RESUMO
The COVID-19 pandemic introduced additional health challenges for people who use substances (PWUS) amid the overdose crisis. Numerous harm reduction services, including supervised consumption sites (SCS) across Canada, faced shutdowns and reduced operating capacity in order to comply with public health measures. Mobile Overdose Response Services (MORS) are novel overdose prevention technologies that allow those who are unable to access alternative means of harm reduction to consume substances under the virtual supervision of a trained operator. Here, we examine the role of MORS in the context of the COVID-19 pandemic. A total of 59 semi-structured interviews were conducted with the following key interest groups: PWUS, healthcare providers, harm reduction workers, MORS operators, and the general public. Inductive thematic analysis informed by grounded theory was used to identify major themes pertaining to the perception of MORS. As the pandemic shifted the public focus away from harm reduction, many participants viewed MORS as an acceptable strategy to reduce the harms associated with solitary substance and alleviate the sense of isolation driven by social distancing measures. While the pandemic may have increased the utility of MORS, concerns surrounding personal privacy and confidentiality remained. Overall, MORS were perceived as a useful adjunct service to address the unmet needs PWUS during the pandemic and beyond.
Assuntos
COVID-19 , Overdose de Drogas , Redução do Dano , Pesquisa Qualitativa , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Overdose de Drogas/prevenção & controle , Canadá , Feminino , SARS-CoV-2 , Masculino , Adulto , Unidades Móveis de Saúde , Entrevistas como Assunto , Pandemias , Pessoa de Meia-Idade , Pessoal de Saúde/psicologiaRESUMO
BACKGROUND: In response to the exacerbated rates of morbidity and mortality associated with the overlapping overdose and COVID-19 epidemics, novel strategies have been developed, implemented, operationalized and scaled to reduce the harms resulting from this crisis. Since the emergence of mobile overdose response services (MORS), two strategies have aimed to help reduce the mortality associated with acute overdose including staffed hotline-based services and unstaffed timer-based services. In this article, we aim to gather the perspectives of various key interest groups on these technologies to determine which might best support service users. METHODS: Forty-seven participants from various interested groups including people who use substances who have and have not used MORS, healthcare workers, family members, harm reduction employees and MORS operators participated in semi-structured interviews. Transcripts were coded and analyzed using a thematic analysis approach. RESULTS: Four major themes emerged regarding participant perspectives on the differences between services, namely differences in connection, perceived safety, privacy and accessibility, alongside features that are recommended for MORS in the future. CONCLUSIONS: Overall, participants noted that individuals who use substances vary in their desire for connection during a substance use session offered by hotline and timer-based service modalities. Participants perceived hotline-based approaches to be more reliable and thus potentially safer than their timer-based counterparts but noted that access to technology is a limitation of both approaches.
Assuntos
Overdose de Drogas , Epidemias , Aplicativos Móveis , Humanos , Linhas Diretas , Overdose de Drogas/epidemiologia , Pesquisa Qualitativa , Redução do DanoRESUMO
BACKGROUND: Supervised consumption sites (SCS) and overdose prevention sites (OPS) have been implemented across Canada to mitigate harms associated with illicit substance use. Despite their successes, they still contend with challenges that limit their accessibility and uptake. Overdose response hotlines and apps are novel virtual technologies reminiscent of informal "spotting" methods that may address some of the limitations. Here, we strove to qualitatively examine the factors that may encourage or deter utilization of these virtual services and SCS. METHODS: A total of 52 participants across Canada were recruited using convenience and snowball sampling methods. These included people with lived and living experience of substance use, family members of people with lived experience, healthcare providers, community harm reduction workers, and virtual harm reduction operators. Semi-structured telephone interviews were conducted and inductive thematic analysis was performed to identify the themes pertaining to SCS and virtual harm reduction. RESULTS: Participants viewed overdose response hotline and apps as an opportunity to consume substances without being hindered by logistical barriers (e.g., wait times), fear of law enforcement, invasion of privacy, and more. They also noted that these virtual services provided more flexibility for clients who opt for routes of consumption that are not supported by SCS, such as smoking. Overall, SCS was perceived to be better than virtual services at facilitating social connection, providing additional resources/referrals, as well as prompt response to overdose. CONCLUSION: In sum, participants viewed SCS and virtual services as filling different needs and gaps. This study adds to a growing body of literature which informs how virtual harm reduction services can serve as useful adjunct to more standard harm reduction methods.
Assuntos
Overdose de Drogas , Redução do Dano , Linhas Diretas , Humanos , Canadá , Feminino , Overdose de Drogas/prevenção & controle , Masculino , Adulto , Programas de Troca de Agulhas , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Pessoa de Meia-Idade , Pesquisa Qualitativa , Aplicativos Móveis , TelemedicinaRESUMO
INTRODUCTION: Unregulated supply of fentanyl and adulterants continues to drive the overdose crisis. Mobile Overdose Response Services (MORS) are novel technologies that offer virtual supervised consumption to minimize the risk of fatal overdose for those who are unable to access other forms of harm reduction. However, as newly implemented services, they are also faced with numerous limitations. The aim of this study was to examine the facilitators and barriers to the adoption of MORS in Canada. METHODS: A total of 64 semi-structured interviews were conducted between November 2021 and April 2022. Participants consisted of people who use substances (PWUS), family members of PWUS, health care professionals, harm reduction workers, MORS operators, and members of the general public. Inductive thematic analysis was used to identify the major themes and subthemes. RESULTS: Respondents revealed that MORS facilitated a safe, anonymous, and nonjudgmental environment for PWUS to seek harm reduction and other necessary support. It also created a new sense of purpose for operators to positively contribute to the community. Further advertising and promotional efforts were deemed important to increase its awareness. However, barriers to MORS implementation included concerns regarding privacy/confidentiality, uncertainty of funding, and compassion fatigue among the operators. CONCLUSION: Although MORS were generally viewed as a useful addition to the currently existing harm reduction services, it's important to monitor and tackle these barriers by engaging the perspectives of key interest groups.
Assuntos
Overdose de Drogas , Opinião Pública , Humanos , Canadá , Overdose de Drogas/prevenção & controle , Pesquisa Qualitativa , Fentanila , Redução do DanoRESUMO
High-resolution peripheral quantitative computed tomography (HR-pQCT) imaging, together with computational finite element analysis (FEA), offers an attractive, noninvasive tool to quantify bone strength development in pediatric studies. Evidence of annual changes and errors in repeated HR-pQCT measures is limited, and time intervals required to reliably capture changes in children's bone strength or microarchitecture have not yet been defined. Our objectives were: (1) to quantify annual changes in bone strength and microarchitectural properties; (2) to define precision errors for pediatric bone strength outcomes; (3) to characterize annual changes in contrast to pediatric precision errors; and (4) to estimate monitoring time intervals (MTIs) required to reliably characterize bone development at the distal radius and tibia. We obtained distal radius (7% of ulnar length) and tibia (8%) bone properties using HR-pQCT and FEA from 38 follow-up study participants (21 girls) at baseline (mean age 10.6 years, SD 1.7 years) and after 1 year; and from 32 precision study participants (16 girls) at baseline (mean age 11.3 years, SD 1.6 years) and after 1 week. We characterized mean annual changes (paired t tests) contrasted to pediatric precision errors (CV%RMS ) and estimated MTIs. Annual increases in bone strength, total area, cortical thickness, and density ranged between 3.0% and 25.3% and 2.4% and 15.6% at the distal radius and tibia, respectively. Precision errors for all bone strength outcomes were ≤6.8% and ≤5.1% at the distal radius and tibia, respectively, and appeared lower than annual gains in bone strength at both sites. Cortical porosity decreased 19.6% at the distal radius and 6.6% at the distal tibia; these changes exceeded respective precision errors, indicating cortical bone consolidation. MTIs ranged between 0.5 years and infinity at the distal radius and 0.5 and 5.9 years at the distal tibia. Estimated MTIs suggest that pediatric bone strength, cortical bone density, and porosity development can be reliably monitored with annual measurements. © 2019 American Society for Bone and Mineral Research.