Reorganization of Substance Use Treatment and Harm Reduction Services During the COVID-19 Pandemic: A Global Survey

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health responses were categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups. Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. Fifty-seven percent of overdose prevention interventions and 81% of outreach services were also negatively impacted. Conclusions: Participants reported that SUD treatment and harm-reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we highlight several issues and complications resulting from the pandemic concerning people with SUDs that should be tackled more efficiently during the future waves or similar pandemics. The issues and potential strategies comprise the following: (1) helping policymakers to generate business continuity plans, (2) maintaining the use of evidence-based interventions for people with SUDs, (3) being prepared for adequate medication supplies, (4) integrating harm reduction programs with other treatment modalities, and (5) having specific considerations for vulnerable groups such as immigrants and refugees.

Keywords: COVID-19 pandemic; addiction services; drug policy; harm reduction; opioid agonist treatment; public health; substance use disorder.

Figure 1

Global distribution of the respondents to the survey. Number of participants from each country is demonstrated as a color spectrum from light to dark purple.

Figure 2

Availability and accessibility of treatment and harm reduction services. Data relating to arranging business continuity plans (Business C Plan), limitations that mobile services faced during the pandemic (mobile services limitation), limitations that harm reduction services faced during the pandemic (HR services limitation), and continuity of other medical and psychiatric necessary care (Med Psyc Care Cont.) are depicted. The Figure shows responses from respondents from 77 countries categorized into low-, middle-, and high-income countries. The light green bars and the numbers associated with each country show the survey respondents who reported having experienced limitations regarding the question in their country (Yes), and the gray bars show the survey respondents who reported having experienced no limitations regarding the question in their country (No). The dark green bars show the overall responses in each category (low, middle, and high income) as well as overall responses.

Figure 3

Medical services for people with substance use disorders during the pandemic. The responses of respondents from 77 countries are shown, categorized into low-, middle-, and high-income countries to the questions related to the shortages in opioid medication (opioid short.), disruption in needle and syringe and/or condom distribution services (NSP Short.), availability or shortages in take-home naloxone services (TH Naloxone short.), availability of COVID-19 screening kits and equipment for people with substance use disorders (PWSUDs) in their countries (COVID-19 screening), and personal protective equipment provision to PWSUDs (PPE for SUD patients).

Figure 4

Effects of COVID-19 on substance use treatment and/or harm reduction services for vulnerable groups. Services for children, pregnant women, refugees, and women, in high-, middle-, and low-income countries are depicted. The red, yellow, and green bars depict the responses indicating lack of availability of services during the COVID-19 pandemic, the existence of limited services, and usual service provision, respectively.

Figure 5

Health policies for COVID-19 among people with substance use disorders (PWSUDs). Plans to restrict any personal contact, provision of prescriptions of longer durations, provision of more take-home doses of opioids drugs, and availability of any program for delivering opioid drugs to patients' homes are depicted. The Figure shows responses from 77 countries, which are categorized into low, middle, and high income. The light green bars and the numbers associated with each country show the survey respondents who reported having experienced limitations regarding the question in their country (Yes), and the gray bars show the survey respondents who reported having experienced no limitations regarding the question in their country (No). The dark green bars show the overall responses in each category (low, middle, and high income) as well as overall responses.

Figure 6

Flexibility of health responses for people with substance use disorders in response to the pandemic in different domains based on the income levels of the countries. Respondents were asked to rate the overall flexibility of their health system in nine different domains, from 1 (extremely poor) to 10 (extremely good).

Figure 7

The overall quality of health response to COVID-19 pandemic based on the subjective ratings by respondents from different countries. Average scores were measured based on responses in nine domains depicted in Figure 6. Score 1 represents the worst quality in response, and 10 represents the best situation in favor of health services. Average scores for each country are shown using a color spectrum from yellow to blue.