Abstract
BackgroundPeople who inject drugs (PWID) are a high-risk group for COVID-19 transmission and serious health consequences. Restrictions imposed in the UK in response to the pandemic led to rapid health and housing service alterations. We aimed to examine PWID experiences of: 1) challenges relating to the COVID-19 public health measures; 2) changes to opioid substitution therapy (OST) and harm reduction services; and 3) perceived effects of COVID-19 on drug use patterns and risk behaviour.MethodsTelephone semi-structured interviews were conducted with 28 PWID in Bristol, Southwest of England. Analysis followed a reflexive thematic analysis.ResultsConcern about COVID-19 and adherence to public health guidance varied. Efforts made by services to continue providing support during the pandemic were appreciated and some changes were preferred, such as less frequent OST collection, relaxation of supervised consumption and needle and syringe programmes (NSP) home delivery. However, remote forms of contact were highlighted as less beneficial and more difficult to engage with than in-person contact. Public health guidance advising people to ‘stay home’ led to increased isolation, boredom, and time to ruminate which impacted negatively on mental health. Lockdown restrictions directly impacted on sources of income and routine. Changes in drug use were explained as a consequence of isolation and fewer interactions with peers, problems accessing drugs, reduced drug purity and reduced financial resources.ConclusionThis study captures the significant impacts and challenges of the COVID-19 pandemic on the lives of PWID. While rapid adaptations to service delivery to help mitigate the risks of COVID-19 were appreciated and some changes such as relaxation of supervised daily OST consumption were viewed positively, barriers to access need further attention. Going forwards there may be opportunities to harness the positive aspects of some changes to services.
Highlights
In the United Kingdom (UK) and worldwide, COVID-19 has resulted in rapid and unprecedented changes to society, with public health measures to limit the spread of infection affecting housing services, healthcare systems, harm reduction and drug treatment provision (Wisse et al, 2021)
Other services used by People Who Inject Drugs (PWID) in the city include a Homeless Health Service offering primary care and opioid substitution therapy (OST) prescribing; temporary accommodation including drug treatment hostels; an inpatient detoxification unit; and mutual aid groups provided by Developing Health and Independence (DHI) and other charitable organisations
Efforts made by services to continue providing support during the pandemic were appreciated and some changes to harm reduction services, such as less frequent OST collection, preferred
Summary
In the United Kingdom (UK) and worldwide, COVID-19 has resulted in rapid and unprecedented changes to society, with public health measures to limit the spread of infection affecting housing services, healthcare systems, harm reduction and drug treatment provision (Wisse et al, 2021). These changes are expected to have severe direct and indirect impacts on People Who Inject Drugs (PWID) (Jacka et al, 2020), a population often living unstable lives in a system of fragile state-provided support. We aimed to examine PWID experiences of: 1) challenges relating to the COVID-19 public health measures; 2) changes to opioid substitution therapy (OST) and harm reduction services; and 3) perceived effects of COVID-19 on drug use patterns and risk behaviour
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