The impact of the COVID-19 pandemic on harm reduction services in Catalonia: the experience of people who use drugs and harm reduction professionals

Abstract

Background Harm reduction services and professionals have had to reorganise and adapt to COVID-19 prevention measures while still ensuring health and social services for people who use drugs (PUD). Objective To assess the impact of the COVID-19 pandemic on PUD and on the professionals who provide harm reduction services. Methods A qualitative, exploratory, multicentre design was used. Two focus groups were held with harm reduction professionals, and 40 individual semi-structured interviews were undertaken with PUD in various harm reduction services in Catalonia. Interviews and focus group discussions were transcribed and analysed using thematic content analysis. Results Harm reduction services adapted to the pandemic situation by employing methods such as reducing opening hours and closing drop in areas, along with health protection measures such as access control, which in turn led to stress among both professionals and service users. Despite the changes implemented, PUD continued to have access to sterile drug use equipment and methadone treatment. In addition, those who were not in treatment were able to access it rapidly. Regarding their emotional state, the PUD reported that it was worse during the pandemic than before the lockdown, with women affected to a greater extent than men. The harm reduction professionals reported difficulties in managing service users’ compliance with the security measures at the beginning of the lockdown and having had to focus primarily on providing food and shelter for the PUD. Conclusions It is important to keep PUD in mind and maintain a harm reduction perspective when implementing confinement measures in situations such as those experienced during the COVID pandemic. Guaranteeing that PUD have their basic needs such as food, hygiene and shelter covered is key.

Experience and views of healthcare professionals towards people who use new psychoactive substances: Evidence from statutory, non‐statutory, and private mental health and addiction healthcare services

“…HCPs experienced several challenges relating to Harm reduction (HR) strategies for MSM and People Who Engage in Chemsex (PWEICS). They reported HR approaches in HCSs lacked advice or information on a national level in reducing the harms of PWUNPS and PWEICS (Bosch‐Arís et al., 2022; Drysdale, 2021; Maxwell et al., 2019; Stuart, 2019). One interviewee (P8) reported a lack of information surrounding HR and expressed a need to prepare NPS‐related questions and provide HR advice.…”

“…Historically, the risk of HIV is 26 times higher for MSM, particularly, those that engage in unprotected sex (UNAID, 2021). Respectively, the HR and HM approaches need to be better integrated across the HCSs (Bosch‐Arís et al., 2022; HRI (Harm Reduction International, 2021). Most importantly, HR is a central aim of substance‐misuse government policy (DH, 2022) and remains central to best practice for clinicians across all tiers (Chuo et al., 2019).…”

“…information on a national level in reducing the harms of PWUNPS and PWEICS (Bosch-Arís et al, 2022;Drysdale, 2021;Maxwell et al, 2019;Stuart, 2019). One interviewee (P8) reported a lack of information surrounding HR and expressed a need to prepare NPSrelated questions and provide HR advice.…”

“…(P13) I think having basic information of how to support someone on the influence of SPICE is a good harm reduction strategy. (P5) 3.5.1 | Potential PWUNPS' HM strategies Arguably, HCPs (or HCSs) can minimise the harm associated with NPS by implementing HM strategies, for instance, needle exchange (NX) (P4), swabs, condoms, citrus acid, and water are required to minimise harm to health associated with NPS, and following HR publications(Abdulrahim & Bowden-Jones, 2022;Bosch-Arís et al, 2022;Bowden-Jones & Abdulrahim, 2020). They queried whether offering basic information on the harms of SPICE (SCRAs), psychosocial interventions, key-working, and contingency management(Cully et al, 2020;Ralphs & Gray, 2018) was beneficial.…”

“…The Capital Card enables service users to earn-spend points system where service users accrue points for engaging with their treatment in addiction HCSs and spend them on a range of activities. Furthermore, P9 discussed the importance of raising awareness of the harms PWUNPS and PWEICS sexual health and, therefore, should promote HM advice towards MSM by offering peer groups, drop-in discussions, Blood Borne Virus monitoring, Prep (pre-exposure prophylaxis), and Pep (post-exposure prophylaxis)(Bosch-Arís et al, 2022;Guise et al, 2016;Nuh, 2016;Owens et al, 2019).We have groups, key working, activities, and Capitalcard. A Capital Card is contingency management.…”