On the 24th August 2021, the Drugs Research Network Scotland (DRNS) hosted a virtual knowledge exchange event focussing on the impact of Covid-19 on people who use drugs. The two-hour session shared research from teams across the country who have been studying the impact of Coivd-19 in a range of settings and focussed on recommendations to improve policy and practice responses.
The event included a series of presentations from researchers on a range of topics. An interactive group discussion followed the presentations, providing an opportunity for attendees to ask questions and give comment to the learning each presentation provided. The event was fully subscribed with 60 individuals attending, including academic researchers, NHS and Public Health Scotland colleagues, third sector service providers, and individuals with lived experience of drug use. This report provides a summary of the presentations, access to slides, a recording of the event, as well as some key points highlighted during the group discussion.
Presentations
The presentations were recorded, with the recording available here.
Unfortunately, due to some issues with technology, Alison Munro was unable to present on her research. However, her slides are available below as well as a link to the recently published paper summarising the findings of the study.
Welcome & Introduction: Professor Catriona Matheson, Professor of Substance Use, University of Stirling and DRNS Co-convenor
Uptake and acceptability of remote psychological therapies in NHS GG&C Alcohol and Drug Recovery Services (ADRS): Dr Peter Brennan, Principal Clinical Psychologist, NHS GG&C
Peter provided an overview of the experience of ADRS throughout the pandemic delivering remote psychological therapies. Key findings of this work included that attendance to group appointments rose when delivered online/remotely, potentially due to an increase in accessibility and helped to manage anxieties about in-person sessions. Additionally, appointments over the phone had slightly better attendance than video appointments, this is likely due to phone calls being available any time and less risk of technology issues. Access his slides here to read the full findings:
A qualitative exploration of the response of one Scottish Homeless service to the COVID-19 pandemic: Wendy Masterton, Research Assistant & Danilo Falzon, Research Assistant, Salvation Army Centre for Addiction Services and Research
Wendy & Danilo presented on their study which explored the response of the ‘Wellbeing Centre’ in Edinburgh to the Covid-19 outbreak. Findings included that the initial lockdown period was confusing and an uncertain time, particularly in terms of what support was available. There was a rapid uptake of changes to service provision in the centre, including the move to practical and emotional support provided via phone and online. In addition services such as injecting equipment and naloxone provision were scaled up. The project team have also additionally published papers on this research which can be accessed here. Read more from their presentation here:
Lockdown and beyond: A COVID insights report: Justina Murray, CEO, Scottish Families Affected by Alcohol & Drugs
Justina, provided insight into the findings of the Scottish Families Affected by Alcohol & Drugs report into the impact of Covid-19 on these families. The report includes open letters from family members and staff reflecting on experiences, as well as trends from their national Helpline and the ways in which they adapted their services to provide digital and virtual support. Justina did not have any slides for her talk, however the full report can be accessed here.
Assessing the impact of COVID-19 control measures on interventions to prevent blood-borne viruses among people who inject drugs in Scotland: Kirsten Trayner, PhD Student, Sexual Health and Blood-borne Virus Research Team, Glasgow Caledonian University
Kirsten’s study explored the effects of COVID-19 and the associated control measures on BBV prevention, through assessing changes in the provision of key harm reduction services during the first wave of COVID-19 in Scotland. Some of her findings included that this first way severely impacted the delivery of key prevention services, interventions have not yet returned to pre-COVID attendee levels and continued surveillance of intervention coverage is important to consider in ongoing and subsequent waves of COVID-19. Access her slides here:
The impact of COVID-19 on Scottish drug markets: A moral economy perspective: Idil Galip, PhD candidate & Dr Angus Bancroft, Senior Lecturer, University of Edinburgh
Angus & Idil presented on their work investigating the impact of Covid on Scottish drug markets. Their findings included that there was an initial shock to drug supplies, there was a loss of income and reduced access to support networks, as well as that some PUWD saw the lockdown as an opportunity to reduce their use and begin opioid substitution therapy. Read more from their presentation here:
Understanding the health impacts of social responses to COVID-19 on people who use drugs in Scotland: Josh Dumbrell, Community Researcher, Drugs Research Network Scotland
Josh provided an overview of the study he worked on which explored the longer-term health impacts of the social response to Covid-19 in relation to Scottish illicit drug distribution, availability of harm reduction services, and provision of addiction treatment medication and services for people in recovery. The findings included that many individuals experience significant challenges resulting from the loss of key harm reduction, treatment, recovery and general health and care services and therapeutic relationships. Services did show a rapid response through introductions to improved access to Opioid Replacement Therapy and the expansion of injecting equipment provision. Access his slides here:
Assessing the impacts of novel coronavirus outbreaks on people who use drugs, drug related deaths and the effectiveness of service responses to them: A systematic review to inform practice and drug policy responses to COVID-19 in Scotland: Dr Alison Munro, Senior Lecturer, University of Dundee
Alison’s presentation discusses the findings of the systematic review completed to explore the impact of COVID-19 on PUWD, drug-related deaths and service provision. Findings highlight that currently evidence is insufficient to inform the response to further outbreaks of COVID-19 and it’s impact on people who use drugs. Further research is required to build the evidence base for appropriate responses. Her slides can be accessed below and the published paper can be accessed here.
Group Discussion
During the event, attendees were provided access to Padlet which is a virtual collaboration tool. This software allows anyone with the link to post comments, opinions or ideas in relation to the topic being discussed. The Padlet board for this event included discussion prompts for attendees to engage with. Below provides a summary of the questions and related comments received throughout the event.
Key themes: What, if any, are the similarities of the presentations and research findings we’ve seen today?
- The innovative and dynamic response of frontline services
- What today has illustrated is the range of approaches services adopted and implemented during the pandemic, often at considerable risk to themselves personally. We mustn’t lose sight of this.
- Disruption to access; appointments/support, testing/prescriptions, drugs
- The impact of services ‘shutting their doors’ and who picked up the pieces in response
- Digital divide, the difficulty some people have in moving to remote engagement
- Does anonymity increase uptake of remote therapy, especially for more people who deal with high levels of anxiety?
- We have become more confident about our digital offer as a staff team, e.g., we will now always offer virtual family support groups and virtual programmes, alongside (hopefully!) in person delivery
- And families have become more confident in using e.g. Zoom too.
Initiatives worth continuing: What had good evidence of benefit?
- Naloxone provision
- Do we know if the legal guidance which changed the provision of naloxone to allow it to be provided across more services is going to be continued post lockdown? In the face of the recent drug related death figures it would make sense if more partners, services to be able to train and supply people with naloxone.
- There is a current UK consultation on this to gather opinion.
- At Scottish Families, we have definitely seen the benefit of offering a range of contact platforms, including voice and non-voice, and a ‘no wrong door’ approach – i.e., we have responded to hundreds of enquiries from individuals although we are a family support service
- What are the challenges of identifying new people and assertive outreach during COVID-19?
Initiatives worth developing: What seemed helpful but requires further evidence of benefit?
- Everything needs more evidence
- There were so many changes during covid that we don’t fully understand the impact of, especially unintended, consequences: Housing homeless, shift to take-home OST, Home testing, click/collect services, telemedicine
- Move from supervised consumption – This was a fundamental shift in treatment, how do we best evaluate the positive and negative impacts of this change, need both quantitative and qualitative work on this – quantitative work is underway via Public Health Scotland.
- Housing of people roofless – ‘everyone in’
- Efforts to offer accommodation to street homeless were remarkable in speed and apparently in effectiveness but what evidence is there of what has happened to this group more recently, what was their experience and what good learning can we take from this and carry on with?
Additional comments
- Public health impact
- Is there still a concern that some of the substances that may have been stockpiled during the pandemic for later manufacturing for street sale could now contain bacteria (due to poor storage facilities) that would lead to higher risk of health harms and increased pressure on NHS services
- Prevalence and impact of COVID
- There needs to be better understanding of the vulnerability of PWUD to infection and transmission of COVID-19, there is some work going on already but more will be required
- Learning for recovery and return
- We need to think about both what we can learn from the last 18 months in terms of recovery and rebuilding services but also what would we do differently if faced with similar challenges in the future
- Could offer more ‘green space’ meeting options for people linked with health and wellbeing effects of the outdoors, and using nature with meeting people in a space where any future covid restrictions would not have such an impact
- Next steps for research
- We now have a good understanding of the impact of COVID-19 on services, next step is to understand how this is impacted on harms, i.e., morbidity and mortality
- Needs to be a focus going forward, although the impacts may not be clear for some time relating to the impact of the HIV outbreak in Glasgow and HCV transmission due to reduced testing levels. Drug-related deaths increased by 5% between 2019 and 2020, perhaps efforts to maintain drug treatment have been key at reducing the impact of the pandemic on drug related deaths, this needs further research
If you have any questions or would like to get in touch with the event speakers, email admin@drns.ac.uk