Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

Abstract

Background : People who inject drugs (PWID) are a high-risk group for COVID-19 transmission and serious health consequences. Restrictions imposed in the UK in response to the pandemic led to rapid health and housing service alterations. We aimed to examine PWID experiences of: 1) challenges relating to the COVID-19 public health measures; 2) changes to opioid substitution therapy (OST) and harm reduction services; and 3) perceived effects of COVID-19 on drug use patterns and risk behaviour. Methods : Telephone semi-structured interviews were conducted with 28 PWID in Bristol, Southwest of England. Analysis followed a reflexive thematic analysis. Results : Concern about COVID-19 and adherence to public health guidance varied. Efforts made by services to continue providing support during the pandemic were appreciated and some changes were preferred, such as less frequent OST collection, relaxation of supervised consumption and needle and syringe programmes (NSP) home delivery. However, remote forms of contact were highlighted as less beneficial and more difficult to engage with than in-person contact. Public health guidance advising people to ‘stay home’ led to increased isolation, boredom, and time to ruminate which impacted negatively on mental health. Lockdown restrictions directly impacted on sources of income and routine. Changes in drug use were explained as a consequence of isolation and fewer interactions with peers, problems accessing drugs, reduced drug purity and reduced financial resources. Conclusion : This study captures the significant impacts and challenges of the COVID-19 pandemic on the lives of PWID. While rapid adaptations to service delivery to help mitigate the risks of COVID-19 were appreciated and some changes such as relaxation of supervised daily OST consumption were viewed positively, barriers to access need further attention. Going forwards there may be opportunities to harness the positive aspects of some changes to services.

The impact of COVID-19 on people who inject drugs in New York City: increased risk and decreased access to services

“…The most prominent of the pandemic’s effects on both groups was its impact on mental health problems, which increased across groups. This finding is consistent with research studies that found higher rates of mental health issues during the pandemic in both the general population [ 48 – 50 ] and people who use drugs [ 25 , 27 , 51 ]. It is possible that social restrictions (prolonged lockdowns, isolation) and social services disruptions during the pandemic have affected participants’ sense of social connection and increased their levels of depression, anxiety, and suicidal thoughts.…”

“…PWID who were more stable prior to the pandemic (e.g., stable income, housing, and resources) were less vulnerable to the negative impacts of the COVID-19 lockdown and public health measures. This same study also shows how pandemic-related social isolation has exacerbated the deterioration of mental health conditions among PWID [ 25 ].…”

“…It is worth noting that many SSPs have adapted by replacing on-site services with telephone and video calls, doorstep delivery, and mobile services [ 25 , 60 , 61 ]. Despite these changes to support PWID, SSPs have experienced significant service disruptions since the arrival of COVID-19.…”

“…Emerging research from Europe, Canada, and the USA on the pandemic’s impact on PWID suggests PWID have faced considerable challenges, including loss of social connections and support, increased isolation, and deterioration of mental health as well as reduced access to social workers, counseling services, HIV/HCV testing, harm-reduction services, and inpatient drug treatment programs [ 9 , 25 – 31 ]. Difficulties in adhering to physical distancing and complying with public health recommendations because of PWID’s living on the streets, in shelters, and in drug-treatment hostels have been reported [ 16 , 25 , 32 ]. In addition, the pandemic has reduced PWID’s ability to engage in income-generating activities in the formal and informal economy, making everyday life even harder [ 25 , 27 ].…”

“…Difficulties in adhering to physical distancing and complying with public health recommendations because of PWID’s living on the streets, in shelters, and in drug-treatment hostels have been reported [ 16 , 25 , 32 ]. In addition, the pandemic has reduced PWID’s ability to engage in income-generating activities in the formal and informal economy, making everyday life even harder [ 25 , 27 ]. A study conducted in Bristol, England, found that COVID-19 has differential effects on PWID.…”