Closing doors, opening windows – Adaptations and opportunities for harm reduction services during the COVID-19 pandemic in Europe

Abstract

Background Across Europe, harm reduction services experienced significant disruptions during the COVID-19 pandemic. This study analyses the experiences of harm reduction service providers during the pandemic in 34 European cities, focusing on their main challenges, adaptations, and opportunities for change. A closer examination of Athens and Dublin offers an in-depth look into these experiences. Methods A mixed-methods approach is used, integrating qualitative and quantitative data. Two surveys conducted in 2020 and 2021 involved 34 European cities. In-depth and informal interviews with four local experts from Athens and Dublin complemented the analysis. Results Despite significant disruptions, many harm reduction services scaled up their operations and achieved favorable policy reforms that were met with resistance before the pandemic. In Athens, major gains were opening the first housing program, the first drug consumption room, and the liberalization of naloxone. In Dublin, new housing, lowered thresholds for methadone provision, benzodiazepine provision, and improved naloxone availability were key gains. Conclusion The pandemic triggered opportunities for policymakers to reframe matters of social equity in the field of drug policies, opening policy windows to further advance harm reduction. Based on these lessons, recommendations to improve social justice and equity for people who use drugs are provided.