Preventing Opioid Overdose Mortality in the United States

We are proposing an urgent competitive revision for our current grant (R01DA04686702) to study the impactof the novel coronavirus (COVID-19) pandemic on syringe service programs (SSPs) throughout the UnitedStates (US). The COVID-19 pandemic has rapidly proliferated and caused unprecedented disruption to health and health services in the US and has the potential to reverse recent reductions in the nation's opioidoverdose mortality rate. As cities, counties, and states tried to stunt the transmission and impact of COVID-19, they began rolling out various social distancing orders (e.g., Shelter-in-Place). A consequence of these public health mandates and the need to protect people from COVID-19 has been disruptions in services forpeople who inject drugs (PWID). Particularly in the context of the opioid epidemic, understanding how theCOVID-19 pandemic has affected services for people who use drugs is critical to know how to respondwithin the current pandemic and to be better prepared for future public health crises. SSPs have been themainstay for community-based prevention efforts for PWID and have pioneered efforts for implementingoverdose education and naloxone distribution (OEND) and improving enrollment into medications for opioiduse disorder (MOUD) programs. SSPs are considered an "essential service" and have not been mandated tosuspend services during Shelter-in-Place orders. As part of our nationwide study of SSPs, our study teamhas documented that SSPs are facing unprecedented challenges and adapting implementations, asnecessary. Leveraging our ongoing study, we propose to build a comprehensive understanding ofadaptations made in response to COVID-19. Using the exploration, preparation, implementation, andsustainment (EPIS) framework, we propose to systematically assess the impacts of the COVID-19 pandemicon SSP services in the US. Our proposed aims are as follows: Aim 1: To characterize the response toCOVID-19 regarding the delivery of syringe services, overdose education and naloxone distribution, andmedications for opioid use disorder among SSPs; Aim 2: To describe barriers and facilitators among SSPsregarding implementation of syringe services, overdose education and naloxone distribution, andmedications for opioid use disorder during the COVID-19 pandemic. To achieve these aims, we will conducta cross-sectional study with all SSPs (N = 407) in the US in late summer/fall 2020. In addition, we willconduct in-depth interviews with 36 SSPs from geographically diverse urban, suburban, and rural locationswhere we observe varying levels of implementation experiences-de-implementation of services, adaptedimplementations, and implementation as usual-during the COVID-19 pandemic. Understanding how theCOVID-19 pandemic has impacted services for PWID is critical for improving our response within the currentpandemic and being better prepared for future pandemics.