Bridging the Gap in Harm Reduction Using Mobile Overdose Response Services (MORS) in the Context of the COVID-19 Pandemic: A Qualitative Study.

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.

Seo B ，Rioux W ，Rider N ，Teare A ，Jones S ，Taplay P ，Ghosh SM ... -  《-》

Perceptions of overdose response hotlines and applications among rural and remote individuals who use drugs in Canada: a qualitative study.

Viste D ，Rioux W ，Medwid M ，Williams K ，Tailfeathers E ，Lee A ，Jafri F ，Zobell S ，Ghosh SM ... -  《-》

Are virtual harm reduction interventions right for everyone?: A qualitative study of the appropriateness of overdose response hotlines and applications for different subgroups of people who use substances.

Overdose response hotlines and apps are novel virtual harm reduction technologies that allow remote monitoring of individuals while they use substances (especially if they use alone) through electronic means. The authors explored partner perspectives to determine which groups of people who use substances (PWUS) these services would be most appropriate for, with the aim of better informing service providers on how to target their use to maximize benefit for clients. The study conducted 64 semi-structured interviews with participants from a variety of backgrounds (individuals with lived or living experience of substance use, lay persons, health care providers, harm reduction workers, and operational experts). All information from interviews was kept confidential, de-identified, and stored on a secure server. Inductive thematic analysis identified major themes and subthemes. Two evaluators coded transcripts using Dedoose software. Once initial coding was complete, transcript coders selected quotes and shared them with a consulting project manager to cross-validate themes. The study conducted interviews until thematic saturation across all participants was reached based on the consensus of the two evaluators and the primary investigator. Overall, the study determined that overdose response hotlines and apps would potentially have at least some utility for any PWUS. However, some were found to have a varying level of appropriateness for specific subgroups of PWUS. There were 11 different subgroups identified in this study and of these subgroups, the majority were identified as groups for whom virtual harm reduction services would be appropriate interventions. Overdose response hotlines and apps are helpful and potentially life-saving adjunctive options which may be more appropriate for some subgroups of PWUS than others. These results may help service providers to target groups with the most potential to benefit.

Teare A ，Rioux W ，Rider N ，Jones S ，Taplay P ，Ghosh SM ... -  《-》

Perspectives of Key Partners on Improving Awareness of Virtual Harm Reduction Services: A Qualitative Study.

Sedaghat N ，Rider N ，Rioux W ，Teare A ，Jones S ，Taplay P ，Ghosh SM ... -  《-》

Visitor Restrictions During the COVID-19 Pandemic and Increased Falls With Harm at a Canadian Hospital: An Exploratory Study.

Falls with harms (FWH) in hospitalized patients increase costs and lengths of stay. The COVID-19 pandemic has resulted in more FWH. Additionally, the COVID-19 pandemic has resulted in increased patients in isolation with fewer visitors. Their relationship with falls has not been previously studied. This is a retrospective, single-site, 12-month before pandemic-12-month after pandemic, observational study. Multiple logistic regression analysis was used to model FWH outcome and associations with isolation and visitor restrictions. There were 4369 isolation events and 385 FWH among 22,505 admissions during the study period. Unadjusted analysis demonstrated a FWH risk of 1.33% (95% CI 0.99, 1.67) in those who were placed in isolation compared to 1.80% (95% CI 1.60, 2.00) in those without an isolation event ( χ2 = 4.73, P = 0.03). The FWH risk during the different visitor restriction periods was significantly higher compared to the prepandemic period ( χ2 = 20.81, P < 0.001), ranging from 1.28% (95% CI 1.06, 2.50) in the prepandemic period to 2.03% (95% 1.66, 2.40) with no visitors permitted (phase A) in the pandemic period. After adjusting for potential confounders and selection bias, only phase A visitor restrictions were associated with an increased FWH risk of 0.75% (95% CI 0.32, 1.18) compared to no visitor restrictions. Our results suggest a moderately strong association between hospitalized patient FWH risk and severe visitor restrictions. This association was muted in phases with even minor allowances for visitation. This represents the first report of the adverse effects of visitor restriction policies on patients' FWH risks.

Shennan S ，Coyle N ，Lockwood B ，DiDiodato G ... -  《-》