Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation
Abstract Background The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing facto...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12954-023-00741-w |
| _version_ | 1811171790997684224 |
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| author | Lisa Frueh Alexandra B. Collins Roxxanne Newman Nancy P. Barnett Josiah D. Rich Melissa A. Clark Brandon D. L. Marshall Alexandria Macmadu |
| author_facet | Lisa Frueh Alexandra B. Collins Roxxanne Newman Nancy P. Barnett Josiah D. Rich Melissa A. Clark Brandon D. L. Marshall Alexandria Macmadu |
| author_sort | Lisa Frueh |
| collection | DOAJ |
| description | Abstract Background The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing factors such as isolation and job loss in these behaviors. Here, we use qualitative methods to examine the impact of the COVID-19 pandemic and pandemic-related response measures on drug use behaviors in a sample of PWUD in Rhode Island. Using a social-ecological framework, we highlight the nested, interactive levels of the pandemic’s influence on increased overdose risk behaviors. Methods From July to October 2021, semi-structured interviews were conducted with 18 PWUD who self-reported any increase in behaviors associated with overdose risk (e.g., increased use, change in drug type and/or more solitary drug use) relative to before the pandemic. Thematic analysis was conducted using a codebook with salient themes identified from interview guides and those that emerged through close reading of transcribed interviews. Guided by a social-ecological framework, themes were grouped into individual, network, institutional, and policy-level influences of the pandemic on drug use behaviors. Results Individual-level influences on increased overdose risk behaviors included self-reported anxiety and depression, isolation and loneliness, and boredom. Network-level influences included changes in local drug supply and changes in social network composition specific to housing. At the institutional level, drug use patterns were influenced by reduced access to harm reduction or treatment services. At the policy level, increased overdose risk behaviors were related to financial changes, job loss, and business closures. All participants identified factors influencing overdose risk behaviors that corresponded to several nested social-ecological levels. Conclusions Participants identified multi-level influences of the COVID-19 pandemic and pandemic-related response measures on their drug use behavior patterns and overdose risk. These findings suggest that effective harm reduction during large-scale crises, such as the COVID-19 pandemic, must address several levels of influence concurrently. |
| first_indexed | 2024-04-10T17:21:04Z |
| format | Article |
| id | doaj.art-ebe4a50255394f28b92b0fdbd50a9021 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-04-10T17:21:04Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-ebe4a50255394f28b92b0fdbd50a90212023-02-05T12:08:00ZengBMCHarm Reduction Journal1477-75172023-02-0120111210.1186/s12954-023-00741-wMulti-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigationLisa Frueh0Alexandra B. Collins1Roxxanne Newman2Nancy P. Barnett3Josiah D. Rich4Melissa A. Clark5Brandon D. L. Marshall6Alexandria Macmadu7Department of Environmental and Occupational Health, Drexel University Dornsife School of Public HealthDepartment of Epidemiology, Brown University School of Public HealthDepartment of Epidemiology, Brown University School of Public HealthDepartment of Behavioral and Social Sciences, Brown University School of Public HealthThe Center for Health + Justice Transformation, The Miriam HospitalDepartment of Health Services, Policy & Practice, Brown University School of Public HealthDepartment of Epidemiology, Brown University School of Public HealthDepartment of Epidemiology, Brown University School of Public HealthAbstract Background The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing factors such as isolation and job loss in these behaviors. Here, we use qualitative methods to examine the impact of the COVID-19 pandemic and pandemic-related response measures on drug use behaviors in a sample of PWUD in Rhode Island. Using a social-ecological framework, we highlight the nested, interactive levels of the pandemic’s influence on increased overdose risk behaviors. Methods From July to October 2021, semi-structured interviews were conducted with 18 PWUD who self-reported any increase in behaviors associated with overdose risk (e.g., increased use, change in drug type and/or more solitary drug use) relative to before the pandemic. Thematic analysis was conducted using a codebook with salient themes identified from interview guides and those that emerged through close reading of transcribed interviews. Guided by a social-ecological framework, themes were grouped into individual, network, institutional, and policy-level influences of the pandemic on drug use behaviors. Results Individual-level influences on increased overdose risk behaviors included self-reported anxiety and depression, isolation and loneliness, and boredom. Network-level influences included changes in local drug supply and changes in social network composition specific to housing. At the institutional level, drug use patterns were influenced by reduced access to harm reduction or treatment services. At the policy level, increased overdose risk behaviors were related to financial changes, job loss, and business closures. All participants identified factors influencing overdose risk behaviors that corresponded to several nested social-ecological levels. Conclusions Participants identified multi-level influences of the COVID-19 pandemic and pandemic-related response measures on their drug use behavior patterns and overdose risk. These findings suggest that effective harm reduction during large-scale crises, such as the COVID-19 pandemic, must address several levels of influence concurrently.https://doi.org/10.1186/s12954-023-00741-wOverdose risk behaviorsDrug usePandemicCOVID-19 |
| spellingShingle | Lisa Frueh Alexandra B. Collins Roxxanne Newman Nancy P. Barnett Josiah D. Rich Melissa A. Clark Brandon D. L. Marshall Alexandria Macmadu Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation Harm Reduction Journal Overdose risk behaviors Drug use Pandemic COVID-19 |
| title | Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation |
| title_full | Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation |
| title_fullStr | Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation |
| title_full_unstemmed | Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation |
| title_short | Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation |
| title_sort | multi level influences on increased overdose risk behaviors during the covid 19 pandemic among people who use drugs in rhode island a qualitative investigation |
| topic | Overdose risk behaviors Drug use Pandemic COVID-19 |
| url | https://doi.org/10.1186/s12954-023-00741-w |
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