused major disruptions to drug markets, negatively impacted participants’ mental health, and resultant economic instability affected the funding and coverage of harm reduction and treatment services ( Zolopa et al, 2021 ). COVID-19 public health measures restricting social interactions to limit the spread of the virus ( Baker et al, 2021 ) are also anticipated to pose significant challenges for PWID ( Jacka et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…In an online survey of adults residing in the Northeastern U.S., daily users of opioids and alcohol were less likely to adhere to COVID-19 related stay-at-home orders, and stimulant users were more likely to report having tested positive for SARS-CoV-2 [ 9 ]. There are also reports that the COVID-19 pandemic has interrupted global drug supplies as well as harm reduction and addiction treatment services, which could alter drug use patterns [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region

et al. 2021

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Background People who inject drugs may be at elevated SARS-CoV-2 risk due to their living conditions and/or exposures when seeking or using drugs. No study to date has reported upon risk factors for SARS-CoV-2 infection among people who inject drugs. Methods and findings Between October, 2020 and June, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month underwent interviews and testing for SARS-CoV-2 RNA and antibodies. Binomial regressions identified correlates of SARS-CoV-2 seropositivity. Results Of 386 participants, SARS-CoV-2 seroprevalence was 36.3% (95% CI: 31.5%-41.1%); 92.1% had detectable IgM antibodies. Only 37.5% had previously been tested. Seroprevalence did not differ by country of residence. None tested RNA-positive. Most (89.5%) reported engaging in ≥1 protective behavior [e.g., facemasks (73.5%), social distancing (46.5%), or increasing handwashing/sanitizers (22.8%)]. In a multivariate model controlling for sex, older age, and Hispanic/Latinx/Mexican ethnicity were independently associated with SARS-CoV-2 seropositivity, as was engaging in sex work (AdjRR: 1.63; 95% CI: 1.18–2.27) and having been incarcerated in the past six months (AdjRR: 1.49; 95% CI: 0.97–2.27). Comorbidities and substance using behaviors were not associated with SARS-CoV-2 seropositivity. Conclusions In this community-based study of people who inject drugs in the San Diego-Tijuana border region, over one third were SARS-CoV-2 seropositive, exceeding estimates from the general population in either city. We found no evidence that substance use behaviors were associated with an elevated risk of SARS-CoV-2 infection, but observed that circumstances in the risk environment, notably sex work and incarceration, were independently associated with higher SARS-CoV-2 seroprevalence. Our findings suggest that a binational policy response to COVID-19 mitigation is warranted beyond the closure of the U.S.-Mexico border. Furthermore, decriminalizing sex work and drug use could reduce the burden of COVID-19 among people who inject drugs.

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“…A big event refers to social crises triggered by diseases, hurricanes, terrorist attacks, and other phenomena that negatively affect PWID health by weakening care structures (macro-level) and changing individual behaviors (micro-level) [ 33 – 36 ]. At the micro-level, big events can lead to changes in drug use and injection risks [ 35 ]. At the macro-level, big events can lead to major disruptions in disease- and overdose-prevention programs [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

“…At the micro-level, big events can lead to changes in drug use and injection risks [ 35 ]. At the macro-level, big events can lead to major disruptions in disease- and overdose-prevention programs [ 35 ]. The last big event in New York City was Hurricane Sandy in 2012, during which shifts in injection risk behaviors and closures of prevention services were documented [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background While people who inject drugs (PWID) are vulnerable to the adverse outcomes of events like COVID-19, little is known regarding the impact of the current pandemic on PWID. We examine how COVID-19 has affected PWID in New York City across four domains: substance use, risk behaviors, mental health, and service utilization. Methods As part of a randomized trial to improve access to HCV treatment for PWID, we recruited 165 participants. Eligibility criteria included detectable HCV RNA and recent drug injection. The present cross-sectional analysis is based on a subsample of 106 participants. We compared responses between two separate samples: 60 participants interviewed prior to the pandemic (pre-COVID-19 sample) and 46 participants interviewed during the pandemic (COVID-19 sample). We also assessed differences by study group [accessible care (AC) and usual care (UC)]. Results Compared to the pre-COVID-19 sample, those interviewed during COVID-19 reported higher levels of mental health issues, syringe reuse, and alcohol consumption and greater reductions in syringe-service programs and buprenorphine utilization. In the analysis conducted by study group, the UC group reported significantly higher injection risk behaviors and lower access to buprenorphine treatment during COVID-19, while during the same period, the AC group reported lower levels of substance use and injection risk behaviors. Conclusion The current study provides insight on how COVID-19 has negatively affected PWID. Placing dispensing machines of harm-reduction supplies in communities where PWID live and increasing secondary exchange, mobile services, and mail delivery of supplies may help maintain access to lifesaving supplies during big events, such as COVID-19. Trial registration ClinicalTrials.gov NCT03214679. Registered July 11 2017. https://clinicaltrials.gov/ct2/show/NCT03214679.

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A rapid review of the impacts of “Big Events ” on risks, harms, and service delivery among people who use drugs: Implications for responding to COVID-19

Cited by 58 publications

References 60 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

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region

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

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