Assessing the impact of COVID-19 and associated control measures on interventions to prevent drug-related harm among people who inject drugs in Scotland

Background: COVID-19 has likely affected the delivery of interventions to prevent drug-related harm among people who inject drugs (PWID). We examined the impact of the first wave of COVID-19 in Scotland on: 1) needle and syringe provision (NSP), 2) opioid agonist therapy (OAT) and 3) blood-borne virus (BBV) testing.

Methods: Interrupted time series; 23rd March 2020 (date of first UK ‘lockdown’) selected as change point. Four data sources representing each intervention were analysed. Study period was from September-2018 to August-2020 and included regions that represent 67% of people with problematic drug use in Scotland.

Results: The number of HIV tests and HCV tests in drug services/prisons, and the number of needles/syringes (N/S) distributed decreased by 94% (RR=0.062, 95% CI 0.041 to 0.094, p<0.001), 95% (RR=0.049, 95% CI 0.034 to 0.069, p<0.001) and 18% (RR=0.816, 95% CI 0.750 to 0.887, p<0.001), respectively, immediately after lockdown. Post-lockdown, an increasing trend was observed relating to the number of N/S distributed (0.6%; RR=1.006, 95% CI 1.001 to 1.012, p=0.015), HIV tests (12.1%; RR=1.121, 95% CI 1.092 to 1.152, p<0.001) and HCV tests (13.2%; RR=1.132, 95 CI 1.106 to 1.158, p<0.001). Trends relating to the total amount of methadone prescribed remained stable, but a decreasing trend in the number of prescriptions (2.4%; RR=0.976, 95% CI 0.959 to 0.993, p=0.006) and an increasing trend in the quantity prescribed per prescription (2.8%; RR=1.028, 95% CI 1.013 to 1.042, p<0.001) was observed post-lockdown.

Conclusions: COVID-19 impacted the delivery of key prevention services for PWID. While there is evidence of service recovery; further effort is likely required to return some intervention coverage to pre-pandemic levels in the context of subsequent waves of COVID-19. Work is currently underway to update this analysis to quantify how service provision was affected over the course of the pandemic (till the end of August 2021), and will include an assessment of trends in take-home naloxone (THN).