Reorganization of Substance Use Treatment and Harm Reduction Services During the COVID-19 Pandemic: A Global Survey

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic.Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health responses were categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups.Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. Fifty-seven percent of overdose prevention interventions and 81% of outreach services were also negatively impacted.Conclusions: Participants reported that SUD treatment and harm-reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we highlight several issues and complications resulting from the pandemic concerning people with SUDs that should be tackled more efficiently during the future waves or similar pandemics. The issues and potential strategies comprise the following: (1) helping policymakers to generate business continuity plans, (2) maintaining the use of evidence-based interventions for people with SUDs, (3) being prepared for adequate medication supplies, (4) integrating harm reduction programs with other treatment modalities, and (5) having specific considerations for vulnerable groups such as immigrants and refugees.

Insights Into Adolescents' Substance Use in a Low–Middle-Income Country During the COVID-19 Pandemic

“…These could be valuable and applicable avenues to explore digitally to enhance prosocial affinity among adolescents and curb alcohol consumption. In light of the shifting psychiatric health provision in many countries (55), these linkages presented the necessity to maintain addiction services, particularly toward the subgroup of vulnerable adolescents.…”

A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic

“…Here, we report results from the first round of the ISAM global survey on drug and alcohol use, price, supply, and complications during the COVID-19 pandemic. Data related to the second section of the survey concerning substance use treatment and harm reduction services responses to the pandemic have been published recently (18). We hypothesized that drug and alcohol use would increase, prices would increase, supply would decrease, and complications would increase and that results would differ by region (given the differential spread of COVID-19 and regional responses to the COVID-19 pandemic).…”

Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19

“…Other mitigation measures that were introduced during periods when social restrictions were in place were increasing dispensing of take-home medications such as methadone. In the results section we noted that two of the included studies examined increases in the provision of take-home medication (OAT) during the initial stages of the pandemic and found there to be few negative consequences associated with this in terms of diversion of medication [52][53][54]. These are interesting findings as the issue of non-supervised consumption of OAT is a contested topic and especially relating to concerns over the diversion of medication and potential increased risk of overdose [78].…”

“…Several studies reported reduced access to harm reduction services owing to the pandemic [48,52,61] though only one study inferred that this was related to a subsequent rise in DRDs [41]. More recent research has provided further evidence of the impacts of reduced service access including reductions in uptake of injecting equipment and MAT as well as a reduction of uptake of HIV and other BBV testing in Spain, UK and Sweden [75][76][77].…”