Rachel Gicquelais, PhD, assistant professor, UW–Madison School of Nursing, and co-principal investigator Ryan Westergaard, MD, PhD, MPH, associate professor, Department of Medicine, used a COVID-19 Response grant to address the dual epidemics of COVID-19 and drug overdose. With a focus on rural Wisconsin residents, the goal of this project was to understand patterns of overdose risk, COVID-19 vaccine willingness, and related attitudes and behaviors. Investigators also tested a novel mobile health intervention to support vaccine uptake in people who inject drugs.
The Challenge
Deaths from drug overdose increased by 28 percent in Wisconsin during the COVID-19 pandemic, resulting in the highest overdose mortality rate recorded in the state during the 20+ year ongoing overdose epidemic. People who inject drugs under-utilize preventive health care and experience stigma and discrimination in medical settings, making them particularly vulnerable to both overdose and vaccine preventable illnesses such as COVID-19.
Project Goals
The primary goal of this research project was to understand overdose risk, COVID-19 vaccine uptake, and related attitudes and behaviors before and after a novel intervention. The grantees identified two specific aims:
Aim 1: To quantify longitudinal demographic and geospatial patterns of COVID-19 vaccine uptake among a large sample of rural-dwelling people who inject drugs in Wisconsin
Aim 2: To test a novel mobile health intervention to reduce overdose risk and support vaccine uptake with people who inject drugs in Wisconsin
Results
Aim 1: The research team conducted a retrospective cohort study using data from a prior cross-sectional study of 991 people who injected drugs from the Wisconsin node of the NIH Rural Opioid Initiative conducted from 2017-2019. They matched this previously collected sample with longitudinal registry data from the Wisconsin Department of Health Services to assess additional outcomes. Analysis showed that people with a history of injecting drugs died at a rate 4.8-fold higher than the general population of Wisconsin (adjusted for age and sex), primarily due to drug overdoses involving opioids and/or stimulants. Results were shared in conference presentations and there are plans to continue analysis of additional key outcomes.
Aim 2: The team developed a new intervention for reducing overdose risk and increasing vaccine confidence that is delivered over a 12-week period via a smartphone application called Thrive4Life Connect. They conducted a pilot, pre-post study design with 60 adults who reported injecting opioids and receiving services at Vivent Health syringe services programs in Milwaukee, Eau Claire and Appleton, Wisconsin. Primary analysis focused on intervention adherence showed that participants completed a median of 9 weekly intervention activities of the total of 12 available activities. The most selected overdose risk reduction goal was “reduce injecting or switch to snorting or smoking,” chosen a mean of 1.4 times over the 12 weeks.
A secondary analysis to estimate preliminary intervention efficacy to reduce overdose risk was conducted. There were statistically significant (p<0.05) declines in number of days reporting all five types of overdose risk behaviors studied between baseline and 6 months. Non-injection opioid use, injection drug use and/or speedballing (i.e., injecting an opioid and stimulant drug at the same time), and opioid and alcohol use declined significantly between baseline and 3 months. There was a lack of evidence for efficacy in changing COVID-19 vaccination behaviors, which may be explained by the lower engagement with the app’s COVID-19-related content relative to the overdose risk reduction content.
Lasting Impact
Multiple publications are forthcoming from this research project, including on the results of the pilot intervention and the analysis of factors related to experiencing a fatal or nonfatal overdose.
This project contributed to the team successfully obtaining funding from the NIH Helping End Addiction Long-Term (HEAL) Initiative and the National Institute on Drug Abuse, which will help them to further develop Thrive4Life Connect. This project involves partnering with people who use opioid and/or stimulant drugs, Vivent Health, and other public health stakeholders to assess the most important considerations when applying new internet- and mobile phone-based tools to extend the reach of harm reduction services to underserved clients.
The PI plans to submit a grant application to the National Institute on Drug Abuse focused on expanding use of overdose prevention tools for people engaged in solitary drug use.
