Calls for Access to Safe Injecting Supplies as a Critical Public Health Measure During the COVID-19 Pandemic

Abstract

More than 3 decades of research has provided compelling evidence regarding the effectiveness, safety, and cost-effectiveness of needle and syringe programs in reducing syringe-sharing and transmission of HIV, HCV, and other bloodborne infections. However, repressive drug policies and drug law enforcement practices around the world continue to undermine their operations and scale-up, as well as access to harm reduction among people who inject drugs. The COVID-19 pandemic has heightened access barriers to needle and syringe programs, raising concerns about unsafe injecting practices due to inadequate access to safe injecting supplies. This commentary discusses the robust public health responses that are needed at this particularly vulnerable and critical juncture to ensure access to safe injecting supplies and minimize the risk for transmission of bloodborne infections among people who inject drugs.

Program Adaptations to Provide Harm Reduction Services During the COVID-19 Pandemic: A Qualitative Study of Syringe Services Programs in the U.S.

“…The novel coronavirus (COVID-19) pandemic exacerbated multiple existing public health concerns and has significantly impacted people who use drugs (PWUD). Health leaders have called attention to the likelihood that isolation and psychosocial consequences of the pandemic may increase substance use, and that decreased access to substance use disorder (SUD) treatment and harm reduction services may increase transmission of drug use-related infections and worsen the overdose crisis [ 1 – 3 ]. Provisional data from the Centers for Disease Control and Prevention [ 4 , 5 ], emergency department records [ 6 , 7 ], and media reports from over 40 U.S. states [ 8 ] suggest that overdose deaths have risen sharply during the pandemic.…”

Maintaining treatment and prevention programs for opioid use disorders during the coronavirus disease 2019 pandemic

“…Comprehensive assessment protocols were developed for people with OUD when they were treated in hospital for COVID-19 and efforts were made to provide and continue OUD treatment for them [ 5 , 19 ]. Maintaining the provision of needle and syringe programs is highlighted by several authors [ 20 ▪ , 21 , 22 ]. Mail-based needle and syringe distribution services, home delivery and vending machine were suggested as these measures provide increased accessibility for patients, no-contact service, and around-the-clock convenience [ 13 ▪▪ , 20 ▪ , 22 ].…”

Rapid Evidence Review of Harm Reduction Interventions and Messaging for People Who Inject Drugs During Pandemic Events: Implications for the On-Going COVID-19 Response

“…Table 3 shows the range of countries that the pieces of evidence were from. Continued unrestricted access to HR services, such as NSP (9), could be facilitated by ensuring an adequate supply of personal protective equipment (PPE) for staff (7,11,12).…”

“…Other authors also recommend vending machines, which provide 24-hour access, and no-contact collection (7,8). The LUCID-B study in Bristol reported positive feedback from PWID in relation to home delivery because it meant they did not have to travel, it kept them safe from COVID-19 and it prevented reuse of equipment (23).…”

“…The Larney & Bruneau (2020) review of evidence from other 'big events' concluded that, in a pandemic type scenario, NSP should offer as many needles and syringes to clients as requested and that exible NSP, such as mobile or outreach models, will increase access (19). Other authors have also recommended this 'low threshold' approach (as opposed to one-for-one exchange) to needle/syringe provision (7,24).…”