Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID-19 response

Abstract

Background People who inject drugs are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. Methods A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic-type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. Results In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly; for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. Conclusions This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.

“You know, we can change the services to suit the circumstances of what is happening in the world”: a rapid case study of the COVID-19 response across city centre homelessness and health services in Edinburgh, Scotland

“…The pandemic provided opportunities for more focused partnership and coordinated working in the city centre, and enhanced and immediate communication across the sector, where competition between organisations was previously commonplace. This aligns with guidance on meeting the needs of people with multiple and complex needs, including with drug and alcohol problems [ 6 ], and specific COVID-19 guidance on strengthening partnerships between harm reduction and wider services such as housing and pharmacy providers [ 46 ]. These responses were not put in place without challenge, but those advocating for the immediate need for reduced administrative barriers were successful in persuading senior leaders in a range of organisations to adapt and allow change.…”

“…The increased likelihood of substance-related harm, and death, that the COVID-19 pandemic has brought to an existing crisis of substance harms has been referred to as a dual public health emergency, with immediate action being called for to prevent the spread of infection amongst an often immune-compromised population [ 44 ]. It is essential that services are maintained and, where necessary, altered to meet the differing needs of people who use substances in response to the pandemic, and that funding for such services is safeguarded [ 45 , 46 ].…”

“…Globally, this has included changes to drugs harm reduction services, including: designating harm reduction services to be essential [ 46 ]; developing emergency harm reduction plans [ 46 ]; access to COVID-19 screening and testing [ 47 ]; changes to service and medication provision to comply with pandemic guidance [ 41 , 42 , 46 – 56 ]; improved access to naloxone and IEP [ 47 , 50 ]; increased awareness of the need for clean water for injecting [ 57 ]; general guidance about reducing COVID-19 spread in services [ 58 – 60 ]; the need for a ‘safe supply’ of drugs [ 46 ]; and the need for holistic models of care that attend to mental and physical health and housing needs [ 46 ]. While evidence is still emerging on how the pandemic impacted drugs harm reduction, strict lockdown rules have appeared to reduce the number of people accessing IEP and other harm reduction services [ 61 , 62 ].…”

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 ].…”

“…Many authors have emphasized the importance of emergency treatment for overdoses and expanding naloxone access as the number of opioid overdoses could rise sharply [ 12 , 20 ▪ , 23 ]. Delivery of naloxone kits by mail, increased street-based outreach, and distributing take-home naloxone in public areas were adopted [ 12 ].…”