Indicators of Drug-Related Community Impacts of Open Drug Scenes: A Scoping Review

Zafarghandi, Mohammad Bagher Saberi; Eshrati, Sahar; Rashedi, Vahid; Vameghi, Meroe; Arezoomandan, Reza; Clausen, Thomas; Waal, Helge

doi:10.1159/000519886

Cited by 7 publications

(10 citation statements)

References 63 publications

(167 reference statements)

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“…In communities around the world, the COVID-19 pandemic laid bare underlying social inequities [40], and as reiterated by our findings, these inequities had notable consequences for the wellbeing of PWUD and their treatment experiences. First, for PWUD experiencing socioeconomic marginalization or unemployment, financial instability can not only jeopardize their material security, but also impact substance use patterns, drug scene involvement, and exposure to overdose risks, criminalization, or violence [41][42][43]. Second, COVID-19 threatened the physical health of iOAT clients, and ongoing research has demonstrated how substance use and comorbidities position PWUD for greater risk of severe COVID-19 outcomes [44,45].…”

Section: Discussionmentioning

confidence: 99%

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

et al. 2023

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Background Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider–client interaction—treatment components made difficult by the pandemic. Methods Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software. Results Qualitative analysis revealed the ways in which the pandemic shaped clients’ lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses. Conclusion Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.

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Section: Discussionmentioning

confidence: 99%

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

et al. 2023

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“…In communities around the world, the COVID-19 pandemic laid bare underlying social inequities [39], and as reiterated by our ndings, these inequities had notable consequences for the wellbeing of PWUD and their treatment experiences. First, for PWUD experiencing socioeconomic marginalization or unemployment, nancial instability can not only jeopardize their material security, but also impact substance use patterns, drug scene involvement, and exposure to overdose risks, criminalization, or violence [40][41][42]. Second, COVID-19 threatened the physical health of iOAT clients, and ongoing research has demonstrated how substance use and comorbidities position PWUD for greater risk of severe COVID-19 outcomes [43,44].…”

Section: Discussionmentioning

confidence: 99%

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

Jaffe

Blawatt

Lehal

et al. 2023

Preprint

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Background Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider-client interaction—treatment components made difficult by the pandemic. Methods Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software. Results Qualitative analysis revealed the ways in which the pandemic shaped clients’ lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses. Conclusion Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment offers, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.

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“…For example, individuals’ motivations to participate may be linked to their own experiences of substance use and treatment (or lack thereof) or a desire to reduce socioeconomic vulnerability that commonly accompanies high-intensity substance use (Richardson et al, 2015; Timmermans & McKay, 2009). Barriers to participation may be a function of reluctance to engage produced by strong social integration in drug use scenes (Saberi Zafarghandi et al, 2021) or negative interactions with surveillance from wide-ranging institutions (Brayne, 2014). Willingness to participate may be predominantly shaped by institutional interactions supportive of enrollment, such as positive interactions with healthcare professionals or social services (Friedmann et al, 2003).…”

Section: Methodsmentioning

confidence: 99%

Research Participation in Substance Use Disorder Trials: Design and Methods of a Multi-Site Nested Qualitative Study

Richardson

Jaffe

Socías

et al. 2022

International Journal of Qualitative Methods

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Background Given the health and social harms of problematic substance use, randomized controlled trials (RCTs) are critical in developing and testing pharmacotherapies for substance use disorders. However, substance use RCTs can be challenging to conduct, considering the social and structural barriers to participating in research among people with substance use disorders (PSUD), including stigma, poverty, and criminalization—factors that can shape trial recruitment, enrollment, protocol adherence and study retention. Despite these barriers, adequate representation and participation of PSUD in RCT research is essential to assessing and developing treatments, and thus a deeper understanding of RCT participation dynamics among PSUD is needed to support clinical trial research. Methods We conducted a nested qualitative study within a Canadian, multisite, phase IV, open-label, pragmatic RCT that tested two approved opioid agonist treatments, methadone and buprenorphine/naloxone, among patients with prescription opioid use disorder. A subset of individuals ( n = 60) participating in this RCT were interviewed across four different regions in Canada at the beginning and end of their trial involvement, as well as study clinicians ( n = 16) and staff ( n = 16) operating the trial. Conclusion As a nested study within a real-world addiction medicine trial, this research offers an innovative approach to investigating the experiences, strategies, and challenges associated with RCTs among PSUD. While we acknowledge challenges related to the operations of multisite research and engaging marginalized populations in experimental research, this study has the potential to generate critical insights around the RCT experiences of PSUDs and trial staff to inform the conduct of future RCTs.

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Indicators of Drug-Related Community Impacts of Open Drug Scenes: A Scoping Review

Cited by 7 publications

References 63 publications

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

Research Participation in Substance Use Disorder Trials: Design and Methods of a Multi-Site Nested Qualitative Study

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