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Publication Detail
A qualitative study exploring the impact of the COVID-19 pandemic on People Who Inject Drugs (PWID) and drug service provision in the UK: PWID and service provider perspective
Background: People Who Inject Drugs (PWID) are subject to distinct socio-structural inequalities that can expose them to high risks of COVID –19 transmission and related health and social complications. In response to COVID –19 mitigation strategies, these vulnerabilities are being experienced in the context of adapted drug treatment service provision, including reduced in–person support and increased regulatory flexibility in opioid substitution therapy (OST) guidelines. This study aimed to explore the longer–term impact of the pandemic on the health and wellbeing of PWID, including provider and client experiences of treatment changes. Methods: Interviews were conducted with 19 PWID and 17 drug treatment providers between May – September 2021, recruited from third –sector drug services in the UK. Data were analysed using reflexive thematic analysis. Results: Most participants expressed ongoing fears of COVID –19 transmission, although socio-structural inequalities limited the contexts in which physical distancing could be practised. In addition, virus mitigation strategies altered the risk environment for PWID, resulting in ongoing physical (e.g. drug use patterns and characteristics), economic (e.g. sex work engagement and income generation) and social (e.g. stigmatization and marginalization) harms. Finally, whilst clients reported favourable experiences from service adaptations prompted by COVID –19, there was continued scepticism and caution among providers toward sustaining any treatment changes beyond the pandemic period. Conclusions: Whilst our findings emphasize the importance of accessible support measures attending to the immediate priorities of PWID during this period, there is a need for additional supports to ensure socio–structural vulnerabilities that disproportionality affect PWID are not exacerbated by the pandemic. In addition, treatment adaptations initiated in response to the pandemic require further attention to ensure they are acceptable to both clients and providers.
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