The effects of COVID-19 on New York State’s Drug User Health Hubs and syringe service programs: a qualitative study

Abstract

Background Syringe service programs (SSPs) deliver critical harm reduction services to people who inject drugs (PWID). Some SSPs in New York State received enhanced funding to provide additional services to combat opioid overdose fatalities. These SSPs, known as Drug User Health Hubs, provide buprenorphine for the treatment of opioid use disorder and other health-related services in addition to their syringe services. While the COVID-19 pandemic posed widespread challenges to the delivery of health services nationwide, the effect of the pandemic on SSPs uniquely impacts PWID. This study examines the impact of COVID-19 on service delivery of Drug User Health Hubs and stand-alone SSPs in New York State. Methods Between July 2020 and September 2020, we performed eleven semi-structured virtual interviews with staff from three Health Hub SSPs and three stand-alone SSPs. The interviews explored the effect of the COVID-19 pandemic on SSPs and their clients as well as the changes implemented in response. Interviews were recorded and transcribed. We performed content analysis to identify emerging themes from the data. Results Due to the COVID-19 pandemic, some SSPs temporarily shut down while others limited their hours of operation. SSPs modified their service delivery to maintain syringe services and naloxone distribution over other services such as STI and HCV testing. They virtualized components of their services, including telemedicine for the provision of buprenorphine. While SSPs found virtualization to be important for maintaining their services, it negatively impacted the intimate nature of client interactions. Participants also described the impact of the pandemic on the well-being of PWID, including isolation, worsened mental health challenges, and increased drug overdoses. Conclusions In response to the COVID-19 pandemic, SSPs demonstrated innovation, adaptability, and togetherness. Despite the challenges posed by the pandemic, SSPs continued to be key players in maintaining access to sterile supplies, buprenorphine, and other services for PWID. In addition to adapting to COVID-19 restrictions, they also responded to the dynamic needs of their clients. Sustainable funding and recognition of the critical role of SSPs in supporting PWID can help to improve outcomes for PWID.

A Scoping Review on the Effects of COVID-19 on Syringe Service Programs in the United States

“…Consequently, staff was diverted to respond to a concurrent HCV outbreak in PWID [ 26 ]. Programs also struggled to obtain PPE such as sanitizers and masks, making it harder for PWID to come to in-person testing and injections, further increasing HIV and HCV outbreaks [ 36 ]. Moreover, the pandemic increased drug overdose due to clients receiving drugs from unfamiliar suppliers and psychological stressors.…”

“…Moreover, the pandemic increased drug overdose due to clients receiving drugs from unfamiliar suppliers and psychological stressors. The SSPs were unable to combat the rise in drug overdoses coming at a time of limited supply of clean syringes and supplies [ 36 ].…”

Non-fatal drug overdose among persons who inject drugs during first two years of the COVID-19 pandemic in New York City: Prevalence, risk factors

“…The lockdown measures included closing of schools and non-essential businesses, mask mandates, and guidance to stay at home. Syringe service programs and substance use programs were considered “essential services” and remained open, though there were temporary disruptions and reduced hours due to staff illness and shortages of personal protective equipment ( Glick et al., 2020 ; Ude et al., 2023 ).…”