Health service utilisation and access for people who inject drugs during COVID‐19

Abstract

Introduction The wide‐spread implementation of interventions to limit transmission and public health consequences of COVID‐19 in the Australian state of Victoria had flow‐on consequences for people who use and inject drugs. Consequences included the interruption of illicit drug supply and drug procurement, and the disruption to the delivery of health services. To inform strategies that can minimise the adverse outcomes of similar future disruptive events, this study explored how COVID‐19 restrictions impacted access to harm reduction and drug treatment services for people who inject drugs in Melbourne, Victoria. Methods Qualitative semi‐structured interviews were conducted via an online calling app, with 11 participants of a broader cohort study (the SuperMIX study) in April 2020. Interviews were focused on participants experiences of accessing and using harm reduction and drug treatment services. Data were thematically analysed using a process of blended coding. Results Findings revealed how disruptions in the delivery of harm reduction and drug treatment services—in response to COVID‐19 restrictions—created barriers accessing sterile injecting equipment, increased risk of arrest by police and exacerbated social isolation. Participants reported difficulties adapting to changes in services access, with some increases in injecting risk behaviours. However, improvements in opioid agonist therapy prescriptions were noted as a beneficial outcome. Discussion By examining the impacts of COVID‐19 and the resultant restrictions on people who inject drugs' access to health services in Melbourne, Victoria, findings provide guidance for future responses to the unanticipated large‐scale effects of the COVID‐19 pandemic, and similar disruptive events.

Impact of COVID-19 among people who use drugs: A qualitative study with harm reduction workers and people who use drugs

“…These market changes as well as pandemic-related social contact restrictions precipitated increases in risky drug use such as using in isolation [ 17 ], sharing injection equipment [ 18 ], and switching drug type [ 18 , 21 ]. Our studies and others also highlighted critical systemic failures exemplified by the disruption of prevention, harm reduction, and treatment services including temporary closures [ 22 , 23 ], capacity restrictions at harm reduction sites [ 17 ], and less access to safe injection equipment [ 24 , 25 ]. There are a few notable exceptions to the consensus view that the COVID-19 pandemic negatively impacted drug markets, drug use behaviors, and service provision.…”

Socioeconomic consequences of the COVID‐19 pandemic for people who use drugs

“…Nonetheless, as our findings highlight, the provision of adequate financial support and housing must be accompanied by responses that also tackle other underlying socioeconomic and structural drivers of illicit drug use (Cohen et al, 2022; Dasgupta et al, 2018). For example, for many participants, illicit drug consumption was the only mechanism they felt they had at their disposal to deal with the additional stresses of the pandemic, including isolation and boredom during lockdowns, challenges accessing scarce emergency food and housing services, being placed in overcrowded crisis housing and limited access to drug treatment (Coleman et al, 2022; Efunnuga et al, 2022). Increasing their drug use to deal with these stresses—while understandable given the consumption of drugs (in particular, alcohol) in the general Australian community also rose during the pandemic in response to these and other stresses (Sutherland et al, 2023)—was exacerbated by the added financial burden of increased methamphetamine and heroin market prices, which offset the benefits of the supplementary payments.…”

“…The near cessation of international air travel, jurisdictional border closures and restrictions on movement within local geographical areas interrupted illicit drug supply chains, with shifts in drug availability, price and purity and consequently the amounts and types of drugs people consumed during the pandemic. (Price et al, 2022; Rathnayake et al, 2023) Studies of the impact of pandemic lockdowns on access to harm reduction services in Australia found social distancing requirements and travel restrictions prevented access to sterile injecting equipment and forced people to inject alone, increasing their risk of exposure to overdose, injecting‐related injuries and disease and blood‐borne viruses (Dietze & Peacock, 2020; Efunnuga et al, 2022). Adjustments in service provision (e.g.…”

Qualitative insights on alcohol and other drug consumption during COVID‐19

“…Finally, shifting focus, the paper by Efunnuga et al [ 11 ] considers the availability and distribution of resources in the context of COVID‐19 for people who use/inject drugs in Melbourne, Victoria. The authors observe that restrictions designed to reduce the spread of COVID‐19, in particular restricting travel to within 5km of home and night‐time curfews, had unintended consequences for people who use/inject drugs.…”

“…The authors find that positive effects emerging from restrictions, such as increased takeaway doses of therapeutic prescriptions, have wide‐reaching potentialities; however, poor or disrupted communication processes emerged as constraints on service access. Efunnuga and colleagues' work [ 11 ] highlights variable effects of COVID‐19 restrictions on drug consumption patterns, which were intertwined with changing quality of available drugs and financial instabilities. As with other articles in the special section, the authors point out lessons to be learnt and applied more broadly (outside the context of COVID‐19), especially in light of the likelihood of social disruptions and crises in the future [ 12 ].…”