O’Callaghan D, Lambert S. J Subst Abuse Treat. 2022108720. Read full paper

This was a qualitative study that conducted interviews with 15 healthcare professionals who work with people who have addictions across the Republic of Ireland. The interviews were held between October 2020 and December 2020. The aim was to explore the impact of Covid-19 on these people. They found four themes emerged:

Shift in priority. This touched on the radical shift in priorities forced on the system by Covid-19. Some interviewees experienced a cognitive dissonance as they also had to prioritise their own, and their families, health at a time when normal harm reduction services were suspended.

Being left behind. There was much concern that a marginalised population were being further disadvantaged and some participants reported how elements of their work had been completely stopped.

Managing a death. The results recognised the “strong emotional investment staff have in their clients’ recovery” and that there is often a deep guilt that they haven’t done enough when someone dies. They highlight that it has never been easy for workers to process this grief and it has become even harder during the pandemic.

Anxious environment. The authors found a theme of anxiety ran through the interviews as staff coped with changing conditions in a high-risk group of people. There was also anxiety amongst service users.

Overall, they found that there was a significant impact on the wellbeing of clinicians who work with people who use drugs “fostering a more anxious environment and compounding what can already be a high-stress occupation”. There was a lot of concern for the wellbeing of people being treated in the service and “uncertainty permeated throughout conversations”.

Commentary:
We need to look after our own. The pandemic has meant we have spent a lot of time scrambling to re-configure services then scratching our heads and wondering what it means for the future of treatment services. Very little time has been used to consider the impact on the people delivering those services. And it has been severe.

I am often struck, when working in services, by the enormous pressure on staff, particular keyworkers. This has, for many years, been ratcheted up as services have been under-funded with a slow bleed away of staff and recruitment challenges. We need to recognise that changes in the pandemic have made it significantly more difficult for staff to cope with a drug death. The authors suggest this needs to be recognised in “more rigorous welfare policies” for staff and organisations must support staff to reduce anxiety when making decisions in difficult circumstances. They also recommended that any measures must address the “clear emotional connections” when marking the death of a service user.

Article taken from our latest Clinical Update, edited by Dr Euan Lawson (Editor of the British Journal of General Practice). To read the full Clinical Update please become a Premium CPD Member.

Articles featured in this Clinical Update:

• Self-harm and suicide during and after opioid agonist treatment among primarycare patients in England: a cohort study.
• Prevalence and factors associated with chronic venous insufficiency, leg ulcerationand deep‐vein thrombosis among people who inject drugs in London, UK.
• A primary care-based cognitive behavioral therapy intervention for long-termopioid users with chronic pain: a randomized pragmatic trial.
• Nasal opioid agonist treatment in patients with severe opioid dependence: a caseseries.

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