Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness. (1st June 2022)

• Record Type: Journal Article
• Authors: Brothers, Thomas D.; Leaman, Malcolm; Bonn, Matthew; Lewer, Dan; Atkinson, Jacqueline; Fraser, John; Gillis, Amy; Gniewek, Michael; Hawker, Leisha; Hayman, Heather; Jorna, Peter; Martell, David; O'Donnell, Tiffany; Rivers-Bowerman, Helen; Genge, Leah
• Is Part Of: Drug and alcohol dependence. Volume 235(2022)
• Publication Date: 2022-06-01
• Subjects: ABV Alcohol by volume -- BCCSU British Columbia Centre on Substance Use -- iOAT Injectable opioid agonist treatment -- MOSH Mobile Outreach Street Health -- NORS National Overdose Response Service -- OAT Opioid agonist treatment -- SROM Slow-release oral morphine; Substance use -- Drug addiction -- Harm reduction -- Substance abuse, intravenous -- Substance-related disorders -- Needle-exchange programs -- Opiate substitution treatments -- SARS-CoV-2; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2022.109440
• Languages: English
• ISSNs: 0376-8716

Abstract

Abstract: Background: During a COVID-19 outbreak in the congregate shelter system in Halifax, Nova Scotia, Canada, a healthcare team provided an emergency "safe supply" of medications and alcohol to facilitate isolation in COVID-19 hotel shelters for residents who use drugs and/or alcohol. We aimed to evaluate (a) substances and dosages provided, and (b) outcomes of the program. Methods: We reviewed medical records of all COVID-19 isolation hotel shelter residents during May 2021. The primary outcome was successful completion of 14 days isolation, as directed by public health orders. Adverse events included (a) overdose; (b) intoxication; and (c) diversion, selling, or sharing of medications or alcohol. Results: Seventy-seven isolation hotel residents were assessed (mean age 42 ± 14 years; 24% women). Sixty-two (81%) residents were provided medications, alcohol, or cigarettes. Seventeen residents (22%) received opioid agonist treatment (methadone, buprenorphine, or slow-release oral morphine) and 27 (35%) received hydromorphone. Thirty-one (40%) residents received prescriptions stimulants. Six (8%) residents received benzodiazepines and forty-two (55%) received alcohol. Over 14 days, mean daily dosages increased of hydromorphone (45 ± 32 – 57 ± 42 mg), methylphenidate (51 ± 28 – 77 ± 37 mg), and alcohol (12.3 ± 7.6 – 13.0 ± 6.9 standard drinks). Six residents (8%) left isolation prematurely, but four returned. During 1059 person-days, there were zero overdoses. Documented concerns regarding intoxication occurred six times (0.005 events/person-day) and medication diversion/sharing three times (0.003 events/person-day). Conclusions: COVID-19 isolation hotel residents participating in an emergency safe supply and managed alcohol program experienced high rates of successful completion of 14 days isolation and low rates of adverse events. Highlights: Safe supply and managed alcohol were delivered in COVID-19 isolation shelters. This was associated with high rates of completion of mandated isolation or quarantine. There were zero overdoses and few adverse events. Emergency safe supply and managed alcohol seems safe in this setting.