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How did the COVID-19 pandemic affect people who inject drugs?

28 July 2021 

People who inject drugs appreciated the efforts made by drug services to continue to provide support during the pandemic, the National Institute for Health Research (NIHR) funded LUCID-B study published (pre-proof) in the International Journal of Drug Policy has found. But for many, the pandemic worsened already precarious and isolated lives. 

Candles, face mask and a syringe

The LUCID-B (Living Under Coronavirus and Injecting Drugs in Bristol) study examined how the pandemic, public health measures such as lockdowns and social distancing, changes to harm reduction services and drug treatment medication (opiate substitutes like methadone) were experienced by people who inject drugs and the impact on their drug use. 

The research was conducted by Bristol Drugs Project (BDP), the NIHR Applied Research Collaboration West (ARC West), NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol and the University of Bath with funding from the Elizabeth Blackwell Institute at the University of Bristol and the Wellcome Trust

Staff from BDP recruited 28 Bristol-based people who inject drugs for telephone interviews over a three-month period in the summer of 2020, including the first national lockdown. 

A key finding was how appreciative people were of the effort services made to continue supporting them during the pandemic. Some of the most positively received changes were the move to collecting drug treatment medication from pharmacies less often and relaxing rules on taking opiate substitutes under supervision. Home delivery of sterile injecting equipment was also welcomed as it was discreet, convenient and overcame difficulties accessing equipment during the lockdown. 

However, interviewees also spoke of the challenges of engaging with telephone and online services describing them as “just not the same”. Many people who were street homeless or vulnerably housed did not have a phone or the internet to access services, making local initiatives to provide phones vital.

The government guidance to ‘stay at home’ increased isolation and boredom, negatively affecting mental health. This disruption to daily routines affected people’s income, including job losses and difficulties earning money from street begging. 

The pandemic’s impact on drug use is not clear cut. While some people described no change, others shared experiences of considerable increases or decreases in consumption. Experiences of isolation, problems accessing drugs, reduced purity and reduced financial resources all appeared to offer explanations for these changes. Difficulties buying drugs in the pandemic meant some people reported changing to more readily available and cheaper drugs like spice. 

Concern about COVID-19 and how closely they followed public health guidance varied. Awareness of public health guidance was good and people were trying to follow the advice. People who were not concerned about COVID-19 talked about not knowing anyone who had the virus and having more pressing issues to deal with, including drug dependence. Others were concerned because they felt at risk of from COVID due to medical issues and difficulties maintaining social distancing with peers and drug dealers. Social distancing was more difficult to do in some situations, such as in crowded hostels, and when buying drugs. 

Overall, the COVID-19 pandemic presented significant challenges for people who inject drugs in relation to accessing services and loss of connection and routine. The researchers conclude that people facing the greatest barriers to accessing services remotely at a time of heightened isolation and loss of routine may require tailored, more intensive support. 

Dr Lindsey Hines, from the Centre for Academic Mental Health at the University of Bristol, who led the study, said: 

“Working in addiction and drug use, it was clear that people who inject drugs were likely to experience a lot of disruption and potentially be much more vulnerable as a result of COVID-19. We are grateful to BDP for their invaluable support, which enabled us to connect rapidly with this population. 

“Our findings highlight the importance of tailoring support to people’s needs, including economic, housing and mental health support, and offering outreach to those who can’t access services remotely. At the same time, the changes brought about by the pandemic could present an opportunity to rethink policy and practice.”

Maggie Telfer, Chief Executive of BDP, said: “As streets and many services emptied, LUCID-B was able to illuminate the real-time experiences of people who inject drugs. It is a fabulous example of research at its best, informing service delivery in unprecedented times.”

Dr Jo Kesten, from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol and the lead author of the study, said: “This study continues our longstanding relationship with BDP. At the start of the pandemic, no one knew what would happen if we made rapid policy and practice changes for people who inject drugs. 

“This study helped us learn about the experiences of people who inject drugs during this unprecedented time. Our findings can help inform decision-making about which changes to continue. We particularly hope it will contribute to policy decision-making about drug treatment medication.”

Paper: Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): a qualitative study of experiences of COVID-19 among people who inject drugs by Joanna Kesten et al. Published (pre-proof, 20 July 2021) in International Journal of Drug Policy

Rapid reports 

We published four interim reports of our findings, covering issues such as social distancing, drug supply, accessing needle and syringe programmes, accommodation and collecting prescriptions:

22 June – LUCID-B study: Interim report 1

7 July – LUCID-B study: Interim report 2

28 July – LUCID-B study: Interim report 3

10 August – LUCID-B study: Interim report 4


Further information

About the NIHR Health Protection Research Unit [HPRU] in Behavioural Science and Evaluation at the University of Bristol 

The NIHR HPRU in Behavioural Science and Evaluation at University of Bristol is one of 14 HPRUs across England, part of a £58.7 million investment by the NIHR to protect the health of the nation. 

The NIHR HPRU in Behavioural Science and Evaluation is a partnership between Public Health England and University of Bristol, in collaboration with MRC Biostatistics Research Unit at the University of Cambridge and University of the West of England. 

Each NIHR HPRU undertakes high quality research that is used by PHE to keep the public safe from current and emerging public health threats.

About the NIHR 

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

  • funds, supports and delivers high quality research that benefits the NHS, public health and social care
  • engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
  • attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
  • invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
  • partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.