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The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19. Findings suggest that countries with stronger social welfare systems pre-COVID introduced durable interventions targeting structural drivers of health. Countries with fragmented social service infrastructures implemented temporary initiatives for PWUD led by non-governmental organisations. The paper summarises the most successful early pandemic responses seen across countries and ends by calling for greater systemic investments in social protections for PWUD, diversion away from criminal-legal systems toward health interventions, and integrated harm reduction, treatment and recovery supports for PWUD.

Zero-tolerance school disciplinary policies have contributed to the proliferation of exclusionary practices, which increase the risk that minoritized students will be harmed by the school-to-prison pipeline (STPP). The purpose of this review was to explore factors that influence the STPP and highlight the role school nurses can play in protecting students from this public health crisis. We used a systematic mixed-studies review method, and 14 studies were included. Exclusionary discipline disproportionately affects minoritized students, but decreased student-teacher ratios, wellness-focused environments, and lower levels of school punishment can improve student achievement and health. The National Association of School Nurses position statement provides a framework to guide school nurses in the dismantlement of the STPP. School nurses should advocate for their position on the interdisciplinary team, funding for alternative disciplinary programs, abolition of school policing, restorative justice approaches, support for at-risk students, and anti-racism education programs for all school staff.

Objectives: Buprenorphine is not reliably stocked in many pharmacies, and pharmacy-level barriers may deter patients from opioid use disorder care. We surveyed all outpatient pharmacies in Philadelphia to describe variation in buprenorphine access and developed a map application to aid in identifying pharmacies that stock the medication. Methods: Using a dataset from the Bureau of Professional and Occupational Affairs, we conducted a telephone survey of operating outpatient pharmacies (N = 422) about their buprenorphine stocking and dispensing practices. We used ArcGIS Pro 3.0.3 to join US Census Bureau ZIP code-level race and ethnicity data, conduct descriptive analyses, and create a map application. Results: We collected data from 351 pharmacies (83% response rate). Two hundred thirty-eight pharmacies (68%) indicated that they regularly stock buprenorphine; 6 (2%) would order it when a prescription is sent. Ninety-one (26%) said that they do not stock or order buprenorphine, and 16 (5%) were unsure. We identified 137 "easier access" pharmacies (39%), meaning they regularly stock buprenorphine, dispense to new patients, and have no dosage maximums. Zip codes with predominantly White residents had a median (interquartile range) of 3 (2–4) "easier access" pharmacies, and those with predominantly Black residents a median (interquartile range) of 2 (1–4.5). Nine zip codes had no "easier access" pharmacies, and 3 had only one; these 3 zip codes are areas with predominantly Black residents. Conclusions: Buprenorphine access is not equitable across Philadelphia and a quarter of pharmacies choose not to carry the medication. Our map application may be used to identify pharmacies in Philadelphia that stock buprenorphine. [ABSTRACT FROM AUTHOR]

Introduction: People who inject drugs (PWID) have a greater burden of multimorbid chronic diseases than the general population. However, little attention has been paid to the engagement in primary care for services related specifically to injection drug use and management of underlying chronic comorbid diseases for this population. This systematic review identified facilitators and barriers to healthcare engagement in the primary care setting among PWID. Design and Methods: Studies were identified by a literature search of PubMed, CINAHL, and EMBASE, and by searching the references of retrieved articles. Studies were included if they measured active injection drug use, and outcomes related to primary care engagement characterized by: diagnosis of a health condition, linkage or retention in care, health condition‐related outcomes, and reported patient–provider relationship. Results: Twenty‐three articles were included. Using the behavioral model, factors within predisposing, enabling, need, and health behavior domains were identified. Having co‐located services and a positive patient–provider relationship were among the strongest factors associated with healthcare utilization and engagement while active injection drug use was associated with decreased engagement. Conclusions: To our knowledge, this is the only review of evidence that has examined factors related to primary care engagement for people who inject drugs. Most articles were observational studies utilizing descriptive designs. Although the assessment of the evidence was primarily rated 'Good', this review identifies a significant need to improve our understanding of primary care engagement for PWID. Future research and intervention strategies should consider these findings to better integrate the holistic care needs of PWID into primary care to reduce morbidity and mortality associated with injection drug use and chronic disease. Clinical relevance: Primary care engagement is important for preventative care, early diagnosis of disease, and management of chronic diseases, including addressing problems of substance use. This review highlights factors nurses can utilize to facilitate primary care engagement of PWID. [ABSTRACT FROM AUTHOR]

Aim: To explore the factors that influence provider pain treatment decision‐making and the receipt of pain management by injured Black patients in the United States. Design: We completed a systematic mixed studies review using a results‐based convergent synthesis design. Data Sources: PubMed, SCOPUS and CINAHL were searched for articles published between 2007–2017 using the search terms 'African American', 'Black American', 'race', 'pain treatment', 'pain management' and 'analgesia'. Twenty studies were included in this review. Review Method: A search of databases and hand‐searching identified peer‐reviewed published papers. The Mixed Method Appraisal Tool was used to appraise the studies. Results: The results indicate that healthcare provider characteristics, racial myths about pain sensitization and assumed criminality all impact provider treatment decision‐making and the receipt of pain treatment by injured Black patients. Impact: This review addresses racial disparities in pain management by focusing on the factors that impact the receipt of pain treatment by injured Black patients. The findings will have an impact on providers who prescribe pain treatment and on the patients they treat. These findings suggest that assumed criminality of certain patients can negatively impact care, which is a type of bias not frequently explored or discussed in health disparities research. This review will help inform further research in healthcare disparities and prompt providers to examine their assumptions about the patients for whom they care. Conclusion: These results provide important areas for further study, including how assumed criminality of certain patients can have a negative impact on care. [ABSTRACT FROM AUTHOR]

Telehealth proves to be more than just a stopgap in providing support to patients., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)