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      Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada

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          Abstract

          Background

          People who use drugs (PWUD) are at high risk of experiencing indirect harms of measures implemented to curb the spread of COVID-19, given high reliance on services and social networks. This study aimed to document short-term changes in behaviours and health-related indicators among PWUD in Montreal, Canada following declaration of a provincial health emergency in Quebec.

          Methods

          We administered a structured rapid assessment questionnaire to members of an existing cohort of PWUD and individuals reporting past-year illicit drug use recruited via community services. Telephone and in-person interviews were conducted in May–June and September–December 2020. Participants were asked to report on events and changes since the start of the health emergency (March 13, 2020). Descriptive analyses were performed.

          Results

          A total of 227 participants were included (77% male, median age = 46, 81% Caucasian). 83% and 41% reported past six-month illicit drug use and injection drug use, respectively. 70% of unstably housed participants reported increased difficulty finding shelter since the start of the health emergency. 48% of opioid agonist treatment recipients had discussed strategies to avoid treatment disruptions with providers; 22% had missed at least one dose. Many participants perceived increased difficulty accessing non-addiction health care services. Adverse changes were also noted in indicators pertaining to income, drug markets, drug use frequency, and exposure to violence; however, many participants reported no changes in these areas. Among persons reporting past six-month injection drug use, 79% tried to access needle-syringe programmes during the health emergency; 93% of those obtained services. 45% tried to access supervised injection sites, of whom 71% gained entry.

          Conclusions

          This snapshot suggests mixed impacts of the COVID-19 pandemic on PWUD in Montreal in the months following declaration of a provincial health emergency. There were signals of increased exposure to high-risk environments as well as deteriorations in access to health services. Pandemic-related measures may have lasting impacts among vulnerable subgroups; continued monitoring is warranted.

          Supplementary Information

          The online version contains supplementary material is available at 10.1186/s12954-022-00620-w.

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          Most cited references32

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          Collision of the COVID-19 and Addiction Epidemics

          People with substance use disorder may be especially susceptible to COVID-19, and compromised lung function from COVID-19 could also put at risk those who have opioid use disorder and methamphetamine use disorder. This commentary describes the risks of the collision of the COVID-19 and addiction epidemics.
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            Impact of COVID-19 on global hepatitis C elimination efforts

            Background & Aims COVID-19 has placed significant strain on national healthcare systems at a critical moment in the context of hepatitis elimination. Mathematical models can be used to evaluate the possible impact of programmatic delays on hepatitis disease burden. The objective of this analysis was to evaluate the incremental change in hepatitis C liver-related deaths and liver cancer, following a 3-month, 6-month, or 1-year hiatus in hepatitis elimination program progress. Methods Previously developed models were adapted for 110 countries to include a status quo or “no delay” scenario and a “1-year delay” scenario assuming significant disruption in interventions (screening, diagnosis and treatment) in the year 2020. Annual, country-level, model outcomes were extracted, and weighted averages were used to calculate regional (WHO and World Bank Income Group) and global estimates from 2020 to 2030. The incremental annual change in outcomes was calculated by subtracting the “no-delay” estimates from the “1-year delay” estimates. Results The “1-year delay” scenario resulted in 44,800 (95% UI: 43,800 – 49,300) excess hepatocellular carcinoma (HCC) cases and 72,300 (95% UI: 70,600 – 79,400) excess liver-related deaths (LRDs), relative to the “no delay” scenario globally, from 2020-2030. Most missed treatments would be in lower-middle income countries, while most excess HCC and LRDs would be among high-income countries. Conclusions The impact of COVID-19 extends beyond the direct morbidity and mortality associated with exposure and infection. In order to mitigate the impact on viral hepatitis programming and reduce excess mortality from delayed treatment, policy makers should prioritize hepatitis programs as soon as it becomes safe to do so.
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              Challenges posed by COVID‐19 to people who inject drugs and lessons from other outbreaks

              Abstract Introduction In light of the COVID‐19 pandemic, considerable effort is going into identifying and protecting those at risk. Criminalization, stigmatization and the psychological, physical, behavioural and economic consequences of substance use make people who inject drugs (PWID) extremely vulnerable to many infectious diseases. While relationships between drug use and blood‐borne and sexually transmitted infections are well studied, less attention has been paid to other infectious disease outbreaks among PWID. Discussion COVID‐19 is likely to disproportionally affect PWID due to a high prevalence of comorbidities that make the disease more severe, unsanitary and overcrowded living conditions, stigmatization, common incarceration, homelessness and difficulties in adhering to quarantine, social distancing or self‐isolation mandates. The COVID‐19 pandemic also jeopardizes essential for PWID services, such as needle exchange or substitution therapy programmes, which can be affected both in a short‐ and a long‐term perspective. Importantly, there is substantial evidence of other infectious disease outbreaks in PWID that were associated with factors that enable COVID‐19 transmission, such as poor hygiene, overcrowded living conditions and communal ways of using drugs. Conclusions The COVID‐19 crisis might increase risks of homelessnes, overdoses and unsafe injecting and sexual practices for PWID. In order to address existing inequalities, consultations with PWID advocacy groups are vital when designing inclusive health response to the COVID‐19 pandemic.
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                Author and article information

                Contributors
                sarah.larney@umontreal.ca
                Journal
                Harm Reduct J
                Harm Reduct J
                Harm Reduction Journal
                BioMed Central (London )
                1477-7517
                18 April 2022
                18 April 2022
                2022
                : 19
                : 38
                Affiliations
                [1 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Université de Montréal Hospital Research Centre (CRCHUM), ; 900 Rue Saint Denis, Montreal, QC H2X 0A9 Canada
                [2 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Department of Social and Preventive Medicine, École de Santé Publique, , Université de Montréal, ; 7101 Ave Parc, Montreal, QC H3N 1X9 Canada
                [3 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Department of Family and Emergency Medicine, Faculty of Medicine, , Université de Montréal, ; 2900 Boul. Édouard-Montpetit, Montreal, QC H3C 3J7 Canada
                Author information
                http://orcid.org/0000-0002-5602-4963
                Article
                620
                10.1186/s12954-022-00620-w
                9013973
                35436936
                f941f50f-beda-426f-9fbd-3aa811964b9e
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 20 October 2021
                : 1 April 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award ID: 442632
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Health & Social care
                covid-19,people who use drugs,harm reduction,drug-related harms,rapid assessment,drug markets,access to health services

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