The impact of the COVID-19 pandemic on harm reduction services in Spain

Abstract

Background Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain. Methods This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March–June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers. Results All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March–21 June 2020). One centre reported complete closure for 2 months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses, human immunodeficiency virus, and tuberculosis) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm. Conclusion Overall, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment such as methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy.

“You know, we can change the services to suit the circumstances of what is happening in the world”: a rapid case study of the COVID-19 response across city centre homelessness and health services in Edinburgh, Scotland

“…Globally, this has included changes to drugs harm reduction services, including: designating harm reduction services to be essential [ 46 ]; developing emergency harm reduction plans [ 46 ]; access to COVID-19 screening and testing [ 47 ]; changes to service and medication provision to comply with pandemic guidance [ 41 , 42 , 46 – 56 ]; improved access to naloxone and IEP [ 47 , 50 ]; increased awareness of the need for clean water for injecting [ 57 ]; general guidance about reducing COVID-19 spread in services [ 58 – 60 ]; the need for a ‘safe supply’ of drugs [ 46 ]; and the need for holistic models of care that attend to mental and physical health and housing needs [ 46 ]. While evidence is still emerging on how the pandemic impacted drugs harm reduction, strict lockdown rules have appeared to reduce the number of people accessing IEP and other harm reduction services [ 61 , 62 ]. Other public health guidelines, such as social distancing, maintaining high levels of personal hygiene including regular hand washing and the wearing of masks, place additional demands on people who use substances, which may hinder the provision of effective services [ 63 ].…”

Impact of the COVID-19 pandemic on HCV elimination in Spain

“…The first wave from March to June prompted a country-wide lockdown and the second wave has been ongoing since September. During this overall period, there has been a drop in HCV testing, linkage to care, harm reduction programs, and microelimination programs 3 . We aimed to assess the impact of COVID-19 on hepatitis C elimination in Spain.…”

Health literacy and changes in pattern of drug use among participants at the Stockholm Needle Exchange Program during the COVID-19 pandemic

“…Also, a study examining the COVID-19 effects on NEP in England showed that the number of clients and number of visits decreased by 36% and the number of needles distributed decreased by 29% [ 4 ]. Furthermore, a study from Spain reported a 22% decrease in service users across all studied harm reduction centres and a 40% decrease in average needle distribution as well as a reduction in in HIV/hepatitis testing [ 4 , 20 ].…”