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Multicenter Study
. 2020 Nov 4;17(1):87.
doi: 10.1186/s12954-020-00432-w.

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

Camila A Picchio  1 , Jorge Valencia  2 , Jason Doran  3 , Tracy Swan  4 , Marta Pastor  5 , Elisa Martró  6   7 , Joan Colom  8 , Jeffrey V Lazarus  9
Affiliations
Multicenter Study

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

Camila A Picchio et al. Harm Reduct J. .

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.

Keywords: COVID-19; Harm reduction; Health systems; Healthcare utilisation; Spain.

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Conflict of interest statement

CAP, JD, TS, MP and JC have no competing interests to report. JV reports Research grants and honoraria for lectures from Gilead Sciences, grants and personal fees from ViiV, grants from Merck, and grants from Janssen, outside the submitted work. EM reports grants and personal fees from Gilead, grants and personal fees from Cepheid, grants and personal fees from Abbott, and personal fees and a donation to IGTP from Abbvie, outside the submitted work. JVL reports reports grants, personal fees and other from AbbVie, MSD and Gilead Sciences, and personal fees from CEPHEID, GSK, Intercept, and Janssen, outside the submitted work.

Figures

Fig. 1
Fig. 1
Time trend graphs describing number of users per centre that reported data (n = 11) during the first 6 months of 2019 and 2020. Notes: Free Y-scale axis utilised to visualise the relative differences
Fig. 2
Fig. 2
Time trend graphs describing the number of distributed needles in each centre that reported data (n = 11) between the months of March and June in 2019 and 2020. Notes: Free Y-scale axis utilised to visualise the relative differences
Fig. 3
Fig. 3
Distribution of responses describing the most important difficulties that PWUD had to experience during the COVID-19 state of alarm in Spain, 2020
See this image and copyright information in PMC

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