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Table 4 Stakeholder Contextualization of Literature to Social Disruptions from COVID-19

From: Opioid use disorder treatment disruptions during the early COVID-19 pandemic and other emergent disasters: a scoping review addressing dual public health emergencies

SOCIAL CONTEXT OF DISRUPTION
What resonates from the literature? Paraphrase of Stakeholder Comments
Social isolation Greater substance use in isolation; scarcer spaces & disrupted networks to more safely use drugs in groups.
Increased illicit substance use from unfamiliar sources; drug supply shifts potentially increasing toxicity.
Amplified quality of life vulnerabilities for PWOUD; “relapse” part of broader substance use intensification.
Sudden income loss and difficulties to secure basic needs driving increased stress & risk taking.
People coming out of incarceration or hospitals are finding their map of where to access normal services have changed, and many don’t know how to navigate not just what is available, but don’t have means via available transportation.
Where could the literature go further? Paraphrase of Stakeholder Comments
Intensified adversities Decreased overall support from social and health services due to closures for physical distancing and planning needed to prepare for a communicable disease pandemic.
Pandemic Income assistance disrupted eligibility for other social assistance, which sometimes led to loss of medication coverage and new barriers.
Disparate approaches to mitigate risk, with pandemic efforts emphasizing COVID-induced barriers to care without sufficient attention to pre-existing gaps in care.
Disruptions differentially impact racialized, gender minority, housing insecure, and other vulnerable groups in specific ways that need to be better understood and addressed.
The crisis for people experiencing OUD is worse than COVID.
We have to compare these two epidemics locally (COVID & overdose), we must call it a dual public health emergency. It 100% affects all, just as infectious diseases do.
Need to look disparity in the eye, why treat COVID with urgency and take away resources and increase risks elsewhere?
Stigma Disruptions aggravate existing adversities & decrease access to care for already underserved groups.
• While focus on stigma facing PWOUD is important, it may limit attention to intersectionality of multiple stigmatized identities, especially racial & gender inequities.
It’s like Maslow’s hierarchy of needs1: when on treatment for addiction, you’re a bit tied to healthcare and there’s a razor’s edge of needs to satisfy at the same time, to eat and drink and stay alive in a toxic environment. We’re seeing the system not meet those needs and being politicized. For Indigenous PWOUD, you have 500 years of colonization, then this pandemic that isolates and incarcerates people for trying to meet basic needs.
They’re not bad people but the stigma that they face … people are dying because of racism.
  1. See [33]