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

  1. Seyed Ramin Radfar
  2. Cornelis A. J. De Jong
  3. Ali Farhoudian
  4. Mohsen Ebrahimi
  5. Parnian Rafei
  6. Mehrnoosh Vahidi
  7. Masud Yunesian
  8. Christos Kouimtsidis
  9. Shalini Arunogiri
  10. Omid Massah
  11. Abbas Deylamizadeh
  12. Kathleen T. Brady
  13. Anja Busse
  14. Marc N. Potenza
  15. Hamed Ekhtiari
  16. Alexander Mario Baldacchino
  17. ISAM-PPIG Global Survey Consortium

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Abstract

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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  1. Version published to 10.3389/fpsyt.2021.639393
  2. ScreenIT

    SciScore for 10.1101/2020.09.21.20199133: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Descriptive data are presented as means and percentages for each country’s response mean (percentage), as well as an average to the global responses. 2.4. Ethics Approval: The survey protocols and all materials, including the survey questionnaires, received approval from the University of Social Welfare and Rehabilitation Sciences, ethics committee in Tehran, Iran (Code: IR.USWR.REC.1399.061).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The number of respondents (for countries with more than one respondent) is indicated in front of their names, and numbers in each column represent valid responses from each country. 2.3. Statistical Analysis: Statistical analyses were performed using SPSS version 22 (IBM Corp.,
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    N.Y., USA) and RStudio (version 1.2.1335).
    RStudio
    suggested: (RStudio, RRID:SCR_000432)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Eighty-one (81) % of participating countries reported limitations in usage of any mobile and other outreach services due to lockdown policies for homeless PWSUDs, with respondents from 57% of participating countries reporting limitations in their harm reduction overdose services during the initial period of the pandemic. This was compounded with reported problems with the distribution of take-home naloxone as reported by respondents from 57% of participating countries. Finally, respondents from 54.8% of participating countries reported that there have been shortages at needle and syringe programs and/or of condom distribution. RECOMMENDATION 4: Harm reduction initiatives should be seen as an integral part of an evidence-based treatment program and not as an adjunct to failed treatment and/or solely as a public health response to reduce blood-borne diseases. Service providers should be considering identifying person-centered, continuous care provision in all therapeutic options available (harm reduction initiatives included) especially during pandemic situations Pregnant women and immigrants /refugees with SUDs are particularly vulnerable groups. According to survey responses, pregnant women were perceived as relatively less impacted during the initial period of the pandemic. This is reassuring as discontinuity of treatment services could place not only a pregnant woman at high risk, but also the developing fetus. However, refugee and immigrant populations were reported as hav...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.09.21.20199133v1 on medRxiv