Background The restrictions introduced in response to COVID-19 present many challenges, particularly for vulnerable and marginalised populations. These include maintaining access to Needle and Syringe Programmes (NSPs) to reduce the harms associated with injecting drugs. NSPs effectiveness is coverage dependent, but lockdowns and social distancing limit NSP access and availability. The impact on NSP provision in England is explored using enhanced monitoring data. Method Data collected through an established comprehensive regional monitoring system from five four-week periods, centred on the implementation of restrictions in the UK in mid-March 2020, are examined. Weekly averages are compared to allow for public holidays and weekly variation in activity. Results The restrictions resulted in the number of NSP clients decreasing by 36%, visits by 36%, and needles distributed by 29%. NSP coverage for those injecting psychoactive drugs halved, declining from 14 needles per-week during the 4-weeks to 15 th March 2020 to 7 needles per-week by mid-April, and coverage has remained at this level since then. Conclusions Though it is currently unclear if there has been a decline in injecting, the decline in NSP coverage is so marked that it almost certainly reflects decreased utilisation among those in need, indicating increased equipment reuse and risk.

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The Occupied Territories of Palestine (OtP) consists of the non-contiguous West Bank including East Jerusalem, and the Gaza Strip. Its dense population with political and economic tensions is affected by a rise in drug trafficking, abuse and addiction. A scoping review mapped what is known about Palestinian children's experiences of drug abuse in the home. Following application of exclusion measures, six records remained. Charting and analysis resulted in three themes; The consequences of being a child with a drug using parent; Causal factors of drug use in Palestinian families; and Prevalence rates of parental drug use are unknown. The review paints a concerning picture of stigma, family dysfunction, school drop-out, child and family isolation and maladaptive child development. Exposure to drugs, trauma and abuse contributes to strong potential for Palestinian child drug use, sexual exploitation, overdose, psychiatric illness, and infectious diseases acquisition. The review will inform the urgent strategic response. Abstract 3 The Occupied Territories of Palestine (OtP) consists of the non-contiguous West Bank including 4 East Jerusalem, and the Gaza Strip. Its dense population with political and economic tensions is 5 affected by a rise in drug trafficking, abuse and addiction. A scoping review mapped what is known 6 about Palestinian children's experiences of drug abuse in the home. Following application of 7 exclusion measures, six records remained. Charting and analysis resulted in three themes; The 8 consequences of being a child with a drug using parent; Causal factors of drug use in Palestinian 9 families; and Prevalence rates of parental drug use are unknown. The review paints a concerning 10 picture of stigma, family dysfunction, school drop-out, child and family isolation and maladaptive 11 child development. Exposure to drugs, trauma and abuse contributes to strong potential for 12 Palestinian child drug use, sexual exploitation, overdose, psychiatric illness, and infectious 13 diseases acquisition. The review will inform the urgent strategic response.14

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The Occupied Territories of Palestine (OtP) consists of the non-contiguous West Bank including East Jerusalem, and the Gaza Strip. Political and economic tensions and its dense populations compound the impact of drug abuse and addiction in the home. A qualitative study using four focus groups (n = 42) was conducted in West Bank and Gaza Strip explored the experiences of professionals working with Palestinian families and children affected by substance use and addiction in the home. Data were analysed using thematic analysis (TA), and four themes emerged. These were 'The rising and shifting problem of drug use in Palestine'; 'Psychosocial causal factors of drug use in Palestine'; 'The consequences for children and families living with drug use'; and 'Potential solutions to the problem are complex and multi-faceted.' The study paints a concerning picture of how drug abuse impacts on Palestinian families subjected to multiple pressures, stigmas, risks and harms relating to their situation.