Opioid use disorder treatment disruptions during the early COVID-19 pandemic and other emergent disasters: a scoping review addressing dual public health emergencies

Abstract

Background During public health emergencies, people with opioid use disorder (PWOUD) may be particularly impacted. Emergent disasters such as the COVID-19 pandemic disrupt already-strained harm reduction efforts and treatment availability. This study aims to answer three research questions. How do public health emergencies impact PWOUD? How can health systems respond to novel public health emergencies to serve PWOUD? How can the results of this scoping review be contextualized to the province of Alberta to inform local stakeholder responses to the pandemic? Methods We conducted a scoping review using the 6-stage Arksey and O’Malley framework to analyse early-pandemic and pre-pandemic disaster literature. The results of the scoping review were contextualized to the local pandemic response, through a Nominal Group Technique (NGT) process with frontline providers and stakeholders in Alberta, Canada. Results Sixty one scientific journal articles and 72 grey literature resources were included after full-text screening. Forty sources pertained to early COVID-19 responses, and 21 focused on OUD treatment during other disasters. PWOUD may be more impacted than the general population by common COVID-19 stressors including loss of income, isolation, lack of rewarding activities, housing instability, as well as fear and anxiety. They may also face unique challenges including threats to drug supplies, stigma, difficulty accessing clean substance use supplies, and closure of substance use treatment centres. All of these impacts put PWOUD at risk of negative outcomes including fatal overdose. Two NGT groups were held. One group (n = 7) represented voices from urban services, and the other (n = 4) Indigenous contexts. Stakeholders suggested that simultaneous attention to multiple crises, with adequate resources to allow attention to both social and health systems issues, can prepare a system to serve PWOUD during disasters. Conclusion This scoping review and NGT study uncovers how disasters impact PWOUD and offers suggestions for better serving PWOUD.

COVID-19 economic impact payments and opioid overdose deaths

“…Regarding the economic impact payments, Tsai et al, (2021) found that those that first received the economic impact payment during the COVID-19 pandemic had a significantly increased use of any illicit drug in the past month. When taken into consideration with the previously identified COVID-19 policy impact on PWOUD such as social isolation, loss of income/ housing, reduced availability of harm reduction strategies and decreased access to MOUD ( Henderson et al, 2021 ), the sudden infusion of economic resources created by the economic impact payments may have also played a contributing role in the exacerbation of the opioid epidemic.…”

“…In their review of the treatment disruptions in OUD associated with COVID-19 pandemic measures, Henderson et al, (2021) clearly and succinctly make the case for public policy makers to adequately predict and anticipate the negative consequences of public health measures implemented in future pandemics and not to only focus on one crisis at a time. Del Pozo & Beletsky (2020) suggest that the COVID-19 pandemic has created an opportunity for innovative and adaptive public health and drug policy.…”

“…Policy responses to the pandemic have inadvertently resulted in contributing to the exacerbation of the epidemic. During the COVID-19 pandemic, people with opioid use disorder (PWOUD) have been shown to be more susceptible to COVID-19 mediated stressors than the general population, namely, social isolation, loss of income/ housing, reduced availability of harm reduction strategies and decreased access to medication treatment for opioid use disorder (MOUD; Holmes et al, 2020 ; Henderson et al, 2021 ). Social isolation increases the likelihood of opioid overdose in part due to the lack of observers to administer naloxone ( Volkow, 2020 ).…”

“…Social isolation increases the likelihood of opioid overdose in part due to the lack of observers to administer naloxone ( Volkow, 2020 ). Further, PWOUD struggle to meet basic needs and therefore may turn to informal income sources and use of substances in isolation ( Henderson et al, 2021 ). Lack of access to MOUD has further resulted in gaps in maintenance therapy ( Narayan et al, 2021 ).…”

“…Although these government provided income assistance payments are intended to pay for basic needs, it may actually be facilitating a cyclic pattern of substance use and increased overdose deaths ( Shaner et.al., 1995 ). The lack of basic needs has placed an increase burden on PWOUD which has contributed to their dangerous use of substances in isolation ( Henderson et al, 2021 ). Here, we set to investigate the timing of the COVID-19 economic impact payments and the increases in opioid overdose deaths that have been reported during the COVID-19 pandemic ( Vieson et.…”