Remote harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA

Abstract

Background Harm Reduction (HR) policies for People Who Use Drugs (PWUD) have a significant positive impact on their health. Such approaches limit the spread of infections and reduce opioid overdose mortality. These policies have led to the opening of specialized structures located mainly in big cities and urbanized zones. The COVID-19 pandemic reduced access to HR structures in locations undergoing lockdown. Before the pandemic, HR services in France and in the USA were complemented by the development of remote HR programs: HaRePo (Harm Reduction by Post) for France, implemented in 2011, and NEXT Distro for the USA founded in 2017. These programs are free and specifically designed for people who have difficulties accessing HR tools and counseling in-person. PWUD can access HaRePo program by phone and/or email. NEXT Distro users can access the program through its dedicated website. The aim of the study is to test if and possibly how COVID-19 pandemic and the associated lockdowns have impacted the HR services in both countries. Methods By using t-test comparing the year 2019 with the year 2020, we analyzed how lockdowns impacted the number of new users entering the programs, as well as the numbers of parcels sent and naloxone distributed, by using records of both structures. Results We showed that the activity of both programs was significantly impacted by the pandemic. Both show an increase in the number of new users joining the programs (+ 77.6% for HaRePo and + 247.7% for NEXT Distro) as well as for the number of parcels sent per month (+ 42.7% for HaRePo and + 211.3% for NEXT Distro). It shows that remote HR was able to partially compensate for the reduced HR activities due to COVID-19. We also observed that the distribution of naloxone per parcel tends to increase for both structures. Conclusion With the ability to reach PWUD remotely, HaRePo and NEXT Distro were particularly effective at maintaining service continuity and scaling up services to meet the needs of PWUD during the COVID-19 pandemic. By studying two independent structures in France and in the USA sharing similar objectives (remote HR), we showed that this approach can be a key solution to crises that impact classical HR structures despite various differences in operating procedures between countries.

Implementing harm reduction kits in an office-based addiction treatment program

“…First, given our OBAT operates as a hybrid telehealth model, we were unable to systematically distribute kits to patients receiving care primarily via telemedicine during the pilot period. Future iterations of this program may explore and incorporate strategies to provide tele-harm reduction services, which have been described in some studies [ 36 , 37 ]. Secondly, procurement of supplies and maintenance of kit inventory was difficult due to heterogeneity of vendors and pricing of kit supplies, unforeseen supply chain shortages, and unexpected variations in patient demands for specific kits.…”

Client experiences using a new supervised consumption service in Sudbury, Ontario: A qualitative study

“…Participants described issues related to the site's location and operational hours, and suggested that due to its current location, the site is not reaching its full potential. Evidence suggests that travel acts as a significant barrier for PWUD in accessing health and social services [23,24], and previous research has emphasized the importance of location and ensuring that travel or distance does not influence one's ability or decision to use at the site [25][26][27][28]. Studies have documented that when harm reduction sites are located far away from where PWUD commonly congregate or are in inconvenient locations, this can act as a significant deterrent for individuals to access the site, which subsequently results in low uptake [24].…”

Comparing harm reduction and overdose response services between community-based and public health department syringe service programmes using a national cross-sectional survey

“…For example, while SSPs have long been champions for community-based naloxone distribution (the medication that reverses opioid overdoses), some now accelerate these efforts through strategies like vending machines and mail programmes. 9 , 10 Fentanyl test strips (FTS) are an emerging strategy used by SSPs; given the proliferation of fentanyl (a synthetic opioid 50 to 100 times more powerful than heroin) in heroin, but especially throughout the illicit drug supply including stimulants and counterfeit pills, paper test strips and other drug checking have emerged as a potential overdose mortality prevention strategy. 11 Drug checking can include testing for the type and quantity of substances; but, more often, and especially given the ability to use federal funding, it includes the distribution of FTS which are small strips of paper that detect the presence of fentanyl with similar strips developed for xylazine.…”