Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada.
MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, ON, Canada.
Harm Reduct J. 2024 Jan 20;21(1):17. doi: 10.1186/s12954-024-00935-w.
Early in the COVID-19 pandemic, there was an urgent need to establish isolation spaces for people experiencing homelessness who were exposed to or had COVID-19. In response, community agencies and the City of Toronto opened COVID-19 isolation and recovery sites (CIRS) in March 2020. We sought to examine the provision of comprehensive substance use services offered to clients on-site to facilitate isolation, particularly the uptake of safer supply prescribing (prescription of pharmaceutical opioids and/or stimulants) as part of a spectrum of comprehensive harm reduction and addiction treatment interventions.
We conducted in-depth, semi-structured interviews with 25 clients and 25 staff (including peer, harm reduction, nursing and medical team members) from the CIRS in April-July 2021. Iterative and thematic analytic methods were used to identify key themes that emerged in the interview discussions.
At the time of implementation of the CIRS, the provision of a safer supply of opioids and stimulants was a novel and somewhat controversial practice. Prescribed safer supply was integrated to address the high risk of overdose among clients needing to isolate due to COVID-19. The impact of responding to on-site overdoses and presence of harm reduction and peer teams helped clinical staff overcome hesitation to prescribing safer supply. Site-specific clinical guidance and substance use specialist consults were crucial tools in building capacity to provide safer supply. Staff members had varied perspectives on what constitutes 'evidence-based' practice in a rapidly changing, crisis situation.
The urgency involved in intervening during a crisis enabled the adoption of prescribed safer supply, meeting the needs of people who use substances and assisting them to complete isolation periods, while also expanding what constitutes acceptable goals in the care of people who use drugs to include harm reduction approaches.
在 COVID-19 大流行初期，迫切需要为接触过 COVID-19 或感染过 COVID-19 的无家可归者建立隔离空间。为此，社区机构和多伦多市于 2020 年 3 月开设了 COVID-19 隔离和康复点 (CIRS)。我们试图研究为现场客户提供全面的药物使用服务，以促进隔离，特别是更安全的供应处方（开处医药类阿片类药物和/或兴奋剂）作为全面减少伤害和成瘾治疗干预措施的一部分。
我们在 2021 年 4 月至 7 月期间对来自 CIRS 的 25 名客户和 25 名员工（包括同伴、减少伤害、护理和医疗团队成员）进行了深入的半结构化访谈。使用迭代和主题分析方法确定访谈讨论中出现的关键主题。
在 CIRS 实施时，提供更安全的阿片类药物和兴奋剂供应是一种新颖且有些争议的做法。开处方更安全的供应是为了解决因 COVID-19 需要隔离的客户因过量用药而面临的高风险。现场处理过量用药的影响以及减少伤害和同伴团队的存在，帮助临床工作人员克服了对开处方更安全供应的犹豫。现场特定的临床指导和药物使用专家咨询是提供更安全供应能力的关键工具。在快速变化的危机情况下，工作人员对什么构成“循证”实践有不同的看法。
在危机中进行干预的紧迫性使得规定的更安全供应得以采用，满足了使用药物的人的需求，并帮助他们完成隔离期，同时也扩大了在照顾使用药物的人中构成可接受目标的范围，包括减少伤害的方法。
