Flexible delivery of opioid agonist treatment during COVID-19 in Norway: qualitative and quantitative findings from an online survey of provider experiences
BMC Health Services Research,
Journal Year:
2023,
Volume and Issue:
23(1)
Published: Sept. 7, 2023
For
patients
receiving
daily
opioid
agonist
treatment
(OAT)
for
dependence,
several
countries
relaxed
guidelines
at
the
beginning
of
COVID-19
pandemic.
This
involved
longer
take-home
intervals
methadone
and
buprenorphine
doses
as
well
a
reduction
in
supervised
dosing
drug
screening.
To
date,
little
is
known
about
medium
or
long-term
experience
OAT
deregulation.
Therefore,
we
conducted
survey
to
explore
how
providers
perceived
greater
flexibility
service
delivery
end
second
year
pandemic.Nationwide
cross-sectional
study
twenty-three
units
19
publicly
funded
hospital
trusts
Norway.
were
sent
29-item
online
questionnaire
comprising
closed-format
open-ended
questions
on
provider
experiences
changes
during
past
12
months
(January
December
2021).Twenty-three
(of
whom
female:
14;
60.8%)
managers
lead
physicians
completed
reporting
that,
2021,
most
(91.3%,
n
=
21)
still
practiced
some
adjusted
approaches
established
The
common
adaptions
special
protocols
cases
(95.7%,
22),
increased
use
telephone-
video
consultations
(87.0%,
20),
medications
(52.2%,
12).
depot
also
substantially
According
providers,
handled
flexible
provision
well.
In
individual
cases,
patients'
substance
was
identified
key
factor
necessitating
reintroduction
Collaboration
with
general
practitioners
municipal
health
social
services
generally
crucial
successful
delivery.Overall,
Norwegian
system
proved
resilient
pandemic,
its
healthcare
workforce
embraced
innovation
technology
(telemedicine)
development
(depot
buprenorphine).
our
nationally
representative
sample
compliant
buprenorphine.
Our
findings
suggest
that
telemedicine
can
be
useful
adjunct
face-to-face
provide
patients.
Language: Английский
Sweden’s first Take-Home Naloxone program: participant characteristics, dose endpoints and predictors for overdose reversals
Elin Holmén,
No information about this author
Anna Warnqvist,
No information about this author
Martin Kåberg
No information about this author
et al.
Substance Abuse Treatment Prevention and Policy,
Journal Year:
2023,
Volume and Issue:
18(1)
Published: April 22, 2023
Opioid
overdoses
are
a
growing
concern,
particularly
among
people
who
inject
drugs.
Sweden,
with
comparatively
high
proportion
of
drug-related
mortality,
introduced
its
first
Take-Home
Naloxone
(THN)
program
in
2018,
at
the
Stockholm
needle
and
syringe
(NSP).
In
this
study
we
compare
THN
participant
characteristics
regarding
refills
overdose
reversals
as
well
investigate
predictors
associated
number
reversals.
We
also
interventions
performed
situations
endpoints
for
naloxone
doses.This
was
prospective
open
inclusion
cohort
conducted
between
January
24th
2018
March
31st
2022
NSP.
Participants
received
THN,
free
charge,
after
training
session
provided
data
drug
use
experiences.
During
refill
visits,
participants
reported
if
used
reversal
and,
so,
responded
to
ten-item
questionnaire
which
included
stating
whether
recipient
themselves
or
somebody
else.
Questionnaire
combined
NSP
database
demographic
data.
Zero-inflated
Poisson
regression
applied
analyse
reversals.Among
(n
=
1,295),
66.5%
stated
opioids
their
primary
drug,
61.4%
81.0%
had
previous
experience
personal
witnessed
overdose,
respectively.
Overall,
44.0%
total
1,625
victim
known
have
survived
95.6%
cases.
Stimulant
(aIRR
1.26;
95%
CI
1.01,
1.58),
benzodiazepine
1.75;
1.1,
2.78)
homelessness
1.35;
1.06,
1.73)
were
an
increased
Mortality
higher
those
least
one
(HR
3.4;
2.2,
5.2).An
NSP's
existent
framework
can
be
utilised
effectively
implement
program,
provide
basic
reach
numerous
high-risk
individuals.
four-year
study,
reversed
sizeable
potentially
fatal
overdoses,
many
by
whose
not
opioids.
rate
high,
indicating
that
motivated
maintain
supply
case
future
events.
Language: Английский
Substance use disorders and COVID-19: reflections on international research and practice changes during the “poly-crisis”
Hannah Carver,
No information about this author
Teodora Ciolompea,
No information about this author
Anna Conway
No information about this author
et al.
Frontiers in Public Health,
Journal Year:
2023,
Volume and Issue:
11
Published: July 17, 2023
Since
March
2020,
the
COVID-19
pandemic
has
had
a
disproportionately
high
toll
on
vulnerable
populations,
coinciding
with
increased
prevalence
of
alcohol-and
drug-related
deaths
and
pre-existing
societal
issues
such
as
rising
income
inequality
homelessness.
This
poly-crisis
posed
unique
challenges
to
service
delivery
for
people
substance
use
disorders,
innovative
approaches
have
emerged.
In
this
Perspectives
paper
we
reflect
changes
research
practice
those
experiencing
following
work
undertaken
part
InterGLAM
project
(part
2022.
Lisbon
Addictions
conference).
The
authors,
who
were
an
working
group,
identified
range
creative
novel
responses
by
gathering
information
from
conference
attendees
about
COVID-19-related
disorder
treatment
in
their
countries.
describe
these
across
countries,
focusing
telehealth,
provision
medications
opioid
alcohol
harm
reduction,
well
how
was
conducted.
Implications
include
better
equity
access
technology
secure
data
systems;
prescribed
safer
supply
countries
where
currently
does
not
exist;
flexible
medication
disorder;
scale
up
reduction
disorders;
greater
involvement
lived/living
experience
research;
additional
support
low-
middle-income
changed
addictions
field
there
are
lessons
ongoing
emerging
crises.
Language: Английский
Closing doors, opening windows – Adaptations and opportunities for harm reduction services during the COVID-19 pandemic in Europe
Drugs Education Prevention and Policy,
Journal Year:
2024,
Volume and Issue:
unknown, P. 1 - 12
Published: June 5, 2024
Background
Across
Europe,
harm
reduction
services
experienced
significant
disruptions
during
the
COVID-19
pandemic.
This
study
analyses
experiences
of
service
providers
pandemic
in
34
European
cities,
focusing
on
their
main
challenges,
adaptations,
and
opportunities
for
change.
A
closer
examination
Athens
Dublin
offers
an
in-depth
look
into
these
experiences.
Language: Английский
Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries
BMJ Open,
Journal Year:
2022,
Volume and Issue:
12(12), P. e064345 - e064345
Published: Dec. 1, 2022
Objective
The
COVID-19
pandemic
increased
the
demand
for
rapid
evaluation
of
innovation
in
health
and
social
care.
Assessment
methodologies
is
lacking
although
challenges
ensuring
rigour
effective
use
resources
are
known.
We
mapped
reports
evaluations
care
innovations,
categorised
different
approaches
to
evaluation,
explored
comparative
benefits
identified
knowledge
gaps.
Design
Scoping
review.
Data
sources
MEDLINE,
EMBASE
Health
Management
Information
Consortium
(HMIC)
databases
were
searched
through
13
September
2022.
Eligibility
criteria
selecting
studies
included
publications
reporting
primary
research
or
methods
interventions
services
high-income
countries.
extraction
synthesis
Two
reviewers
developed
piloted
a
data
form.
One
reviewer
extracted
data,
second
checked
10%
studies;
disagreements
uncertainty
resolved
consensus.
used
narrative
map
conducting
evaluation.
Results
16
759
records
162
which
met
inclusion
criteria.
four
main
evaluation:
(1)
Using
methodology
designed
specifically
evaluation;
(2)
Increasing
rapidity
by
doing
less
using
time-intensive
methodology;
(3)
alternative
technologies
and/or
increase
speed
existing
method;
(4)
Adapting
part
non-rapid
resulted
an
some
limited
changes
methods.
found
little
comparing
Conclusions
lack
clarity
about
what
‘rapid
evaluation’
means
but
useful
preliminary
categories.
There
need
consistency
constitutes
consistent
terminology
as
rapid;
development
specific
making
more
assessment
advantages
disadvantages
terms
rigour,
cost
impact.
Language: Английский
Disruptions to naloxone training among lay and occupational responders in Maryland during the emergence of COVID-19: Early impacts, recovery, and lessons learned
Drug and Alcohol Dependence Reports,
Journal Year:
2023,
Volume and Issue:
8, P. 100173 - 100173
Published: June 16, 2023
:
Opioid
overdose
death
rates
increased
during
the
COVID-19
pandemic.
Disruptions
in
community-based
naloxone
trainings
could
have
reduced
likelihood
of
reversal
and
chances
a
fatal
overdose.
We
investigated
changes
number
people
trained
administration
distribution
Maryland
before,
during,
after
COVID-related
stay-at-home
orders.
Data
on
training
are
from
Department
Health.
used
interrupted
time
series
models
to
estimate
average
monthly
trained:
[1]
pre-interruption
(4/2019-3/2020),
[2]
1-month
post-interruption
(4/2020-5/2020),
[3]
12-months
(4/2020-3/2021).
Trainees
were
classified
as
lay
(e.g.,
who
use
drugs)
or
occupational
law
enforcement
officers
harm
reduction
workers)
responders.
There
101,332
trainees;
54.1%
lay,
21.5%
occupational,
23.4%
unknown
responder
status.
observed
decrease
trainees
period
(-235,
p<0.001),
larger
93.2%
(-846,
p=0.013),
an
increase
(+217,
p<0.001).
was
significant
among
responders
post-interruption,
12-month
period.
Findings
suggest
marked
immediately
order,
followed
by
moderate
rebound
order.
The
may
limited
access
naloxone,
but
would
likely
been
offset
increases
trained.
Strengthening
connections
maintain
public
health
crises.
Language: Английский
National increase in the community supply of take‐home naloxone associated with a mass media campaign in Scotland: a segmented time series analysis
KMA Trayner,
No information about this author
Alan C. Yeung,
No information about this author
Harry Sumnall
No information about this author
et al.
International Journal of Drug Policy,
Journal Year:
2023,
Volume and Issue:
131, P. 104106 - 104106
Published: Aug. 8, 2023
Language: Английский
Is a definitive trial of Take-Home Naloxone in emergency settings indicated? Results of a cluster randomised feasibility study
Research Square (Research Square),
Journal Year:
2024,
Volume and Issue:
unknown
Published: March 15, 2024
Abstract
Background
Opioids
kill
more
people
than
any
other
class
of
drug.
Naloxone
is
an
opioid
antagonist
which
can
be
distributed
in
kits
for
peer
administration.
We
aimed
to
determine
feasibility
undertaking
a
definitive
randomised
controlled
trial
(RCT)
Take-home
(THN)
emergency
settings.
Methods
Using
individual-level-routine
health
records
(2015-21)
we
tested
developing
discriminant
function
identify
at
high-risk
fatal
poisoning
outcome
comparisons.
undertook
clustered
RCT
on
paired
UK
Emergency
Department
(ED)
and
ambulance
service
sites.
At
intervention
sites,
recruited
practitioners
administer
THN
patients
presenting
with
overdose
or
related
condition
during
ta
1year
recruitment
period,
2019
–
21.
assessed
methods
against
predetermined
progression
criteria.
Results
Within
routine
the
population
Wales
(~3,200,000),
identified
1,105
adult
deaths
from
poisoning,
whom
307
(27.8%)
had
no
ED
drugs
contacts
year
before
death.
predicted
probability
threshold
0.0003,
based
demographics
recent
healthcare
809
within
1
(sensitivity
74.7%)
989,151
people,
missing
274
cases.
Lowering
0.0002
increased
sensitivity
86.1%
but
included
further
608,191
non-cases;
raising
it
0.0004
reduced
65.4%
inclusion
non-cases
646,750.
two
randomly
selected
4:
299/687
(43.5%)
clinical
staff
were
trained;
60/277
eligible
(21.7%)
supplied
kit
adverse
events
reported.
Conclusion
With
low
incidence
opioid-related
death
significant
proportion
contact
drug
services
death,
numbers
needed
reach
reasonable
was
very
high.
This
study
did
not
meet
criteria,
fully
powered
planned.
Trial
Registration
ISRCTN13232859
(Registered
16/02/2018)
Language: Английский
Take-home naloxone administered in emergency settings: feasibility of intervention implementation in a cluster randomized trial
BMC Emergency Medicine,
Journal Year:
2024,
Volume and Issue:
24(1)
Published: Aug. 29, 2024
Opioids
kill
more
people
than
any
other
class
of
drug.
Naloxone
is
an
opioid
antagonist
which
can
be
distributed
in
kits
for
peer
administration.
We
assessed
the
feasibility
implementing
a
Take-home
(THN)
intervention
emergency
settings,
as
part
designing
definitive
randomised
controlled
trial
(RCT).
Language: Английский
Take-home naloxone in multicentre emergency settings: the TIME feasibility cluster RCT
Health Technology Assessment,
Journal Year:
2024,
Volume and Issue:
unknown, P. 1 - 69
Published: Oct. 1, 2024
Background
Opioids
kill
more
people
than
any
other
drug.
Naloxone
is
an
opioid
antagonist
which
can
be
distributed
in
take-home
‘kits’
for
peer
administration
(take-home
naloxone).
Aim
To
determine
the
feasibility
of
carrying
out
a
definitive
randomised
controlled
trial
naloxone
emergency
settings.
Design
We
used
Welsh
routine
data
(2015–21)
to
test
developing
discriminant
function
identify
at
high
risk
fatal
overdose.
carried
cluster
and
qualitative
study
examine
experiences
service
users
providers.
assessed
intervention
methods
against
predetermined
progression
criteria
related
to:
site
sign-up,
staff
trained,
identification
eligible
patients,
proportion
given
kits,
who
died
poisoning,
linkage
retrieval
outcomes.
Setting
This
was
environment;
sites
comprised
department
associated
ambulance
catchment
area.
Participants
At
sites,
we
invited
clinicians
paramedics
participate.
recruited
adult
patients
arrived
or
were
attended
by
problem
use
with
capacity
consent
receiving
training.
Interventions
Usual
care
basic
life
support
plus
staff.
The
offered
addition
usual
care,
guidance
recipients
on
support,
importance
calling
services,
duration
effect,
safety
legality
administration.
Results
Discriminant
With
low
numbers
opioid-related
deaths
(1105/3,227,396)
having
no
contact
health
services
year
before
death,
predictive
link
between
death
healthcare
events
weak.
Logistic
regression
models
indicated
would
need
monitor
one-third
population
capture
75%
decedents
from
overdose
1-year
follow-up.
Randomised
Four
participated
299
687
(44%)
clinical
trained.
Sixty
kits
supplied
during
recruitment.
Eligible
not
164
times:
‘forgot’
(
n
=
136);
‘too
busy’
15);
suspected
intentional
3).
Qualitative
interviews
Service
had
levels
knowledge
about
naloxone.
They
supportive
but
noted
concerns
withdrawal
resistance
attending
hospital
providers
positive
reported
barriers
including
difficulty
consenting
training
high-risk
users.
Health
economics
able
calculate
costs
train
three
(£40
per
AS
£17
Site
1
ED).
No
adverse
reported.
Progression
met
–
fewer
50%
received
outcomes
retrieved
within
reasonable
timescales.
Future
work
needs
developed
evaluated
settings,
appropriate
methods.
Limitations
Take-home
Intervention
Multicentre
Emergency
setting
interrupted
coronavirus
disease.
Conclusions
did
meet
feasibility,
so
followed
up
fully
powered
planned.
Trial
registration
registered
as
ISRCTN13232859.
Funding
award
funded
National
Institute
Care
Research
(NIHR)
Technology
Assessment
programme
(NIHR
ref:
16/91/04)
published
full
;
Vol.
28,
No.
74.
See
NIHR
Awards
website
further
information.
Language: Английский