Theme: Epidemiology and Public Health Research Year: 2021
Background: Psychological impacts of the COVID-19 pandemic have been widely reported; however, data is limited among people who use drugs. This study aimed to determine the prevalence and correlates of psychological distress among people who use drugs during the pandemic period and assess if these differ by mode of drug administration. Methods: We conducted a rapid assessment study from May-December 2020 among participants drawn from HEPCO, a community-based cohort of people who inject drugs in Montreal (N=127), and community organizations serving people who use illicit drugs (N=99). We collected and analyzed data on changes in drug use behaviours and survival needs since the declaration of COVID-19 as a public health emergency and assessed past-month psychological distress using the Kessler K6 scale. Multivariable logistic regression was conducted to examine correlates of severe psychological distress (score≥13), overall and stratified by recent drug injection (past 6 month). Results: Of 226 survey participants, 21.7% were female, 41.6% reported recent drug injection, 15% and 41% reported opiates and stimulants as their drug of choice, respectively. A quarter (n=56) screened positive for severe psychological distress. In multivariable analysis, younger age (aOR=0.95 [95%CI: 0.92,0.98]) and increases in: i) food insecurity (3.30 [1.56,6.97]), ii) frequency of non-injection drug use (4.19 [1.53,11.51]) and iii) non-fatal overdose (6.81 [1.29,35.97]) since the emergency declaration were positively associated with past-month psychological distress. In stratified analyses, severe distress was associated with increased frequency of injection drug use and opioid withdrawal among PWID, and with stimulant use among noninjection drug users. Conclusions. This study documented a high prevalence of severe psychological distress among people who use drugs during the COVID-19 pandemic. In addition to drug use-related factors, food insecurity emerged as a possible determinant of distress. Ongoing monitoring and intervention will be necessary to mitigate negative impacts of the pandemic in this vulnerable population.
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