Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia.
National Drug Research Institute, Curtin University, Perth, Australia.
Public Health. 2023 Nov;224:90-97. doi: 10.1016/j.puhe.2023.08.019. Epub 2023 Sep 22.
The COVID-19 pandemic disrupted service provision of harm reduction and drug treatment services for people who inject drugs in many countries. The two supervised injecting facilities (SIFs) in Sydney and Melbourne were differentially impacted by the pandemic, requiring local procedural changes in each service. We aimed to examine the impact of pandemic responses (including restrictions on movement, known as 'lockdowns') on service use and key parameters such as client reports of drug injected and recorded overdose rates.
Time series analysis of weekly client visits and monthly overdoses occurring at each service.
Administrative client data from the two SIFs (Sydney data from 1 January 2018 to 30 April 2022; Melbourne data from 1 July 2018 to 30 April 2022) were examined using interrupted time series analyses with lockdown dates in each state entered as interruption terms. We analysed weekly SIF visits overall and by drug type, and monthly rates of opioid overdose at each service.
Lockdowns resulted in decreased visits to both services. The number of weekly client visits decreased during the first national lockdown for both the Sydney (trend change = -57.9; 95% CI [-109.4, -6.4]) and Melbourne SIF (near sig trend change = -54.8 [-110.8, 1.05]). Trends in visit numbers increased after lockdowns were lifted in each city; however, visits in Sydney have not returned to the numbers recorded prior to the pandemic. Visits to the Melbourne SIF related to heroin use declined at each lockdown (trend 1 = -42.7 [-81.5, -3.9]; trend 2 = -56.1 [-94.6, -17.7]; trend 3 = -33.8 [-67.4, -0.2]); heroin visits to the Sydney SIF declined during the first lockdown and remained low (trend = -55.6 [-82.8, -28.3]). Methamphetamine visits to the Sydney SIF fluctuated, surpassing heroin visits at several timepoints. Rates of monthly opioid overdoses at both services declined immediately following the start of the first lockdown (Sydney = -16.6 [-26.1, -6.8]; Melbourne = -6.4 [-8.7, -4.1]), with increasing trends recorded at the end of the final lockdown in each jurisdiction (Sydney = 2.8 [0.6, 5.0]; Melbourne = 1.3 [0.72, 3.2]).
Public health restrictions related to the COVID-19 pandemic were associated with reduced client visits to, and overdoses in, Australian SIFs. Variations were noted in the drugs injected, likely reflecting changes in local drug markets. Shifts to other drugs during these periods were evident: methamphetamine in Sydney; co-injection of heroin and diphenhydramine in Melbourne.
新冠疫情大流行使许多国家的减少伤害和药物治疗服务的提供受到干扰。悉尼和墨尔本的两家监督注射设施（SIF）受到疫情的不同程度的影响，每个服务都需要进行当地的程序变更。我们旨在研究疫情应对措施（包括限制行动，即“封锁”）对服务使用和关键参数的影响，例如客户报告的注射药物和记录的过量用药率。
对每个服务的每周客户访问量和每月过量用药情况进行时间序列分析。
使用中断时间序列分析，分析来自两个 SIF 的行政客户数据（悉尼数据来自 2018 年 1 月 1 日至 2022 年 4 月 30 日；墨尔本数据来自 2018 年 7 月 1 日至 2022 年 4 月 30 日），每个州的封锁日期作为中断项输入。我们分析了总体和按药物类型的每周 SIF 访问量，以及每个服务的阿片类药物过量用药的每月发生率。
封锁导致两个服务的访问量都减少了。悉尼 SIF 的每周客户访问量在全国第一次封锁期间减少（趋势变化= -57.9；95%置信区间[-109.4，-6.4]），墨尔本 SIF 的每周客户访问量也减少（接近显著趋势变化= -54.8 [-110.8，1.05]）。在每个城市解除封锁后，访问量的趋势有所增加；然而，悉尼的访问量尚未恢复到疫情前的水平。墨尔本 SIF 的海洛因使用量每次封锁都有所下降（趋势 1= -42.7 [-81.5，-3.9]；趋势 2= -56.1 [-94.6，-17.7]；趋势 3= -33.8 [-67.4，-0.2]）；悉尼 SIF 的海洛因访问量在第一次封锁期间下降，并一直保持低位（趋势= -55.6 [-82.8，-28.3]）。悉尼 SIF 的冰毒访问量波动不定，在几个时间点超过了海洛因访问量。在第一次封锁开始后，两个服务的每月阿片类药物过量用药率立即下降（悉尼= -16.6 [-26.1，-6.8]；墨尔本= -6.4 [-8.7，-4.1]），在每个司法管辖区的最后一次封锁结束时记录到上升趋势（悉尼= 2.8 [0.6，5.0]；墨尔本= 1.3 [0.72，3.2]）。
与新冠疫情相关的公共卫生限制措施与澳大利亚 SIF 客户访问量和过量用药量减少有关。注射药物的变化，可能反映了当地毒品市场的变化。在这些时期，转向其他药物的情况明显：悉尼的冰毒；墨尔本的海洛因和苯海拉明混合使用。
