Good Samaritan Drug Overdose Act awareness among people who use drugs in British Columbia, Canada

Introduction: To address the increase in opioid-related overdoses and deaths in Canada the Good Samaritan Drug Overdose Act (GSDOA) was enacted in May 2017. The GSDOA aims to reduce concerns of police attending overdose events and encourage bystanders to call emergency services. This study explores GSDOA awareness and understanding and the factors associated with GSDOA awareness among people who use drugs (PWUD). Methods: A cross-sectional drug and harm reduction service use survey containing GSDOA-specific questions wasconducted from October to December 2019 at 22 harm reduction supply distribution sites across British Columbia.Descriptive analysis and multivariable logistic regression were conducted to assess correlates of GSDOA awareness. Results: Overall, 54.2% (n = 315) of the eligible study sample (n = 581) reported being aware of the GSDOA. Of respondents reporting awareness, 45.2% and 61.3%, respectively, had a full understanding of when and to whom the GSDOA provides legal protection. In the multivariable model, GSDOA awareness was significantly associated with respondents identifying as cis-men (adjusted odds ratio (AOR) = 2.03 [95% CI: 1.30–3.19]); and those who obtained harm reduction supplies frequently (at least a few times/week) compared with those who did not obtain supplies or obtained them less frequently (AOR = 1.78 [95% CI: 1.14–2.76]). Conclusion: More than 2 years after its introduction, approximately half of harm reduction site clients reported being aware of the GSDOA, and, of these, less than two-thirds had a complete understanding of who is legally protected by the GSDOA. Future GSDOA knowledge dissemination should target PWUD who are less engaged with harm reduction services to improve GSDOA awareness and understanding.

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The impact of the COVID-19 pandemic on harm reduction services in Spain

Harm Reduction Journal ◽

10.1186/s12954-020-00432-w ◽

2020 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Camila A. Picchio ◽

Jorge Valencia ◽

Jason Doran ◽

Tracy Swan ◽

Marta Pastor ◽

...

Keyword(s):

Infectious Disease ◽

Harm Reduction ◽

Social Services ◽

Methadone Maintenance ◽

The State ◽

People Who Use Drugs ◽

Service Users ◽

Cross Sectional ◽

The Impact ◽

Disease Testing

Abstract Background Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain. Methods This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March–June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers. Results All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March–21 June 2020). One centre reported complete closure for 2 months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses, human immunodeficiency virus, and tuberculosis) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm. Conclusion Overall, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment such as methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy.

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The impact of the COVID-19 pandemic on harm reduction services in Spain

10.21203/rs.3.rs-66726/v1 ◽

2020 ◽

Author(s):

Camila A Picchio ◽

Jorge Valencia ◽

Jason Doran ◽

Tracy Swan ◽

Marta Pastor ◽

...

Keyword(s):

Infectious Disease ◽

Harm Reduction ◽

Social Services ◽

Methadone Maintenance ◽

The State ◽

People Who Use Drugs ◽

Service Users ◽

Cross Sectional ◽

The Impact ◽

Disease Testing

Abstract Background: Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain.Methods: This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March–June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers.Results: All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March–21 June 2020). One centre reported complete closure for two months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses [HBV, HCV], human immunodeficiency virus (HIV), and tuberculosis [TB]) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm.Conclusion: Overall, like other European countries, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment (methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy).

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The impact of the COVID-19 pandemic on harm reduction services in Spain

10.21203/rs.3.rs-66726/v2 ◽

2020 ◽

Author(s):

Camila A Picchio ◽

Jorge Valencia ◽

Jason Doran ◽

Tracy Swan ◽

Marta Pastor ◽

...

Keyword(s):

Infectious Disease ◽

Harm Reduction ◽

Social Services ◽

Methadone Maintenance ◽

The State ◽

People Who Use Drugs ◽

Service Users ◽

Cross Sectional ◽

The Impact ◽

Disease Testing

Abstract Background: Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain. Methods: This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March–June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers.Results: All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March–21 June 2020). One centre reported complete closure for two months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses [HBV, HCV], human immunodeficiency virus (HIV), and tuberculosis [TB]) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm.Conclusion: Overall, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment such as methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy.

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A qualitative study on overdose response in the era of COVID-19 and beyond: how to spot someone so they never have to use alone

Harm Reduction Journal ◽

10.1186/s12954-021-00530-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Melissa Perri ◽

Natalie Kaminski ◽

Matthew Bonn ◽

Gillian Kolla ◽

Adrian Guta ◽

...

Keyword(s):

Drug Use ◽

Harm Reduction ◽

Emergency Services ◽

Community Support ◽

People Who Use Drugs ◽

Sexually Transmitted ◽

Prevention Services ◽

Rural Settings ◽

Structured Audio ◽

Research Assistants

Abstract Background Spotting is an informal practice among people who use drugs (PWUD) where they witness other people using drugs and respond if an overdose occurs. During COVID-19 restrictions, remote spotting (e.g., using a telephone, video call, and/or a social media app) emerged to address physical distancing requirements and reduced access to harm reduction and/or sexually transmitted blood borne infection (STBBI’s) prevention services. We explored spotting implementation issues from the perspectives of spotters and spottees. Methods Research assistants with lived/living expertise of drug use used personal networks and word of mouth to recruit PWUD from Ontario and Nova Scotia who provided or used informal spotting. All participants completed a semi-structured, audio-recorded telephone interview about spotting service design, benefits, challenges, and recommendations. Recordings were transcribed and thematic analysis was used. Results We interviewed 20 individuals between 08/2020–11/2020 who were involved in informal spotting. Spotting was provided on various platforms (e.g., telephone, video calls, and through texts) and locations (e.g. home, car), offered connection and community support, and addressed barriers to the use of supervised consumption sites (e.g., location, stigma, confidentiality, safety, availability, COVID-19 related closures). Spotting calls often began with setting an overdose response plan (i.e., when and who to call). Many participants noted that, due to the criminalization of drug use and fear of arrest, they preferred that roommates/friends/family members be called instead of emergency services in case of an overdose. Both spotters and spottees raised concerns about the timeliness of overdose response, particularly in remote and rural settings. Conclusion Spotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/STBBI’s prevention services, additional supports (e.g., changes to Good Samaritan Laws) are needed. The criminalization of drug use may limit uptake of formal spotting services.

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Good Samaritan harm reduction policy and drug overdose deaths

Health Services Research ◽

10.1111/1475-6773.13119 ◽

2019 ◽

Vol 54 (2) ◽

pp. 407-416 ◽

Cited By ~ 4

Author(s):

Danielle N. Atkins ◽

Christine Piette Durrance ◽

Yuna Kim

Keyword(s):

Harm Reduction ◽

Drug Overdose ◽

Good Samaritan ◽

Overdose Deaths

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Harm Reduction for Adolescents and Young Adults During the COVID-19 Pandemic: A Case Study of Community Care in Reach

Public Health Reports ◽

10.1177/0033354921999396 ◽

2021 ◽

pp. 003335492199939

Author(s):

Elizabeth Noyes ◽

Ellis Yeo ◽

Megan Yerton ◽

Isabel Plakas ◽

Susan Keyes ◽

...

Keyword(s):

Young Adults ◽

Harm Reduction ◽

Community Care ◽

Control Measures ◽

Adolescents And Young Adults ◽

People Who Use Drugs ◽

Staff Members ◽

Infection Control Measures ◽

Semistructured Interviews ◽

High Level

The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of harm reduction programs to provide vital services to adolescents, young adults, and people who use drugs, thereby increasing the risk of overdose, infection, withdrawal, and other complications of drug use. To evaluate the effect of the COVID-19 pandemic on harm reduction services for adolescents and young adults in Boston, we conducted a quantitative assessment of the Community Care in Reach (CCIR) youth pilot program to determine gaps in services created by its closure during the peak of the pandemic (March 19–June 21, 2020). We also conducted semistructured interviews with staff members at 6 harm reduction programs in Boston from April 27 through May 4, 2020, to identify gaps in harm reduction services, changes in substance use practices and patterns of engagement with people who use drugs, and how harm reduction programs adapted to pandemic conditions. During the pandemic, harm reduction programs struggled to maintain staffing, supplies, infection control measures, and regular connection with their participants. During the 3-month suspension of CCIR mobile van services, CCIR missed an estimated 363 contacts, 169 units of naloxone distributed, and 402 syringes distributed. Based on our findings, we propose the following recommendations for sustaining harm reduction services during times of crisis: pursuing high-level policy changes to eliminate political barriers to care and fund harm reduction efforts; enabling and empowering harm reduction programs to innovatively and safely distribute vital resources and build community during a crisis; and providing comprehensive support to people to minimize drug-related harms.

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A Cross-Sectional Study: Patient Privacy According to Doctors and Nurses

Nursing Science Quarterly ◽

10.1177/0894318420987171 ◽

2021 ◽

Vol 34 (2) ◽

pp. 114-122

Author(s):

Nilüfer Demirsoy ◽

Hülya Öztürk ◽

Nurdan Ergün Acar

Keyword(s):

Work Environment ◽

Healthcare Professionals ◽

Emergency Services ◽

Cross Sectional Study ◽

Study Patient ◽

Patient Privacy ◽

Sectional Study ◽

Right To Privacy ◽

Cross Sectional ◽

Building Trust

Confidentiality is fundamental in building trust between patients and healthcare professionals. This research aims at presenting healthcare professionals’ opinions on patient privacy, using a 5-point Likert-type scale titled “Opinion of the Healthcare Professionals on Patient Privacy,” and 262 physicians’ and 231 nurses’ opinions were evaluated. Results showed that nurses and doctors working at emergency services got higher mean scores than those working at other units. Results revealed that doctors had the highest mean score for the item “ It is important that the patient’s body is not seen by other patients and professionals during the treatment,” while nurses had the highest mean score for the item “ I approach with due care to protect privacy in the work environment.” Results of this work highlight that patient’s right to privacy constitutes one of the most significant issues to be noted by healthcare professionals.

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Civil society involvement in harm reduction drug policy: reflections on the past, expectations for the future

Harm Reduction Journal ◽

10.1186/s12954-020-00426-8 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Aileen O’Gorman ◽

Eberhard Schatz

Keyword(s):

Civil Society ◽

Harm Reduction ◽

Lived Experience ◽

Political Institutions ◽

Drug Policy ◽

Policy Development ◽

Policy Decision ◽

People Who Use Drugs ◽

Annual Conference ◽

Health Crisis

Abstract Background A range of civil society organisations (CSOs) such as drug user groups, non-governmental/third sector organisations and networks of existing organisations, seek to shape the development of drugs policy at national and international levels. However, their capacity to do so is shaped by the contexts in which they operate nationally and internationally. The aim of this paper is to explore the lived experience of civil society participation in these contexts, both from the perspective of CSOs engaged in harm reduction advocacy, and the institutions they engage with, in order to inform future policy development. Methods This paper is based on the presentations and discussions from a workshop on ‘Civil Society Involvement in Drug Policy hosted by the Correlation - European Harm Reduction Network at the International Society for the Study of Drugs Policy (ISSDP) annual conference in Paris, 2019. In the aftermath of the workshop, the authors analysed the papers and discussions and identified the key themes arising to inform CSI in developing future harm reduction policy and practice. Results Civil society involvement (CSI) in policy decision-making and implementation is acknowledged as an important benefit to representative democracy. Yet, the accounts of CSOs demonstrate the challenges they experience in seeking to shape the contested field of drug policy. Negotiating the complex workings of political institutions, often in adversarial and heavily bureaucratic environments, proved difficult. Nonetheless, an increase in structures which formalised and resourced CSI enabled more meaningful participation at different levels and at different stages of policy making. Conclusions Civil society spaces are colonised by a broad range of civil society actors lobbying from different ideological standpoints including those advocating for a ‘drug free world’ and those advocating for harm reduction. In these competitive arena, it may be difficult for harm reduction orientated CSOs to influence the policy process. However, the current COVID-19 public health crisis clearly demonstrates the benefits of partnership between CSOs and political institutions to address the harm reduction needs of people who use drugs. The lessons drawn from our workshop serve to inform all partners on this pathway.

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Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low- and middle-income countries

Harm Reduction Journal ◽

10.1186/s12954-021-00461-z ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Judy Chang ◽

Shaun Shelly ◽

Machteld Busz ◽

Claudia Stoicescu ◽

Arif Rachman Iryawan ◽

...

Keyword(s):

Harm Reduction ◽

Resource Scarcity ◽

Rapid Review ◽

People Who Use Drugs ◽

Financial Barriers ◽

Community Knowledge ◽

Middle Income ◽

Peer Involvement ◽

Stigma And Discrimination ◽

Low And Middle Income

Abstract Introduction Peer involvement of people who use drugs within HIV and harm reduction services is widely promoted yet under-utilised. Alongside political and financial barriers is a limited understanding of the roles, impacts, contexts and mechanisms for peer involvement, particularly in low- and middle-income settings. We conducted a rapid review of available literature on this topic. Methods Within a community-academic partnership, we used a rapid review approach, framed by realist theory. We used a network search strategy, focused on core journals and reference lists of related reviews. Twenty-nine studies were included. We developed thematic summaries framed by a realist approach of exploring interventions, their mechanisms, outcomes and how they are shaped by contexts. Results Reported outcomes of peer involvement included reduced HIV incidence and prevalence; increased service access, acceptability and quality; changed risk behaviours; and reduced stigma and discrimination. Mechanisms via which these roles work were trust, personal commitment and empathy, using community knowledge and experience, as well as ‘bridge’ and ‘role model’ processes. Contexts of criminalisation, under-resourced health systems, and stigma and discrimination were found to shape these roles, their mechanisms and outcomes. Though contexts and mechanisms are little explored within the literature, we identified a common theme across contexts, mechanisms and outcomes. Peer outreach interventions work through trust, community knowledge and expertise, and ‘bridge’ mechanisms (M) to counter criminalisation and constraining clinic and service delivery environments (C), contributing towards changed drug-using behaviours, increased access, acceptability and quality of harm reduction services and decreased stigma and discrimination (O). Conclusion Peer involvement in HIV and harm reduction services in low- and middle-income settings is linked to positive health outcomes, shaped by contexts of criminalisation, stigma, and resource scarcity. However, peer involvement is under-theorised, particularly on how contexts shape mechanisms and ultimately outcomes. Efforts to study peer involvement need to develop theory and methods to evaluate the complex mechanisms and contexts that have influence. Finally, there is a need to expand the range of peer roles, to embrace the capacities and expertise of people who use drugs.

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Mental health service use, depression, panic disorder and life events among Swedish young adults in 2000 and 2010: a repeated cross-sectional population study in Stockholm County, Sweden

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796017000099 ◽

2017 ◽

Vol 27 (5) ◽

pp. 510-518 ◽

Cited By ~ 2

Author(s):

A. Lundin ◽

Y. Forsell ◽

C. Dalman

Keyword(s):

Young Adults ◽

Panic Disorder ◽

Life Events ◽

Service Use ◽

Psychiatric Service ◽

Psychiatric Services ◽

Mental Health Service Use ◽

Stockholm County ◽

Cross Sectional ◽

Psychiatric Service Use

Aims.The use of specialised psychiatric services for depression and anxiety has increased steadily among young people in Sweden during recent years. It is not known to what extent this service use is due to an increase in psychiatric morbidity, or whether other adversities explain these trends. The aim of this study is to examine if there is increased use of psychiatric services among young adults in Sweden between 2000 and 2010, and if so, to what extent this increase is associated with differences in depression, anxiety and negative life events.Methods.This is a repeated cross-sectional study of 20–30-year old men and women in Stockholm County in 2000 and 2010 (n = 2590 and n = 1120). Log-binomial regression analyses were conducted to compare the prevalence of service use, depression and panic disorder between the two cohorts. Self-reported life events were entered individually and as a summary index, and entered as potential mediators. Different effects of life events on service use were examined through interaction analysis. We report prevalence proportion ratios (PPR) with 95% confidence intervals.Results.Specialised psychiatric service use, but also depression and panic disorder was more common in the younger cohort (current service use 2.4 and 5.0%). The younger cohort did not report more life events overall or among those with depression or anxiety. Neither depression, panic disorder nor life events could explain the increased use of psychiatric services in the younger cohort (Fully adjusted model PPR = 1.70, 1.20–2.40 95% CI). There was no significant interaction between cohort and life events in predicting psychiatric service use.Conclusion.This study provides initial support for an increase in service use among young adults compared with 10 years earlier. The increased service use cannot be explained with increasing worse life situations.

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