Harm reduction


Everyone we spoke to was aware of naloxone and many had previously been trained and received a take home naloxone kit. Several people gave examples that showed drug treatment and recovery support services had increased their harm reduction work under Covid including home delivery of naloxone and targeted outreach services. One site, a residential hostel, continued to provide naloxone training and kits on request:

You get them in here, aye, I just take them just in case. (M, 31)

Injecting Equipment Provision (IEP)

Despite worries of pharmacy supplies running out of supplies and/or reduced access to services, participants generally reported only minimal disruptions to pharmacy provision of injecting equipment:

I didn’t actually know that they’d be there to do like exchange, but through the pandemic (…) they were actually telling you, if you went in twice a week, to get your, to get your exchange, what they would say is, double up on the stuff that you got, you know, if you were only basically taking yourself one day a week instead of two, that’s what they were telling you. (M, 42)

A needle exchange was also installed within one residential data collection site, in response to intelligence which suggested high risk injecting practices were taking place onsite. This was well received by the residents we interviewed, with several describing it as a ‘good thing’ that allowed them ‘to be safe’, and that it reduced stigma. Participants commented on upscaling of IEP which, in some areas, included delivery of injecting equipment to people who were shielding:

Yeah, well actually, there’s lots of posters up about it, yeah, yeah, there was lots of posters up in the chemist about it (…) Yeah, yeah, you just tell them and they can post it out to you and that. (F, 43)


Personal Covid protection practices

Despite the increased risk of harm from Covid to people who use drugs, very few participants said they were able to adhere to Covid guidance. People reported little change in their behaviours such as social distancing or wearing masks. The social and financial aspects of drug use also made it difficult to avoid contact:

I’ve got asthma and things as well, so I have to be a little bit more careful, but again it is harder, because you’re on the street as well, and the people that you’re around, they don’t really care about stuff like that, and if we, if you go halfers with somebody, to buy a drug, just say for crack, for instance, and we’re sharing a pipe, there’s always that chance, but you can’t really do it, you’re stuck, you know, so you can only take risks, do you know what I mean, it’s, it is hard to try and watch what you’re doing. (F, 33)

Service efforts to protect against COVID

Participants discussed the Covid protection policies and practices across two residential data collection sites. One participant spoke of the impact of distancing requirements at the rehabilitation unit and her gratitude for staff keeping her and her peers safe:

Because Covid right now as well, we’ve not been able to do, I mean they were telling me that before the Covid right, you could go on walks of 4 and all that, and they’re having to do walks of 2, which is a big drain in here as well, for instance (…) we’ve all got to be separated out a bit, and you know what I mean, there’s people that go to hospitals and back and to and forth, so the staff do their utmost best to keep us all safe, which I like. (F, 38)

Personal concerns about COVID-19

Only two participants were tested for Covid and both receive negative results, however multiple people spoke of suffering flu-like symptoms, which were recognised as also being similar to substance withdrawal:

It was, I was actually, I was scared I was going to die on my own, I’ve never felt like that before … dying, the years of taking drugs, I’m going to die of this bloody Covid, you know, in a hostel, on my own, nobody is going to find me till they smell me, you know, and I thought, oh, yeah, all good now (…) it took about 2 and a half months too, before I felt okay. (M, 45)

Many participants were aware of the risks of, and concerned about, Covid – but this rarely translated into changes in personal behaviour. The impact of the virus and the attendant Public Health response was most evident in participants’ reports of worsening mental and physical health and general quality of life under lockdown.