Harm Reduction for Adolescents and Young Adults During the COVID-19 Pandemic: A Case Study of Community Care in Reach

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of harm reduction programs to provide vital services to adolescents, young adults, and people who use drugs, thereby increasing the risk of overdose, infection, withdrawal, and other complications of drug use. To evaluate the effect of the COVID-19 pandemic on harm reduction services for adolescents and young adults in Boston, we conducted a quantitative assessment of the Community Care in Reach (CCIR) youth pilot program to determine gaps in services created by its closure during the peak of the pandemic (March 19–June 21, 2020). We also conducted semistructured interviews with staff members at 6 harm reduction programs in Boston from April 27 through May 4, 2020, to identify gaps in harm reduction services, changes in substance use practices and patterns of engagement with people who use drugs, and how harm reduction programs adapted to pandemic conditions. During the pandemic, harm reduction programs struggled to maintain staffing, supplies, infection control measures, and regular connection with their participants. During the 3-month suspension of CCIR mobile van services, CCIR missed an estimated 363 contacts, 169 units of naloxone distributed, and 402 syringes distributed. Based on our findings, we propose the following recommendations for sustaining harm reduction services during times of crisis: pursuing high-level policy changes to eliminate political barriers to care and fund harm reduction efforts; enabling and empowering harm reduction programs to innovatively and safely distribute vital resources and build community during a crisis; and providing comprehensive support to people to minimize drug-related harms.

Substance Use Among Youth During the COVID-19 Pandemic: a Systematic Review

“…The pandemic has also increased feelings of loneliness among young people because of long-term social isolation and limited opportunities to interact with peers [ 12 ]. During this period, inconsistent and poorly planned institutional responses have been reported [ 19 ], including a decline in access to harm-reduction services and treatment of substance use [ 20 ]. In a recent review, Pfefferbaum highlighted the negative psychological effects of the pandemic on children and youth, including the significant increase in the prevalence of clinical depression, suicidal ideation, and anxiety, all of which have the potential to contribute to an increase in substance use behaviors [ 21 ].…”

“We were building the plane as we were flying it, and we somehow made it to the other end”: syringe service program staff experiences and well-being during the COVID-19 pandemic

“…Most US SSPs remained open during the COVID-19 pandemic but reduced their hours of operation [7,8] and experienced challenges related to staffing and supply chain shortages, loss of funding, and rapidly changing guidance from local governments and funders [8][9][10]. In response to COVID-19-related prevention recommendations and directives from federal and state agencies including the US Centers for Disease Control and Prevention (CDC) [11], most SSPs rapidly modified operations [9] to accommodate physical distancing [10,12], expand existing or develop new outdoor and mobile delivery strategies, implement telemedicine [10,13], pre-package harm reduction supplies for mailing to clients [7,8], and increase and adapt community outreach strategies [12]. In line with these changes, many organizations prioritized the distribution of harm reduction supplies (e.g., syringes and sterile injection equipment) [9] over the provision of on-site prevention and clinical services including infectious disease testing and medications for opioid use disorder [7][8][9][10].…”

Changes in harm reduction service providers professional quality of life during dual public health emergencies in Canada

“…These increases are not surprising given the ongoing and escalating drug toxicity emergency, coupled with the additional stress of the pandemic. Respondents reported becoming more sensitive to the well-being of their clients, which has been reported as a reaction to the pandemic elsewhere [ 55 , 56 ].…”

“…Effectively responding to mental health needs may lead to improved outcomes, not only for an individual and the clients they serve but on system capacity and healthcare costs as well. All initiatives to support this workforce should be undertaken with meaningful engagement of people who use substances and HR providers in alignment with the principle “nothing about us without us” [ 56 , 65 ]. HR services are often among the first place individuals who use substances seek support.…”