Changes In Drug Use Research Articles

Implementation of time-limited parenteral hydromorphone in people with treatment-resistant injecting opioid use disorder: a protocol for a single-site, uncontrolled, open-label study to assess feasibility, safety and cost

IntroductionSupervised injectable opioid treatment (SIOT) is an evidence-based intervention targeting opioid-dependent people for whom existing treatments have been ineffective. This project will primarily assess the feasibility and the acceptability of...

W134 - Pandemic Era Changes in Drug Use and Harm Reduction Behavior Among People who Use Drugs in Rural Illinois

W134 - Pandemic Era Changes in Drug Use and Harm Reduction Behavior Among People who Use Drugs in Rural Illinois

Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry

BackgroundIn recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings.MethodsWe conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use.ResultsWe interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment.ConclusionIn a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.

Impact of supply chain disruptions and drug shortages on drug utilization: A scoping review protocol.

This proposed scoping review aims to examine studies assessing the impact of drug shortages on population-level drug utilization trends. The objectives of this review are to a) assess which drugs have been studied and describe associated drug characteristics, b) determine jurisdictions and healthcare settings that have conducted these studies, and c) describe how changes in drug use and the extent of shortage impacts are reported in literature. Drug shortages continue to impair drug access and delivery of quality care across the world. However, the impact of drug supply disruptions on availability and drug use are understudied in current literature. This proposed scoping review will identify this gap and inform future research initiatives aimed at determining the real-world impacts of drug shortages. Published and unpublished observational studies reporting on the effects of drug supply chain disruptions (shortages, discontinuations, and safety-based withdrawals) on consequent utilization trends faced by pharmaceutical products (i.e. prescription drugs, over-the-counter drugs, vaccines, therapy products, pharmaceutical solutions). Literature reviews, meta-analyses, randomized control trials, case series, case reports, and opinion pieces will be excluded. The search strategy will combine two key search concepts: drug shortages and drug utilization. The search will be conducted in MEDLINE and EMBASE. This will be followed by an extensive grey literature search in grey literature databases, targeted websites and Google. Furthermore, reference lists of included articles will be searched. Articles will be independently screened, selected and extracted by two reviewers. Data will be descriptively analyzed and presented in tables. Review registration number: Open Science Framework, https://osf.io/2p6e5.

Evidence into practice: a national cohort study of NICE-recommended oncological drug therapy utilisation among women diagnosed with invasive breast cancer in England

BackgroundMultiple drug treatments are approved for invasive breast cancer (IBC). We investigated uptake of NICE-recommended oncological drugs and variation by age, comorbidity burden and geographical region.MethodsWomen (aged 50+ years) diagnosed with IBC from 2014 to 2019, were identified from England Cancer Registry data and drug utilisation from Systemic Anti-Cancer Therapy data. Interrupted time series analysis assessed national-level changes in drug use after publication of NICE recommendations. Regression models analysed variation in use.ResultsThis national cohort included 168,449 women. Use of drugs recommended for first-line treatment varied, from 26.6% for CDK 4/6 inhibitors to 63.8% for HER2-targeting therapies. Utilisation of drugs with a NICE recommendation published between 2014 and 2019, increased among patients diagnosed around the time of publication, except in the case of pertuzumab for metastatic breast cancer (MBC) which was previously accessible via the Cancer Drugs Fund (though use of pertuzumab for MBC increased from 34.1% to 75.0% across the study period). Use of trastuzumab and neoadjuvant/adjuvant pertuzumab varied by geographical region. Use was low for ribociclib (2.2%), abemaciclib (2.3%) and for drugs recommended beyond the first-line setting. For all drugs, use after NICE recommendation varied by age at diagnosis and increased as stage increased.ConclusionsUse of NICE-recommended drugs for IBC in routine care is variable, with lowest use among women aged 70+ years. Improving access to effective treatments is an important step in improving outcomes.

Effectiveness of Addiction Treatment Programs in Iran in Terms of Social, Psychological, Economic, and Therapeutic Outcomes: An Appraisal

Objectives: In recent years, various treatment programs have been implemented in Iran aimed at rehabilitation and improvement of drug-dependent patients but so far, few studies have been conducted on the effectiveness of different treatment programs in terms of different outcomes. This study was conducted to determine the differences among patients participating in three therapeutic programs, outpatient, mid-term residential program, and therapeutic community (TC) in terms of social, psychological, economic, and therapeutic outcomes. Methods: The present study was conducted using a descriptive design and ex post facto method. Data were collected from patients participating in three treatment plans (outpatient treatment=49; mid-term residential treatment=49; and TC plan=49). Patients participating in the TC program were all enumerated and patients participating in the outpatient and mid-term residency treatment plan were selected by random sampling. Data collection tools were a socio-demographic characteristics checklist, researcher-made questionnaire for relapse, a general health questionnaire (GHQ), a world health organization quality of life (WHOQOL) questionnaire, and a family relationship index (FRI). The data were analyzed by one-way analysis of variance (ANOVA), chi-square, and Scheffe’s post hoc test. Results: Significant differences were observed between the three treatments in terms of the rate of relapse (P<0.01), participation in criminal activities (P<0.01), changes in drug use in the treatment process or after treatment (P<0.01), employment status (P<0.01), mental health (P<0.01), quality of life (P<0.01), and family relationships index (FRI) (P<0.01). Discussion: The TC program showed more positive outcomes in terms of the rate of relapse and quality of life compared to the other two therapeutic programs. The outpatient treatment program was more effective in terms of participation in criminal activities, changes in drug use, employment, and quality of family relationships. The mid-term residency program showed a low or negative impact on all studied outcomes. Therefore, it is necessary to reevaluate the programs presented in the mid-term residential program.

Monitoring medication and illicit drug consumption in a prison by wastewater-based epidemiology: Impact of COVID-19 restrictions

Drug consumption in prisons is a concern for the safety of incarcerated people and staff. Typically, drug use prevalence in prisons is estimated through urinalysis and intelligence operations, which can be intrusive and stressful. An alternative approach, wastewater-based epidemiology (WBE), was used in this study to estimate the consumption of licit and illicit drugs for the entire population of a prison in Australia. Wastewater samples were collected from March to December 2020, covering periods of no restrictions and periods when prison access was restricted to prevent the transmission of COVID-19. Target biomarkers were analysed by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). The average consumption of common illicit drugs (MDMA, methamphetamine and cocaine) over the sampling period in the prison (0.5 – 4.5 mg/1000 people/day) was two to three orders of magnitude lower than in the community population (254 – 1000 mg/1000 people/day). Comparison of WBE estimates against pharmacy dispensing data suggested potential illicit buprenorphine consumption at the prison. Methamphetamine and buprenorphine use decreased when no visitors were allowed (18% - 72% decrease for methamphetamine; about half decrease for buprenorphine) and increased once these restrictions were eased (22% - 39% increase for methamphetamine; 44% - 67% increase for buprenorphine). The changes in drug use may be attributed in part to a reduction of drug trafficking into the prison from visitors or non-essential staffs and in part to the reduced contribution of urine from staff who used toilets within the prison. This study provided useful information on the scale of illicit drug use and extra-medical use of licit drugs in prison, and its changes under different security conditions.

Is a change in social competencies associated with a change in drug use and crime in substance-abusing offenders? Evidence from the breaking the cycle demonstration project.

The Breaking the Cycle (BTC) Demonstration Project is an intensive drug intervention programme designed to break the cycle of drug use and offending in which many substance-abusing offenders find themselves trapped, by providing them with alternatives to drug use and crime. To determine whether an increase in social competencies mediates between any relationship involving enrolment in the Breaking the Cycle Demonstration Project and subsequent drug use or self-reported offending. A group of 1088 Project participants (847 males and 241 females) were compared to a set of 987 offenders who received standard probation services alone (756 males and 231 females) using a quasi-experimental research design. Project participants reported a significant rise in social competencies and significant reductions in both drug use and self-reported offending compared to the comparison group. While social competencies mediated the BTC-subsequent drug use association, drug use did not mediate the BTC-subsequent social competencies association. The direction of the social competencies-offending relationship was more equivocal in that both progressions (from BTC to social competencies and from BTC to offending) were significant. These findings add to the evidence of the success of the Breaking the Cycle Demonstration Project in reducing drug use and offending by finding that improvements in social competencies among substance-abusing participants may be a critical step in reducing drug use. The route to reducing reoffending is not so dependent on a single pathway, although findings suggest that more attention should be paid to both changing and measuring social competencies in future interventions with substance-misusing offenders.

Leaving Their Drugs at the Gate? Exploring Changes in Drug Use From Before to During Incarceration in Norway.

As the number of incarcerated persons who use drugs increases in many countries, it is important to understand the nature of drug use in prison by exploring how substance use patterns change from before to during incarceration. In this study, we rely on cross-sectional, self-report data from The Norwegian Offender Mental Health and Addiction (NorMA) study to identify the nature of changes in drug use among incarcerated respondents who reported having used either narcotics, non-prescribed medications, or both, during the 6 months before their incarceration (n = 824). Results show that about 60% (n = 490) stop using drugs. Of the remaining 40% (n = 324), about 86% changed their use patterns. Most commonly, incarcerated people stopped using stimulants and started using opioids; switching from cannabis to stimulants was the least common change. Overall, the study illustrates that the prison context leads most individuals to change their use patterns, some in unanticipated ways.

Drug Use, Family Support, and Depressive Symptoms Among Latinx Sexual Minority Men: A Longitudinal Analysis.

Family rejection has negative health consequences for Latinx sexual minority men(LSMM). However, LSMM often reconcile with their families, a phenomenon cross-sectional studies miss. We analyzed longitudinal data from the Healthy Young Men's Study in Los Angeles. We used individual fixed-effects Poisson regression to model changes over time in the associations among family support, drug use, and depressive symptoms. We found that (1) the initiation of drug use was associated with a 7.2% (Ratio=1.072, 95% CI 1.006 - 1.142, p = 0.03) increase in family support among LSMM who reported high depressive symptoms (depression subscale T-score ≥ 63) in at least one data wave; (2) a 1-unit increase in family support was associated with a 4.7% (RR = ;0.953, 95% CI 0.931 - 0.976, p < 0.001) decrease in the probability of high depressive symptoms; and (3) no significant association between a change in drug use and a change in high depressive symptoms. Over time, LSMM appear to benefit from the health effects of family support associated with Latinx family structures.

Drug consumption in German cities and municipalities during the COVID-19 lockdown: a wastewater analysis

Analysis of illicit drugs, medicines, and pathogens in wastewater is a powerful tool for epidemiological studies to monitor public health trends. The aims of this study were to (i) assess spatial and temporal trends of population-normalized mass loads of illicit drugs and nicotine in raw wastewater in the time of regulations against SARS-CoV-2 infections (2020–21) and (ii) find substances that are feasible markers for characterizing the occurrence of selected drugs in wastewater. Raw sewage 24-h composite samples were collected in catchment areas of 15 wastewater treatment plants (WWTPs) in urban, small-town, and rural areas in Germany during different lockdown phases from April 2020 to December 2021. Parent substances (amphetamine, methamphetamine, MDMA, carbamazepine, gabapentin, and metoprolol) and the metabolites of cocaine (benzoylecgonine) and nicotine (cotinine) were measured. The daily discharge of WWTP influents were used to calculate the daily load (mg/day) normalized by population equivalents (PE) in drained catchment areas (in mg/1,000 persons/day). A weekend trend for illicit drugs was visible with higher amounts on Saturdays and Sundays in larger WWTPs. An influence of the regulations to reduce SARS-CoV-2 infections such as contact bans and border closures on drug consumption has been proven in some cases and refuted in several. In addition, metoprolol and cotinine were found to be suitable as marker substances for the characterization of wastewater. A change in drug use was visible at the beginning of the SARS-CoV-2 crisis. Thereafter from mid-2020, no obvious effect was detected with regard to the regulations against SARS-CoV-2 infections on concentration of drugs in wastewater. Wastewater-based epidemiology is suitable for showing changes in drug consumption during the COVID-19 lockdown.

COVID-19 Infection and Seropositivity in Multiple Sclerosis Patients in Guilan in 2021

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. COVID-19 has presented a significant challenge to the care providers of patients with MS. Objectives: The present study aimed to investigate the frequency of COVID-19 infection and its seropositivity in MS patients in Guilan, Iran, in 2021. Materials &amp; Methods: In this analytical-cross-sectional study, all patients with relapsing-remitting MS registered in the Guilan MS Association with an expanded disability status scale of less than 5 who were referred for evaluation participated in the study. Information related to the clinical and serological symptoms of COVID-19 infection, changes in drug use, and the occurrence of new attacks were collected. Serological results of COVID-19 (IgG) among them were registered. Results: In total, 260 patients with MS (78.8% women, and 21.2% men) with a Mean±SD age of 38.7±9.9 years, and a Mean±SD duration of MS of 8.9±4.9 years were investigated. The most commonly used drugs were Dimethyl fumarate, Interferon, and Rituximab, respectively. Thirty-three patients (12.6%) had a clinical COVID-19 infection, of which 32 people had a mild and only one had a critical infection. Eight patients (1.3%) had positive COVID-19 IgG tests. No significant relationship was found between the COVID-19 infection with the type of medication, medication change, clinical attack of MS, and co-morbidities (P&gt;0.05). Conclusion: A few patients had positive COVID-19 IgG tests and clinical COVID-19 infection. The vast majority had mild disease, and the clinical attack was not related to COVID-19 infection.

A mixed-methods evaluation of an Irish remote model of opioid substitution treatment.

Providing health care to rural communities is a challenge, particular for marginalised groups like people who use drugs. The ongoing COVID-19 pandemic further increases these challenges. The use of remote models of care, including telemedicine, help to mitigate the impact of COVID-19 and provide new opportunities to engage existing and new patients in treatment. It is recognised that people who used opioids have increased health needs and struggle to engage in health care compared to the general population. Opioid substitution treatment (OST) is effective at reducing these health inequalities but coverage is often inadequate. To increase access to OST during the pandemic, a national remote model of OST was developed in Ireland. An evaluation is being conducted 18 months after commencement to evaluate its effectiveness at engaging people in OST, its impact on their drug use, general health and quality of life. The evaluation also aims to describe the experiences of both services providers and users and report aspects that can be modified and improved. A mixed-methods evaluation is being conducted. It consists of a chart review that collects demographic data (age, sex, family details and education and employment status). It also includes the collection and analysis of data on engagement in treatment, changes in drug use and general health. A series of one-to-one interviews are being conducted (service providers (n=12) and service users (n=10).Thematic analysis of the interview narratives will be conducted using NVivo 11. The results will be ready in 2022.

LONGITUDINAL ASSOCIATIONS OF SOCIAL CONNECTEDNESS, SOCIAL CONTRIBUTION, SOCIAL ENGAGEMENT, AND LATE-LIFE DRUG USE

Abstract Substance misuse among older adults is a growing and complex problem with implications for society, aging adults, and their families. It is understudied in research and clinical practice. Limited and mixed evidence exists that suggests relationships between changes in older adults’ social environment and their drug use over time. This study addressed this gap by examining potential associations between social environment and drug use among community-dwelling older adults. Data were drawn from 3-waves of the national longitudinal survey of Midlife Development in the United States (MIDUS) (N= 2,020; age range=55-94 years; Mean=63.10, SD=5.66 at Wave 1). We estimated multilevel logistic growth models to assess the relationships between social environment indicators (social connectedness, social contribution, social engagement) and drug use, controlling for age, marital status, race/ethnicity, education level, household income, employment status, and number of chronic conditions. Our findings showed significant odds of drug use over the 20-year period of study, which were increased among older adults with multiple chronic conditions with a 59.5% risk of drug-related problems. Social contribution (feelings of being valued by society) negatively predicted older adults’ drug use whereas social connectedness and social engagement were not significant predictors over time. The models also indicated a moderating effect of social contribution on drug use, showing low changes in drug use over time with low social contribution. Our findings illuminate the differential roles of social environment indicators in drug use. Future research, policy, and practice may particularly focus on the role of social contribution in late-life drug use.

Social distancing and changes in drug use: Results from a cross-sectional study during the COVID-19 pandemic in Brazil.

The outbreak of coronavirus disease 19 has led to measures of social distancing and quarantine worldwide. This stressful period may lead to psychological problems, including changes in substance use. In addition, sociodemographic factors are linked to changed levels of drug use and abuse observed during the COVID-19 pandemic, which are also associated with increased anxiety, depression, and other disorders. Thus, the aim of the study was to investigate (i) changes in drug use during the COVID-19 pandemic associated with social distancing, and (ii) to verify factors associated with those changes. A web-based cross-sectional observational survey was completed by a self-selected adult general population in Brazil (N = 2,435) during September/October 2020 (first wave) before and throughout the pandemic. Key outcomes: social distancing, self-reported drug use (ASSIST), and emotional states (DASS-21). High social distancing was associated with fewer chances (prevalence ratio) of increased drug use for alcohol (0.71, CI95%: 0.64-0.80), tobacco (0.72; CI95%: 0.60-0.87), cannabis (0.65; CI95%: 0.55-0.78), and others. Low social distancing presented a higher DASS-21 score for anxiety (P = 0.017). Concerning covariates analysis by a general linear model, men (alcohol: 1. 71; cannabis: 3.86), younger age (alcohol: 0.97), less education (alcohol, tobacco, cannabis and cocaine/crack comparing several lower schooling categories vs. higher education), lower income (alcohol: 0.42; tobacco: 0.47; and cannabis: 0.36), and higher depression DASS-21 score (alcohol: 1.05; tobacco: 1.08; cannabis: 1.07; and cocaine/crack: 1.07) were associated with higher use prevalence of several drugs. Individuals reporting low social distancing increased the use of most drugs during the pandemic, while high social distancing significantly decreased drug use. Anxiety and depressive states and several sociodemographic factors (men; lower income; less education) were associated with higher drug use patterns.

The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial

BackgroundThere is limited knowledge regarding the process of deprescribing psychotropic drugs to people with dementia (PwD) conducted by general practitioners (GP). We investigated the impact of a multicomponent intervention, emphasizing medication reviews, on psychotropic drugs and behavioral and psychological symptoms (BPSD) in home-dwelling PwD and quantified change in patient-GP communication evaluated by their informal caregivers.MethodsLIVE@Home.Path is a stepped-wedge closed-cohort cluster randomized controlled trial for people with mild to moderate dementia aged ≥65 and their informal caregivers (dyads) in Norway. Complementary to health care as usual (control condition), municipal coordinators implemented the multicomponent LIVE intervention: Learning, Innovation, Volunteer support, and Empowerment (including medication review by the PwD’s regular GPs). Block-randomization was used to allocate dyads in three groups receiving the intervention sequentially in periods of 6 months duration. Prepandemic data from the first period is reported, resulting in a 1:2 intervention-to-control ratio. Primary outcome was change in psychotropic drug use. Secondary outcomes were changes in BPSD by Neuropsychiatric Inventory and Cornell Scale of Depression in Dementia and patient-GP communication by an adaption of the Clinical Global Impression of Change.ResultsFour hundred thirty-eight dyads were screened, 280 included, and 237 participated at 6 months (intervention group n=67; control condition n=170). At baseline, 63% used psychotropic medication regularly: antidementia drugs (47%), antidepressants (13%), hypnotics/sedatives (13%), antipsychotics (5%), and anxiolytics (2%). At 6 months, medication reviews were more frequently conducted in the intervention group compared to control (66% vs 42%, P=0.001). We found no differences regarding a change in drug use and BPSD. Patient-GP communication enhanced in the intervention group (mean score 0.95 [standard deviation 1.68] vs 0.41 [1.34], P=0.022). In the intervention group, control group, and overall sample, the informal caregivers of those who had their medications reviewed reported improved patient-GP communication compared to those who did not.ConclusionsChange in psychotropic drug use and BPSD did not differ, even though patient-GP communication improved with medication reviews. Restricted psychotropic drug use among PwD likely reflects more judicious prescribing practices in recent years. Nevertheless, medication reviews could be cultivated to optimize pharmacologic treatment for this complex population.Trial registrationClinicalTrials.gov: NCT04043364; registered 15/03/2019.

TwentyYears of Addiction and Mental Illness in Alaska: Using the National Survey on Drug Use and Health to Understand Addiction in a Low Population and Rural State.

Understanding changes in substance use in a small population state is challenging. Many national datasets restrict data to reduce the probability of identifying persons. Alaska is a small population state (731,000 residents) with a large geographic region (25% the size of the lower 48), a diverse population, and highly variable seasons, with fewer than 10% of the state being road accessible. Given the uniqueness of Alaska, this project sought to understand what could be learned about addiction and its relationships with unemployment and median income in Alaska. National Survey on Drug Use and Health, State and Small Area Estimates (1999-2020) data were analyzed to measure prevalence changes. Outcome prevalence were independently correlated with median income and annual unemployment rate as the annual collection periods varied. Analyses were limited to simple bivariate analyses due to the data restrictions. Median income was found to have stronger correlational relationships and significant relationships with more negative outcomes compared to unemployment. While annual unemployment rates had statistically significant relationships with substance use outcomes, negative mental health outcomes appeared more related to unemployment than median income. Alcohol use in the past month, cigarette and tobacco use, and pain reliever misuse declined while binge drinking in the past month and illicit drug use increased. More people reported depression, serious mental illness, and suicidal ideation and planning over time peaking in the last year of data collection. While NSDUH data provide some idea of the changes in drug use over time, their effectiveness in Alaska is unknown. Many data sources claim they are nationally representative, but these statements cannot be objectively measured. We will use these outcomes and data as a baseline for future studies where we will explore state specific data sources.

Were self-described introverts "immune" to increased drug use and entrapment during the pandemic?

BackgroundSocial restrictions and other stressors related to the Covid-19 pandemic disrupted daily life in ways that might have increased drug use and undermined mental health. We investigated whether such changes depended on the amount and quality of a person's social activity. We also evaluated the popular idea that effects of pandemic-related restrictions would depend on introversion; to this end, we used self-described introversion as a proxy for preferred frequency of social activity. MethodsBetween September 2020 and March 2021, we obtained online-survey data from 2615 respondents who retrospectively reported alcohol, opioid, or psychostimulant use. We analyzed (1) changes in drug use and entrapment (a psychological construct linked to suicidality) as a function of introversion and the frequency and quality of social activity, and (2) changes in drug use as a function of change in entrapment. ResultsMost felt more entrapped during the pandemic, but only a minority increased drug use. Generally: (1) entrapment and drug use increased in respondents unsatisfied with their social activity, (2) introversion and frequency of activity had less influence than satisfaction, (3) introverts reported more symptoms of entrapment, anxiety, depression, and loneliness than non-introverts, (4) when social activity was frequent and unsatisfying, psychostimulant use increased in introverts and opioid use increased in extraverts, (5) alcohol use increased in those who felt increased entrapment, and (6) alcohol and opioid use decreased in those who felt decreased entrapment. ConclusionsSatisfactory social activity (even in small amounts) was associated with better outcomes, mostly without regard to introversion.

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs.

BackgroundPeople 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.MethodsTelephone semi-structured interviews were conducted with 28 PWID in Bristol, Southwest of England. Analysis followed a reflexive thematic analysis.ResultsConcern 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.ConclusionThis 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.

Assessing the impact of COVID-19 pandemic in vulnerable social groups in Athens, Greece

BackgroundThe first case of SARS-CoV-2 in Greece was identified in February 2020. During the COVID-19 pandemic two lockdowns took place (March-May 2020/November 2020-ongoing). People who use drugs (PWUD), as well as the homeless, constitute vulnerable social groups. The main aim of this study is to assess the impact of social distancing measures during the COVID-19 pandemic on these groups.MethodsA program was implemented in Athens between December 2020 and January 2021 in a sample of PWUD and homeless recruited both in Substitution Treatment Units and the Homeless Shelters. The interview was conducted with a structured questionnaire.ResultsThe study included 303 participants (215 PWUD and 88 homeless individuals (HI)). The mean (SD) age was 49.2 (9.7) and 61.9 (10.2) years for PWUD and HI respectively. Chronic hepatitis C was reported by 33% of PWUD and 1.1% of HI. HIV infection was reported in 9.3% of PWUD. Testing for SARS-CoV-2 was reported by 55% and 100% of PWUD and HI respectively; 0.8% of PWUD and 5.7% of HI were found positive. Compliance with individual measures against SARS-CoV-2 was reported to be high (98-100%) during lockdowns. 88.8% and 98.9% of PWUD and HI reported change in the quality life. Feelings of isolation were reported by 46.6% and 11.5% on PWUD and HI, respectively. PWID enrollment in OST programmes during the 1st and 2nd lockdown was 67.1% and 92.9% respectively. OST attendees did not report changes in treatment during lockdowns. Access to hygiene materials was 9.8% and 100% in 1st and 2nd lockdown. Access to drugs was high (91.5% and 94.3%) in both lockdowns. The illegal drug use as compared to regular use was increased 12.2%/14.3%, decreased 40.2%/40%, stable 47.6%/45.7% for 1st/2nd lockdown respectively.ConclusionsThe population studied is well-aware and compliant with the prevention measures against COVID-19 with access to frequent laboratory testing, low levels of SARS-CoV-2 and access to prevention materials.Key messages Among PWUD the OST services provision was stable. Provision of antiseptics was higher during the 2nd lockdown while changes in drug use were similar during the 1st and 2nd lockdown.Limitation: This study does not assess PWUD with limited access to OST and HI living in the streets.