What's the Status of Harm Reduction Services?

A recent study analyzing the impact of the pandemic on harm reduction in Maine offers insights into its acceptance and effectiveness

By Alison Jones Webb

The impact of changes in harm reduction policies during the COVID-19 pandemic on people who inject drugs (PWID) varied from one state to another. Researchers previously identified barriers to harm reduction services like syringe service programs (SSPs) and medications for opioid use disorder (MOUD) in rural areas. Barriers include transportation, fees, scheduling, fear of law enforcement, concerns about confidentiality and a lack of awareness of services. In Maine, a heavily rural state, distance to services is an additional barrier. In a recent paper in Harm Reduction Journal, researchers interviewed PWID, community partners and healthcare providers to understand how access to services changed during the early months of the COVID pandemic in Maine.

SSPs experienced staff shortages, a lack of personal protective equipment (PPE) and shortages of safe injection supplies, all of which decreased the availability of harm reduction services.

Access to services was hampered by the emergency shutdown order declared on March 31, 2020. Some SSPs were temporarily closed and then reopened with limited hours and restricted access to indoor locations. After the initial shutdown order, the governor temporarily relaxed some policies by expanding telehealth, permitting mailing of harm reduction supplies and eliminating the state’s one-for-one needle exchange requirement.

Harm Reduction Findings

The new research on access to harm reduction services in Maine identified key barriers and facilitators.

Awareness. Awareness of how to access services was significantly impaired in the confusion immediately following the shutdown order and policy changes, and significant communication challenges with SSP service users arose. SSPs and community partners developed new communication channels, including outreach through new SSP mobile units and sharing information about service availability in the mailed packages of supplies (both permitted under the emergency orders) and delivery of low barrier buprenorphine services outdoors, thereby demonstrating to clients the availability of services.
Acceptability. Some COVID restrictions, like temperature checks, testing, social distancing when accessing SSP services and quarantine protocols, created barriers to acceptability of services, as not all SSP clients were open to new locations and times for services. Social distancing when accessing services and required masking at, for example, a methadone program were especially unacceptable for certain clients, and some eventually abandoned the services. On the other hand, acceptability of SSP services increased as a result of mobile units in extremely rural parts of the state and the anonymous nature of telehealth visits for MOUD appointments.
Accessibility. Mobile SSP units, mailing supplies, telehealth visits and outdoor harm reduction services all increased access to SSP services. Clients without access to smartphones or internet services, or without a permanent address, did not benefit from these opportunities.
Availability. SSPs experienced staff shortages, a lack of personal protective equipment (PPE) and shortages of safe injection supplies, all of which decreased the availability of harm reduction services. In addition, some PWID increased their drug use, thereby increasing demand for supplies and services. SSPs responded with increased communication across peer organizations to share supplies and PPE.
Accommodation. Some SSPs were closed early in the pandemic and later were open for limited hours. Mobile SSPs eventually filled many gaps in service. Peer support organizations remained open, providing online services. Some peers continued to provide in-person support, and some SSP outreach workers continued to deliver face-to-face services despite COVID social-distancing policies.
Affordability. One urban SSP did not follow the policy change that temporarily did away with the one-for-one needle exchange requirement. This meant clients who appeared at the SSP with more than one used needle were not able to acquire more; some participants had to purchase them from pharmacies. In the rest of the state, though, the policy change in conjunction with the mobile units meant more clients had access to more free equipment. In addition, telehealth options meant more clients did not have to travel to buprenorphine and methadone providers.