\u27More of the Same, But Worse Than Before\u27: A Qualitative Study of the Challenges Encountered by People Who Use Drugs in Nova Scotia, Canada During COVID-19

Background To learn about the experiences of people who use drugs, specifically opioids, in the Halifax Regional Municipality (HRM), in Nova Scotia, Canada during the COVID-19 pandemic through qualitative interviews with people who use drugs and healthcare providers (HCP). This study took place within the HRM, a municipality of 448,500 people. During the pandemic many critical services were interrupted while overdose events increased. We wanted to understand the experiences of people who use drugs as well as their HCPs during the first year of the pandemic. Methodology We conducted a qualitative study using semi-structured interviews with 13 people who use drugs and 6 HCPs, including physicians who work in addiction medicine (3), a pharmacist, a nurse, and a community-based opioid agonist therapy (OAT) program staff member. Participants were recruited within HRM. Interviews were held via phone or videoconference due to social distancing directives. Interviews focused on the challenges people who use drugs and HCPs faced during the pandemic as well as elicited perspectives on a safe supply of drugs and the associated barriers and facilitators to the provision of a safe supply. Results Of the 13 people who use drugs who participated in this study, ages ranged from 21–55 years (mean 40). Individuals had spent on average 17 years in HRM. Most people who use drugs (85%, n = 11) utilized income assistance, the Canadian Emergency Response Benefit, or disability support. Many had experienced homelessness (85%, n = 11) and almost half (46%, n = 6) were currently precariously housed in the shelter system. The main themes among interviews (people who use drugs and HCPs) were housing, accessing healthcare and community services, shifts in the drug supply, and perspectives on safe supply. Conclusions We identified several challenges that people who use drugs face in general, but especially during the COVID-19 pandemic. Access to services, housing support, and interventions to use safely at home were limited. As many challenges faced by people who use drugs exist outside of COVID-19, we concluded that the formal and informal interventions and changes in practice that were made to support people who use drugs should be sustained well past the end of the pandemic. The need for enhanced community supports and a safe supply of drugs, despite its complicated nature, is essential for the health and safety of people who use drugs in HRM, especially during COVID-19

Ultrafast optical switching of the THz transmission through metallic subwavelength hole arrays

Euan Hendry, Matthew J. Lockyear, J. Gómez Rivas, L. Kuipers, and M. Bonn, Physical Review B, Vol. 75, article 235305 (2007). "Copyright © 2007 by the American Physical Society."We demonstrate ultrafast optical switching of the transmission of terahertz radiation through a metal grating with subwavelength holes. By fabricating the grating on a semiconductor silicon substrate, we are able to control the grating transmission intensity by varying the photodoping level of the silicon and thereby the resonant coupling to the metal grating. As such, we are able to switch the transmission on picosecond time scales with low visible light intensities, observing a factor of 2–5 improvement in photomodulation efficiency at resonance wavelengths over a bare silicon surface

Time periods of altered risk for severe injection drug use-associated skin and soft-tissue infections: protocol for a self-controlled case series in New South Wales, Australia, 2001-2018

Injection drug use-associated bacterial and fungal infections (e.g., skin and soft-tissue infections, endocarditis, osteomyelitis, etc.) are common health problems among people who inject drugs, associated with pain, disability, and death. The incidence of these infections is rising, and better understanding of the social and environmental factors that shape individual injecting practices and risk for injecting-related infections is urgently needed. Using a self-controlled study design, the aim of this proposed study is to quantify the risks of injecting-related skin and soft-tissue infections associated with initiation of, exposure to, and discontinuation of incarceration and OAT among a sample of people with opioid use disorder

Social and structural determinants of injection drug use-associated bacterial and fungal infections: a qualitative systematic review and thematic synthesis

BACKGROUND AND AIMS: Injection drug use-associated bacterial and fungal infections are increasingly common, and social contexts shape individuals' injecting practices and treatment experiences. We sought to synthesize qualitative studies of social-structural factors influencing incidence and treatment of injecting-related infections. METHODS: We searched PubMed, EMBASE, Scopus, CINAHL, and PsycINFO from January 1, 2000, to February 18, 2021. Informed by Rhodes' "risk environment" framework, we performed thematic synthesis in three stages: (1) line-by-line coding; (2) organizing codes into descriptive themes, reflecting interpretations of study authors; (3) consolidating descriptive themes into conceptual categories to identify higher-order analytic themes. RESULTS: We screened 4,841 abstracts and included 26 qualitative studies on experiences of injecting-related bacterial and fungal infections. We identified six descriptive themes organized into two analytic themes. The first analytic theme, social production of risk, considered macro-environmental influences. Four descriptive themes highlighted pathways through which this occurs: (1) unregulated drug supply, leading to poor drug quality and solubility; (2) unsafe spaces, influenced by policing practices and insecure housing; (3) health care policies and practices, leading to negative experiences that discourage access to care; and (4) restrictions on harm reduction programs, including structural barriers to effective service provision. The second analytic theme, practices of care among people who use drugs, addressed protective strategies people employ within infection risk environments. Associated descriptive themes were: (5) mutual care, including assisted-injecting and sharing sterile equipment; and (6) self-care, including vein health and self-treatment. Within constraining risk environments, some protective strategies for bacterial infections precipitated other health risks (e.g., HIV transmission). CONCLUSIONS: Injecting-related bacterial and fungal infections are shaped by modifiable social-structural factors, including poor quality unregulated drugs, criminalization and policing enforcement, insufficient housing, limited harm reduction services, and harmful health care practices. People who inject drugs navigate these barriers while attempting to protect themselves and their community

Securing Safe Supply During COVID-19 and Beyond: Scoping Review and Knowledge Mobilization

Background Safe supply is defined as the legal and regulated provision of drugs with mind and/or body altering properties that have been typically accessible only through the illegal drug market. In response to the coronavirus disease 2019 (COVID-19) pandemic and related social/physical distancing measures, efforts have been made to scale up and increase access to safe supply programs in an effort to reduce overdose and other drug- and drug policy-related risks. However, it remains unclear whether these efforts taken thus far have meaningfully mitigated the barriers to safe supply experienced by People Who Use Drugs (PWUD), both during and beyond the context of COVID-19. We thus undertook a scoping review to identify key concepts, strategies and gaps in evidence with respect to the provision of safe supply during pandemics and other emergencies. Methods We conducted three searches across Scopus, Medline, Embase, CINAHL, and The Cochrane Central Register of Controlled Trials (CENTRAL) for peer-reviewed and grey literature articles to understand barriers/facilitators to both accessing and prescribing legal, pharmaceutical-grade drugs, including opioids, benzodiazepines, and/or stimulants during public health emergencies from January 1 2002 to June 30 2020. We also included opioid agonist therapies (OAT) during emergency conditions. All potential sources underwent title/abstract screening and duplicate full- text review to determine eligibility for inclusion. Three reviewers extracted characteristics and barriers/facilitators to accessing or prescribing drugs for each study, and these were then inductively analyzed to identify common themes. Key stakeholders (PWUD, prescribers, and policymakers/regulators) informed the search strategy and validated findings and interpretations. Input from PWUD and prescribers was gathered through Advisory Committee meetings and one-on-one consultations, respectively. Results We screened 9,839 references and included 169 studies (135 peer-reviewed articles and 36 grey literature reports). From 119 articles, we identified 35 themes related to barriers/facilitators to prescribing safe supply or OAT. Few studies (n=24) focused on emergency or pandemic contexts. Among the most frequently reported barriers were restrictive laws or policies (n= 33; 28%). The most frequently cited facilitator was temporary legal or regulatory exemptions (n= 16; 13%). Further stakeholder consultation identified barriers/facilitators to safe supply absent in the reviewed literature: PWUD reported barriers including lack of access to desired substances, concerns about child apprehension, and a lack of cultural competency within safe supply/OAT programs; prescribers reported barriers including regional differences in service delivery, colleague support, and a lack of, or disagreement between, clinical guidance documents. Conclusion We identified multiple barriers and facilitators to accessing and/or prescribing safe supply or OAT. With few peer-reviewed studies on safe supply models, particularly in the context of emergencies, input from PWUD and other stakeholders offered crucial insights not reflected in the existing literature. To address the overdose epidemic stemming from the criminalization of an unregulated drug supply, prescribers, regulators, and public health authorities should focus on scaling up, and then evaluating, diverse safe supply frameworks that address the facilitators and barriers we have identified

Detecting fractions of electrons in the high-TcT_c cuprates

We propose several tests of the idea that the electron is fractionalized in the underdoped and undoped cuprates. These include the ac Josephson effect, and tunneling into small superconducting grains in the Coulomb blockade regime. In both cases, we argue that the results are qualitatively modified from the conventional ones if the insulating tunnel barrier is fractionalized. These experiments directly detect the possible existence of the chargon - a charge $e$ spinless boson - in the insulator. The effects described in this paper provide a means to probing whether the undoped cuprate (despite it's magnetism) is fractionalized. Thus, the experiments discussed here are complementary to the flux-trapping experiment we proposed in our earlier work(cond-mat/0006481).Comment: 7 pages, 5 figure

Exotic quantum phases and phase transitions in correlated matter

We present a pedagogical overview of recent theoretical work on unconventional quantum phases and quantum phase transitions in condensed matter systems. Strong correlations between electrons can lead to a breakdown of two traditional paradigms of solid state physics: Landau's theories of Fermi liquids and phase transitions. We discuss two resulting "exotic" states of matter: topological and critical spin liquids. These two quantum phases do not display any long-range order even at zero temperature. In each case, we show how a gauge theory description is useful to describe the new concepts of topological order, fractionalization and deconfinement of excitations which can be present in such spin liquids. We make brief connections, when possible, to experiments in which the corresponding physics can be probed. Finally, we review recent work on deconfined quantum critical points. The tone of these lecture notes is expository: focus is on gaining a physical picture and understanding, with technical details kept to a minimum.Comment: 22 pages, 15 figures; Notes of the Lectures at the International Summer School on Fundamental Problems in Statistical Physics XI, September 2005, Leuven, Belgium; High-resolution version available at http://w3-phystheo.ups-tlse.fr/~alet/leuven.htm

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

BACKGROUND: During a COVID-19 outbreak in the congregate shelter system in Halifax, Nova Scotia, Canada, a multidisciplinary health care team provided an emergency “safe supply” of pharmaceutical-grade medications and beverage-grade alcohol to facilitate isolation in COVID-19 hotel shelters for residents who are dependent on these substances. We aimed to evaluate (a) substances and dosages provided, and (b) effectiveness and safety of the program. METHODS: We retrospectively reviewed medical records of all COVID-19 isolation hotel shelter residents during May 2021. We extracted data on medication and alcohol dosages provided each day. The primary outcome was residents prematurely leaving isolation against public health orders. Adverse events included (a) overdose; (b) intoxication; and (c) diversion, selling, or sharing of medications or alcohol. RESULTS: Over 25 days, 77 isolation hotel residents were assessed (mean age 42 ± 14 years; 24% women). Sixty-two (81%) residents were provided medications, alcohol, or cigarettes. Seventeen residents (22%) received opioid agonist treatment medications (methadone, buprenorphine, or slow-release oral morphine) and 27 (35%) received hydromorphone tablets. Thirty-one (40%) residents received stimulant tablets with methylphenidate (27; 35%), dextroamphetamine (8; 10%), or lisdexamfetamine (2; 3%). Six residents (8%) received benzodiazepines. Forty-two (55%) residents received alcohol, including 41 (53%) with strong beer, three (3%) with wine, and one (1%) with hard liquor. Over 14 days in isolation, mean daily dosages increased of hydromorphone (45 ± 32 to 57 ± 42mg), methylphenidate (51 ± 28 to 77 ± 37mg), dextroamphetamine (33 ± 16 to 46 ± 13mg), and alcohol (12.3 ± 7.6 to 13.0 ± 6.9 standard drinks). Six residents (8%) left isolation prematurely, but four of those residents returned. Over 1,059 person-days in isolation, there were zero overdoses. Documented concerns regarding intoxication occurred six times (0.005 events/person-day) and medication diversion or sharing three times (0.003 events/person-day). CONCLUSIONS: An emergency safe supply and managed alcohol program, paired with housing, was associated with low rates of adverse events and high rates of successful completion of the 14-day isolation period in COVID-19 isolation hotel shelters. This supports the effectiveness and safety of emergency safe supply prescribing and managed alcohol in this setting

Pyrochlore Photons: The U(1) Spin Liquid in a S=1/2 Three-Dimensional Frustrated Magnet

We study the S=1/2 Heisenberg antiferromagnet on the pyrochlore lattice in the limit of strong easy-axis exchange anisotropy. We find, using only standard techniques of degenerate perturbation theory, that the model has a U(1) gauge symmetry generated by certain local rotations about the z-axis in spin space. Upon addition of an extra local interaction in this and a related model with spins on a three-dimensional network of corner-sharing octahedra, we can write down the exact ground state wavefunction with no further approximations. Using the properties of the soluble point we show that these models enter the U(1) spin liquid phase, a novel fractionalized spin liquid with an emergent U(1) gauge structure. This phase supports gapped S^z = 1/2 spinons carrying the U(1) ``electric'' gauge charge, a gapped topological point defect or ``magnetic'' monopole, and a gapless ``photon,'' which in spin language is a gapless, linearly dispersing S^z = 0 collective mode. There are power-law spin correlations with a nontrivial angular dependence, as well as novel U(1) topological order. This state is stable to ALL zero-temperature perturbations and exists over a finite extent of the phase diagram. Using a convenient lattice version of electric-magnetic duality, we develop the effective description of the U(1) spin liquid and the adjacent soluble point in terms of Gaussian quantum electrodynamics and calculate a few of the universal properties. The resulting picture is confirmed by our numerical analysis of the soluble point wavefunction. Finally, we briefly discuss the prospects for understanding this physics in a wider range of models and for making contact with experiments.Comment: 22 pages, 14 figures. Further minor changes. To appear in Phys. Rev.

Social and structural determinants of injection drug use-associated bacterial and fungal infections: A qualitative systematic review and thematic synthesis

BACKGROUND AND AIMS: Injection drug use-associated bacterial and fungal infections are increasingly common, and social contexts shape individuals' injecting practices and treatment experiences. We sought to synthesize qualitative studies of social-structural factors influencing incidence and treatment of injecting-related infections. METHODS: We searched PubMed, EMBASE, Scopus, CINAHL and PsycINFO from 1 January 2000 to 18 February 2021. Informed by Rhodes' 'risk environment' framework, we performed thematic synthesis in three stages: (1) line-by-line coding; (2) organizing codes into descriptive themes, reflecting interpretations of study authors; and (3) consolidating descriptive themes into conceptual categories to identify higher-order analytical themes. RESULTS: We screened 4841 abstracts and included 26 qualitative studies on experiences of injecting-related bacterial and fungal infections. We identified six descriptive themes organized into two analytical themes. The first analytical theme, social production of risk, considered macro-environmental influences. Four descriptive themes highlighted pathways through which this occurs: (1) unregulated drug supply, leading to poor drug quality and solubility; (2) unsafe spaces, influenced by policing practices and insecure housing; (3) health-care policies and practices, leading to negative experiences that discourage access to care; and (4) restrictions on harm reduction programmes, including structural barriers to effective service provision. The second analytical theme, practices of care among people who use drugs, addressed protective strategies that people employ within infection risk environments. Associated descriptive themes were: (5) mutual care, including assisted-injecting and sharing sterile equipment; and (6) self-care, including vein health and self-treatment. Within constraining risk environments, some protective strategies for bacterial infections precipitated other health risks (e.g. HIV transmission). CONCLUSIONS: Injecting-related bacterial and fungal infections are shaped by modifiable social-structural factors, including poor quality unregulated drugs, criminalization and policing enforcement, insufficient housing, limited harm reduction services and harmful health-care practices. People who inject drugs navigate these barriers while attempting to protect themselves and their community