Impact of COVID-19 on drug services and help-seeking in Europe
EMCDDA trendspotter briefing
The situation regarding public health responses to the COVID-19 pandemic is rapidly evolving. Up-to-date information can be found in the guidelines prepared by national public health sources and the regular updates from the European Centre for Disease Prevention and Control and the World Health Organization. The EMCDDA has created a COVID-19 resource hub for people who use drugs and drug service providers.
Since the start of 2020, European countries have been experiencing an unprecedented public health threat with the emergence of the coronavirus disease (COVID-19). In order to investigate the effects and implications of this pandemic for drug services in Europe, the European Monitoring Centre for Drugs and Drug Addiction instigated a mixed-method trendspotter study to provide a snapshot of the current situation. This exercise provides a rapid assessment of the state of play in respect to the impact of COVID-19 on service provision and help-seeking behaviour among people who use drugs.
Preliminary findings suggest there has been a decline in the availability of European drug services during the first two months of the pandemic, both those providing treatment and those providing harm reduction interventions. Drug services have largely been affected in similar ways to other frontline health services, with some providers forced to close down or restrict access. Services still working directly with clients need to implement new hygiene and social distancing measures which can be especially challenging in some of the settings in which drug services operate. It is also reported that services are increasingly using mobile or online platforms to mitigate for the current difficulties in providing face-to-face care.
While they are trying to keep operations running efficiently, service providers have identified a number of specific new COVID-19-related challenges. These include: accessing sufficient personal protective equipment for staff; informing and educating clients about COVID-19 risks; managing infected clients and concerns about staff vulnerability to infection; helping more marginalised clients to access essential hygiene-related services; challenges linked to the use of remote technology (phone and video); staffing shortages; problems enrolling new clients and managing the demand for substitution treatment; and the need to mitigate potential risks of unintended consequences associated with rapidly implemented adaptations to normal working practices.
In respect to implications for help-seeking behaviour, an analysis of data from four countries with information available on treatment demand between January and March 2020 shows a steady decline in both new and all treatment entrants. This includes a marked overall drop of more than 50 % in opioid-using entrants over this period. While not necessarily generalisable to other countries, this suggests that a combination of public health confinement measures in combination with service closures and/or reduction in service availability may be taking a toll.
The study also provides some insight into the innovations adopted by drug services across Europe in response to the COVID-19-related challenges. When asked their opinions on what the post-COVID-19 ‘new normal’ might look like for drug services in Europe, experts highlighted a number of changes that they considered would be advantageous to maintain after the first wave of the crisis has passed. The most commonly cited examples included the new flexibility associated with opioid substitution treatment service models and the potential future use of telemedicine approaches.
In response to the COVID-19 pandemic in February 2020, European countries have implemented a range of containment and mitigation measures to reduce the spread of the virus among their general populations. While people who use drugs run the same risk of infection with COVID-19 as the general population, they also face additional risks and vulnerabilities that need both consideration and mitigation (EMCDDA, 2020). The emerging evidence suggests that European drug services, like other healthcare providers, face a range of challenges in maintaining adequate provision for their clients. In many instances, services have had to be innovative and adapt very rapidly in response to the new and fast-changing landscape in the wake of the pandemic and associated national control measures.
Very limited information is available at European level on the challenges faced and the adaptations made by drug treatment and harm reduction services following the emergence of COVID-19 in the Member States. In order to gain an insight into the impact on drug services and the adaptations being made since the beginning of the pandemic in Europe, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) initiated an investigative rapid assessment using the agency’s trendspotter methodology. This study was conducted in April 2020. The primary aim of the study was to provide a rapid snapshot that would increase our understanding on the impact of COVID-19 on the demand for and provision of drug services across Europe.
Recognising the potentially harmful consequences of COVID-19 and related restrictions on drug services for people with more severe drug problems, including opioid users and people who inject drugs, this first EMCDDA briefing concentrates on the implications for drug treatment and harm reduction services for these client groups. Future investigative rounds will explore the impact on service provision for stimulant and cannabis users as well as focusing in more detail on interventions delivered in prisons, interventions in recreational settings and online interventions.
The trendspotter methodology
The trendspotter methodology is based on the triangulation of a range of investigative approaches and data collection from multiple qualitative and quantitative sources with a systematic analysis incorporating the use of expert opinion (EMCDDA, 2018). Specifically, for this COVID-19 impact study, the methodology was adapted to suit online investigation, taking into account the national emergency restrictions on both the EMCDDA team and the study participants (Figure 1). The study has been divided into a number of investigative and reporting waves, with the first wave focusing on the impact of COVID-19 on drug service provision and help-seeking.