Impact of COVID-19 on Harm Reduction Services for Drug Users in Chicago

The COVID-19 pandemic has greatly affected many groups, especially those who use drugs. People who use drugs, particularly those who inject, faced higher risks of getting COVID-19 and having severe symptoms. This is especially true for those with other health issues like heart disease, diabetes, obesity, or cancer. Additionally, people who inject drugs often have more complicated health problems and face social issues such as homelessness, being in jail, and poverty.

These challenges worsened during the pandemic due to economic hardships, making it harder for these individuals to access food, shelter, and sanitation. Research has shown that the pandemic led to increased feelings of loneliness and mental health issues for many people who inject drugs. Following public health rules, like keeping distance from others, was difficult for those living in shelters or on the streets. Furthermore, access to important services like counseling, testing for HIV and hepatitis C, and addiction treatment was limited.

Harm reduction services, which include syringe services (where people can get clean needles), safe spaces for drug use, and distributing Naloxone (a drug that helps prevent overdose deaths), are crucial for helping people who use drugs. These services also have benefits for public health, like reducing hospital visits and linking individuals to treatment. Importantly, these services help lessen stigma connected to drug use and provide access to other essential resources, like food banks and mental health support.

During the pandemic, some measures made it easier to access these services, such as mobile outreach and online distribution. However, other measures, like social distancing, restricted access to harm reduction services, leading to fewer opportunities for HIV testing and acquiring clean supplies. The reduction in social interactions due to these changes also increased feelings of isolation among people who inject drugs.

While there is valuable information about how the pandemic affected access to harm reduction services from the viewpoint of service providers, there is limited research capturing the perspectives of those who use these services. Furthermore, existing studies mainly focus on specific regions, such as New York, which suggests more research is needed to see if similar patterns exist in other areas.

This study aims to look into how the COVID-19 pandemic affected access to harm reduction services from the perspective of people who inject drugs in Chicago.

#Study Setting

Data for this study comes from a long-term project involving people who inject drugs in Chicago. The study included a specific section about COVID-19. It was done at Community Outreach Intervention Projects (COIP), a center that offers harm reduction services. COIP provides syringe services, naloxone, and testing for HIV and hepatitis C, along with counseling and other support.

In Chicago, a stay-at-home order was put into effect on March 20, 2020. This meant non-essential workers had to stay home, and many businesses had to close. This affected organizations like COIP, which had to change how they operated by reducing hours and limiting in-person contact. COIP continued to provide services while following health guidelines. For instance, staff wore protective gear and interacted with clients using barriers to ensure safety.

During the early stages of the pandemic, COIP cut down public access to services but later adopted a mix of in-person and remote operations. By June 2021, they resumed full operations. It is important to explore how these changes affected access to services for people who inject drugs during this time.

#Sample and Recruitment

This study used data from a COVID-19 survey done during an ongoing long-term project involving young people who inject drugs and their social networks in Chicago. Participants had to be between 18 and 30, report injecting drugs in the past month, speak English, and have lived in Chicago or nearby for the past year. Participants could also bring in people from their networks to participate in the study.

Participants filled out surveys every six months for up to three years to provide information about their demographics, social networks, and health status. During their visits, they were also asked COVID-19 specific questions related to their drug use, living situations, and access to services.

#Data Collection

The COVID-19 survey was integrated into the main study from May 2020 to December 2022. Participants were given chances to retake the survey during their follow-up visits. They were recruited from COIP, which operates in areas with high rates of drug-related issues. All participants gave consent before participating.

The study analyzed their demographics, drug use behavior, perceptions of risk, and views on accessing harm reduction services during the pandemic. The demographic information included their age, gender, and ethnicity.

#Drug Use Behaviors during COVID-19

Participants were asked if they were currently using or injecting drugs and how their injection frequency and use of new syringes changed during the pandemic. Responses indicated whether their injection frequency increased and whether they used sterile syringes more or less than before.

#Perceptions of Drug Use Risk during COVID-19

Participants provided their views on whether people were more likely to share syringes since COVID-19 started and how their concerns about overdose changed. Responses identified whether individuals thought syringe sharing increased and if their worry about Overdoses went up.

#Perceptions of Access to Harm Reduction Services

Participants shared their thoughts on accessing harm reduction services, including how easy it was to get syringes and naloxone since the beginning of the pandemic. They indicated whether finding syringes was harder than before and if their usual sources for syringes changed during this time.

#Statistical Analysis

Data were analyzed using statistical software. The researchers compared responses from individuals enrolled in the study before and during the pandemic to see if there were any noticeable differences in their demographics and drug use. They conducted descriptive analyses to summarize participant responses and compared responses from different phases of the COVID-19 pandemic.

#Results

The results presented information about participants’ demographics and drug use behaviors during the pandemic. The sample mostly consisted of males and non-Hispanic whites, with a significant portion reporting that they were currently injecting drugs. There were differences in the number of people reporting on their drug use depending on when they filled out the survey.

Most participants did not perceive difficulty in accessing syringes or naloxone during the pandemic, with many stating that their access to syringes remained consistent and they were not more likely to share syringes than before. However, fewer people reported challenges accessing syringes in later phases of the pandemic compared to earlier phases.

#Mixed Effects Logistic Regression

The researchers conducted further analysis to understand the factors influencing perceptions of ease or difficulty in accessing syringes. The analysis found that participants in the later phase had lower odds of reporting issues accessing syringes compared to earlier in the pandemic. Changing sources for syringes or seeing others more likely to share syringes were linked with higher odds of reporting challenges in accessing syringes.

#Discussion

This study looked at how people who inject drugs in Chicago viewed their access to harm reduction services during the COVID-19 pandemic. The analysis showed that access to syringes was perceived as easier over time, particularly after vaccines were available. Factors like changing how they got syringes and perceiving an increase in syringe sharing were linked to reporting more difficulty accessing these supplies.

The results reflect both city policies in Chicago and the adjustments made by COIP to remain operational during the pandemic. The quick responses from harm reduction services allowed many individuals to continue accessing syringes and naloxone throughout the pandemic.

While most participants felt that accessing these supplies did not become more difficult, it is important to consider that perceptions might not represent the reality of accessing services. Some studies indicated that drug-related risks and overdoses increased during the pandemic, suggesting that even if access seemed steady, actual engagement with services may have declined.

The study highlights the importance of maintaining access to harm reduction services during crises and suggests that while some adaptations were effective, further research is necessary to understand how the pandemic impacted other services like counseling and testing.

The current study does have limitations, including a more confined participant group, which makes it harder to generalize the findings. Also, because responses were based on individual perceptions, interpretation of questions may vary, affecting the outcomes. Future studies should consider these limitations and explore how COVID-19 affected access to a wider range of harm reduction services.

#Conclusion

This study examined perceptions of access to harm reduction services for people who inject drugs in Chicago throughout the COVID-19 pandemic. Results showed that most participants did not feel significant barriers to accessing syringes and naloxone during the pandemic. The findings suggest that adaptations made by harm reduction services helped to provide continued access, but more research is needed to understand the full impact of the pandemic on engagement with all critical services.