Substance use Treatment and Harm Reduction Services for Migrants and Refugees in the COVID-19 Pandemic: Findings from a Global Survey

Abstract Migrants and refugees are considered vulnerable to mental health problems and substance use disorders; and may be particularly affected by service disruptions associated with the COVID-19 pandemic The International Society of Addiction Medicine (ISAM) ran a multi-phased global survey among clinicians and health professional that are actively working in the field of addiction medicine to investigate the impact of the COVID-19 pandemic on substance use and related services. In March 2020, the first month after the announcement of the pandemic by the World Health Organization, 177 informants from 77 countries took part in the global survey, and only 12.9% of them reported their countries’ substance use treatment and harm reduction services for the migrants and refugees with substance use disorders continued as usual. In May 2020, 11.7% of respondents of the second phase reported that the services for refugees and migrants improved in comparison to March 2020; 11.7% reported that these services in their country discontinued. Results suggest that refugee and migrants access to treatment and harm reduction services has been reduced as a result of COVID-19. It can be concluded that it is crucial to improve the visibility of migrants’ needs and exploit appropriate interventions for those with substance use disorders.

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Reorganization of Substance Use Treatment and Harm Reduction Services During the COVID-19 Pandemic: A Global Survey

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.639393 ◽

2021 ◽

Vol 12 ◽

Author(s):

Seyed Ramin Radfar ◽

Cornelis A. J. De Jong ◽

Ali Farhoudian ◽

Mohsen Ebrahimi ◽

Parnian Rafei ◽

...

Keyword(s):

Substance Use ◽

Harm Reduction ◽

Service Providers ◽

Vulnerable Groups ◽

Business Continuity ◽

Treatment Modalities ◽

Addiction Medicine ◽

Global Survey ◽

Prevention Interventions ◽

Needle And Syringe Programs

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic.Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health responses were categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups.Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. Fifty-seven percent of overdose prevention interventions and 81% of outreach services were also negatively impacted.Conclusions: Participants reported that SUD treatment and harm-reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we highlight several issues and complications resulting from the pandemic concerning people with SUDs that should be tackled more efficiently during the future waves or similar pandemics. The issues and potential strategies comprise the following: (1) helping policymakers to generate business continuity plans, (2) maintaining the use of evidence-based interventions for people with SUDs, (3) being prepared for adequate medication supplies, (4) integrating harm reduction programs with other treatment modalities, and (5) having specific considerations for vulnerable groups such as immigrants and refugees.

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788. Outcomes of Multidisciplinary Care Conferences for Patients with Substance Use Disorders Requiring Prolonged Antimicrobial Therapy for Severe Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.856 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S349-S349

Author(s):

Sara J Gore ◽

Luke Strnad ◽

Honora Englander ◽

Jessica Gregg ◽

Monica Sikka ◽

...

Keyword(s):

Substance Use ◽

Harm Reduction ◽

Substance Use Disorders ◽

Antimicrobial Therapy ◽

Patient Preferences ◽

Treatment Plan ◽

Definitive Treatment ◽

Care Plans ◽

Hospital Days ◽

The Impact

Abstract Background Infectious complications in people with substance use disorders (SUD) are rising, and while outpatient parenteral antimicrobial therapy (OPAT) is widely used in the general population, OPAT failure rates in SUD are high. Due to perceived PICC risks and OPAT safety, serious infections in people with SUD at our institution often resulted in hospitalization for the duration of treatment. Prolonged inpatient treatment is difficult to tolerate and increases healthcare costs. Our OPAT and addiction medicine teams initiated multidisciplinary discharge planning conferences (OPTIONS-DC) for inpatients with SUD requiring prolonged antimicrobials. The goal was to prioritize patient preferences regarding OPAT setting while incorporating harm-reduction principles. The goal of this study is to assess the impact and outcomes of the OPTIONS-DC. Methods We prospectively recorded comprehensive notes at OPTIONS-DC and retrospectively performed chart review for conferences held from February 2018 to March 2019.We performed a content analysis of OPTIONS-DC notes and patient records to identify ways that OPTIONS-DC modified care plans and prioritized patient preferences. Results Thirty-one conferences were held during the study period. Twenty-eight patients reported substance use within 90 days, 24 used intravenous substances, 12 were homeless, 24 had a mental health diagnosis, and 20 started medication-assisted treatment during hospitalization (Table 1). For 16 patients the conference altered the definitive treatment plan to align with patient preferences while emphasizing safety, and 13 of those were changed to an outpatient setting. A total of 10 patients had a decreased length of stay, with a total of 238 hospital days saved overall. OPAT was planned at discharge for 15 patients, 11 of whom completed their OPAT course. Overall, 21/31 (68%) completed their recommended antimicrobial course and 3 were lost to follow-up. Conclusion A multidisciplinary conference that prioritizes patient preferences and uses harm reduction strategies to optimize infection treatment plans is feasible and effective. The OPTIONS-DC model has potential to expand treatment options for infections in SUD, reduce hospital days, and may serve as an example for other institutions. Disclosures All authors: No reported disclosures.

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Adapting inpatient addiction medicine consult services during the COVID-19 pandemic

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00221-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Miriam T. H. Harris ◽

Alyssa Peterkin ◽

Paxton Bach ◽

Honora Englander ◽

Emily Lapidus ◽

...

Keyword(s):

Substance Use ◽

Discharge Planning ◽

Medical Center ◽

Health Care Systems ◽

Opioid Use Disorder ◽

Substance Use Treatment ◽

New Haven ◽

Opioid Use ◽

Addiction Medicine ◽

The Impact

Abstract Background We describe addiction consult services (ACS) adaptations implemented during the Novel Coronavirus Disease 2019 (COVID-19) pandemic across four different North American sites: St. Paul’s Hospital in Vancouver, British Columbia; Oregon Health & Sciences University in Portland, Oregon; Boston Medical Center in Boston, Massachusetts; and Yale New Haven Hospital in New Haven, Connecticut. Experiences ACS made system, treatment, harm reduction, and discharge planning adaptations. System changes included patient visits shifting to primarily telephone-based consultations and ACS leading regional COVID-19 emergency response efforts such as substance use treatment care coordination for people experiencing homelessness in COVID-19 isolation units and regional substance use treatment initiatives. Treatment adaptations included providing longer buprenorphine bridge prescriptions at discharge with telemedicine follow-up appointments and completing benzodiazepine tapers or benzodiazepine alternatives for people with alcohol use disorder who could safely detoxify in outpatient settings. We believe that regulatory changes to buprenorphine, and in Vancouver other medications for opioid use disorder, helped increase engagement for hospitalized patients, as many of the barriers preventing them from accessing care on an ongoing basis were reduced. COVID-19 specific harm reductions recommendations were adopted and disseminated to inpatients. Discharge planning changes included peer mentors and social workers increasing hospital in-reach and discharge outreach for high-risk patients, in some cases providing prepaid cell phones for patients without phones. Recommendations for the future We believe that ACS were essential to hospitals’ readiness to support patients that have been systematically marginilized during the pandemic. We suggest that hospitals invest in telehealth infrastructure within the hospital, and consider cellphone donations for people without cellphones, to help maintain access to care for vulnerable patients. In addition, we recommend hospital systems evaluate the impact of such interventions. As the economic strain on the healthcare system from COVID-19 threatens the very existence of ACS, overdose deaths continue rising across North America, highlighting the essential nature of these services. We believe it is imperative that health care systems continue investing in hospital-based ACS during public health crises.

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Reorganization of Substance Use Treatment and Harm Reduction Services during the COVID-19 Pandemic: A Global Survey

10.1101/2020.09.21.20199133 ◽

2020 ◽

Author(s):

Seyed Ramin Radfar ◽

Cornelis A J De Jong ◽

Ali Farhoudian ◽

Mohsen Ebrahimi ◽

Parnian Rafei ◽

...

Keyword(s):

Substance Use ◽

Harm Reduction ◽

Service Providers ◽

Vulnerable Groups ◽

Business Continuity ◽

Treatment Modalities ◽

Addiction Medicine ◽

Global Survey ◽

Health Response ◽

Prevention Interventions

Background: The COVID-19 pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health response is categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups. Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. 57% of overdose prevention interventions and 81% of outreach services also having been negatively impacted. Conclusions: Participants reported that SUD treatment and harm reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we provide a series of recommendations to support countries to be prepared more efficiently for future waves or similar pandemics to 1) help policymakers generate business continuity plans, 2) maintain the use of evidence-based interventions for people with SUDs, 3) be prepared for adequate medication supplies, 4) integrate harm reduction programs with other treatment modalities and 5) have specific considerations for vulnerable groups such as immigrants and refugees.

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COVID-19 Social Restrictions: An Opportunity to Re-visit the Concept of Harm Reduction in the Treatment of Alcohol Dependence. A Position Paper

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.623649 ◽

2021 ◽

Vol 12 ◽

Author(s):

Christos Kouimtsidis ◽

Bernadette Pauly ◽

Tessa Parkes ◽

Tim Stockwell ◽

Alexander Mario Baldacchino

Keyword(s):

Substance Use ◽

Alcohol Use ◽

Harm Reduction ◽

Alcohol Use Disorders ◽

Position Paper ◽

Substance Use Treatment ◽

Health And Social Care ◽

Substance Use Services ◽

Alcohol Harm Reduction ◽

The Impact

The COVID-19 pandemic is presenting significant challenges for health and social care systems globally. The implementation of unprecedented public health measures, alongside the augmentation of the treatment capacity for those severely affected by COVID-19, are compromising and limiting the delivery of essential care to people with severe substance use problems and, in some cases, widening extreme social inequities such as poverty and homelessness. This global pandemic is severely challenging current working practices. However, these challenges can provide a unique opportunity for a flexible and innovative learning approach, bringing certain interventions into the spotlight. Harm reduction responses are well-established evidenced approaches in the management of opioid dependence but not so well-known or implemented in relation to alcohol use disorders. In this position paper, we explore the potential for expanding harm reduction approaches during the COVID-19 crisis and beyond as part of substance use treatment services. We will examine alcohol use and related vulnerabilities during COVID-19, the impact of COVID-19 on substance use services, and the potential philosophical shift in orientation to harm reduction and outline a range of alcohol harm reduction approaches. We discuss relevant aspects of the Structured Preparation for Alcohol Detoxification (SPADe) treatment model, and Managed Alcohol Programs (MAPs), as part of a continuum of harm reduction and abstinence orientated treatment for alcohol use disorders. In conclusion, while COVID-19 has dramatically reduced and limited services, the pandemic has propelled the importance of alcohol harm reduction and created new opportunities for implementation of harm reduction philosophy and approaches, including programs that incorporate the provision of alcohol as medicine as part of the substance use treatment continuum.

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The Role of Negative Affect in the Course of Substance Use Disorders

10.1093/oso/9780190499037.003.0014 ◽

2018 ◽

Author(s):

Elizabeth D. Reese ◽

Jennifer Y. Yi ◽

Ryan P. Bell ◽

Stacey B. Daughters

Keyword(s):

Substance Use ◽

Negative Affect ◽

Substance Use Disorders ◽

Substance Use Disorder ◽

Theoretical Models ◽

Central Mechanism ◽

Substance Use Treatment ◽

Increased Risk ◽

The Impact

Negative affect (NA) plays a prominent role in theoretical models characterizing the course of substance use disorders and is thus considered a central mechanism contributing to maintenance of symptoms and increased risk for relapse. This chapter overviews theoretical models of substance use, highlighting the impact of NA within the addiction cycle. In this context, it examines the evidence linking NA to substance use disorder (SUD) development, maintenance, and relapse, highlighting the association between NA and addiction-specific processes including withdrawal and craving. It concludes with a discussion of current substance use treatment approaches that target NA, including promising new pharmacological and neurobiological treatments.

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Co-designing a Mobile Gamified Attention Bias Modification Intervention for Substance Use Disorders: Participatory Research Study

JMIR mhealth and uhealth ◽

10.2196/15871 ◽

2019 ◽

Vol 7 (10) ◽

pp. e15871 ◽

Cited By ~ 7

Author(s):

Melvyn Zhang ◽

Sandor Heng ◽

Guo Song ◽

Daniel SS Fung ◽

Helen E Smith

Keyword(s):

Health Care ◽

Substance Use ◽

Substance Use Disorders ◽

Health Care Professionals ◽

Attention Bias ◽

Second Phase ◽

Attention Bias Modification ◽

The Impact ◽

Bias Modification ◽

Modification Intervention

Background Advances in experimental psychology have highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. The effectiveness of bias modification has been well studied for substance use disorders. With recent advances in technology, it is now possible to work outside the laboratory with Web-based and mobile-based attention bias interventions. Gamification technologies might also help diminish the repetitiveness of the task and increase the intrinsic motivation to train. The inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. Objective The aim of this study was to involve patients, together with health care professionals, in the design of a gamified mobile attention bias modification intervention for substance use disorders. Methods The participatory design research method adopted is that of a user-oriented design approach in the form of a future workshop. In the first phase of the workshop, participants shared their critique of an attention bias modification intervention. In the second phase of the workshop, participants were asked to brainstorm features. Participants were also shown gamification approaches and asked to consider if gaming elements could enhance the existing app. In the last phase, participants were asked to sketch a new prototype. Results Three co-design workshops were conducted with health care professionals, inpatients, and outpatients. There were 20 participants, consisting of 10 health care professionals and 10 patients. When asked to identify the limitations in the existing app, common issues identified were those of the design, visual probe task, and the included images. Outpatients were also concerned with the safety of administration of the intervention. In the brainstorming sessions, health care professionals made recommendations as to how the stimulus, the mechanism of responding, and the presentation of the scores could be enhanced. Inpatient participants recommended the addition of functionalities, such as information on the harms associated with the substance use, and for there to be enhancements in the design, images, and task. Outpatient participants perceived a need to improve the images and presentation of the results and recommended the inclusion of gaming features. There were differences in opinion on the inclusion of gaming features, as only health care professionals endorsed their inclusion. In the last phase of the workshop, participants were tasked with the conceptualization of prototypes, and the commonality in the design was for a gradual shortening of the interval for stimulus/image presentation. Conclusions The results from this research will guide the development of an app that meets the specific needs of patients and is still based on a pre-existing validated task paradigm.

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Improvement in psychological wellbeing among adolescents with a substance use disorder attending an outpatient treatment programme

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2021.6 ◽

2021 ◽

pp. 1-8

Author(s):

N.M. Gamage ◽

C. Darker ◽

B.P. Smyth

Keyword(s):

Substance Use ◽

Psychological Symptoms ◽

Significant Proportion ◽

Cannabis Use ◽

Psychological Wellbeing ◽

Substance Use Treatment ◽

Disruptive Behaviour ◽

Treatment Programme ◽

The Impact

Objectives: Adolescents with substance use disorders (SUDs) exhibit high rates of comorbid psychological problems. This study aimed to examine the impact of an outpatient substance use treatment programme upon the psychological wellbeing of adolescents. Methods: A prospective study was carried out examining psychological symptoms in a group of adolescents attending the Youth Drug and Alcohol (YoDA) Addiction Service in Dublin. Participants were treated with evidenced based psychological models such as cognitive behavioural therapy, motivational interviewing and systemic family therapy. The Becks Youth Inventory was utilised to assess psychological symptoms at treatment entry and repeated three months later at follow up. Results: Among 36 adolescents who were included in this study, poly-substance misuse was the norm. Almost three-quarter had a cannabis use disorder (CUD). There were significant reductions in mean subscale scores of depression (56.0 to 50.8, p = 0.003), anger (55.2 to 49.5, p < 0.001) and disruptive behaviour (61.6 to 56.5, p = 0.002) at follow up. Although there wasn’t a statistically significant reduction in mean scores for anxiety, we observed a significant proportion of participants (p = 0.008) improving and moving out of a moderate to severe symptom range when examined by category. This was also the case for self-concept (p = 0.04). Furthermore this study revealed a positive correlation between the reduction in days of cannabis use and reduction in depressive scores (Pearson correlation 0.49, p = 0.01) among those with a CUD. Conclusion: The findings indicate that substance use treatment for adolescents is associated with important psychological and behavioural improvements.

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The impact of poly-traumatization on treatment outcomes in young people with substance use disorders

BMC Psychiatry ◽

10.1186/s12888-021-03129-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sidsel Karsberg ◽

Morten Hesse ◽

Michael Mulbjerg Pedersen ◽

Ruby Charak ◽

Mads Uffe Pedersen

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Psychological Trauma ◽

Well Being ◽

Traumatic Experiences ◽

Treatment Entry ◽

Trauma Types ◽

Using Data ◽

The Impact ◽

Drug Use Disorder

Abstract Background It is believed that clients with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders. However, knowledge on the effect of the number of trauma experiences is scarce. Methods Using data from drug use disorder (DUD) treatment in Denmark, we assessed the impact of having experienced multiple potentially traumatic experiences on DUD treatment efficacy. Baseline and follow-up data from 775 young participants (mean age = 20.2 years, standard deviation = 2.6) recruited at nine treatment centers were included in analyses. Results Analyses showed that participants who were exposed multiple trauma experiences also reported a significantly higher intake of cannabis at treatment entry, and a lower well-being score than participants who reported less types or no types of victimization experiences. During treatment, patients with multiple types of trauma experiences showed a slower rate of reduction of cannabis than patients with few or no trauma experiences. The number of trauma types was not associated with number of sessions attended or the development of well-being in treatment. Conclusion Overall, the results show that although traumatized youth in DUD treatment show up for treatment, helping them to reduce substance use during treatment is uniquely challenging. Trial registration ISRCTN88025085, date of registration: 29.08.2016, retrospectively registered.

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