28 July 2020
Researchers from the Universities of Bristol and Bath are working with Bristol Drugs Project (BDP) to explore the experiences of people who inject drugs during the COVID-19 pandemic. In the Living Under COVID-19 and Injecting Drugs in Bristol (LUCID-B) project, researchers are conducting phone interviews with BDP service users and rapidly analysing the results. Dr Lindsey Hines, Dr Joanna Kesten, Dr Adam Holland, and the LUCID-B study team reflect on the journey so far.
COVID-19 highlights the social, economic and health disparities in society, with marginalised groups experiencing the heaviest burden from both the disease and measures to reduce transmission. Working in addiction and drug use, it was clear to us that people who inject drugs would be a vulnerable population.
Injecting drugs increases the risk of COPD and immune system diseases, so people who inject drugs are more likely to fall into the high-risk categories.
Distancing and isolation were key to stopping COVID-19’s spread but the need to buy drugs would regularly bring people into contact with others. This put people who inject drugs at high-risk of catching and spreading COVID-19.
Alongside these risks from the virus, we were concerned about a third element: effects on people’s drug use. The pandemic resulted in widespread changes to health services in the UK, including drug services.
People who are addicted to heroin are often prescribed opiate substitutes, such as methadone. Typically, people will visit a pharmacy daily to pick up and consume methadone. As lockdown hit, many people’s treatment was altered so they were given enough methadone to self-administer for a few days or weeks at a time.
The lockdown also hindered access to sterile needles and syringes. Provision of these is vital to reduce risks of developing wounds or blood borne viruses through unsafe injecting practices.
At the moment, we’re writing rapid reports on the interviews. Participants have consistently expressed their gratitude towards the staff at BDP, who rapidly adapted their service to ensure people remained supported and had access to safe injecting equipment and harm reduction services.
Like so many of us, the participants in our study reported struggling with the lack of connection that lockdown imposed.
Some participants decreased their drug use due to a perceived reduction in availability and quality, whereas others increased their drug use due to boredom and isolation. We’ve heard that some drug dealers use masks and social distancing, whereas others haven’t changed their practices to reduce the risk of transmission.
People have shared their experiences of being housed in hotels and hostels under the government’s rough sleepers’ emergency scheme. Some found elements of this housing situation chaotic, but it was generally a welcome development. As restrictions ease we’re hearing concern and uncertainty about the future for those housed under this scheme.
Conducting rapid interviews on sensitive topics took a great deal of hard work and engagement from our researchers. Interviews had to be done by phone, and it was a challenge to conduct sensitive interviews without visual cues to understand how the participant felt. Researchers engaged in these often emotional discussions at home, so they didn’t have the space to decompress after a difficult interview. We mitigated this by offering peer support, and by allowing time to process our individual emotional responses with the rest of the team in weekly meetings.
Because drug use is illegal, engaging with people who inject drugs can be difficult. We also anticipated that some people would be in unstable housing or leading chaotic lives. We were concerned that these people may not have consistent access to a mobile and would be excluded from the study. Despite the rapid nature of the study, at times we paused recruitment to review who had taken part, to ensure we had a range of perspectives.
The support of BDP has been invaluable. From the start of the project they’ve provided vital input to make recruitment feasible, to ensure we’re covering key topics, and to give us context on the changing delivery of services. The effort and enthusiasm of the assertive engagement workers on the study has propelled the recruitment. By explaining the study and enabling phone access they have ensured participation from people that we would never have been able to reach otherwise. The relationship BDP has with its service users has certainly contributed to people’s willingness to discuss sensitive topics with the interview team.
BDP staff working on the study have seen unexpected benefits from the participants in the study being able to share their experiences without stigma or judgement. Following the research interview, several participants felt ready to access support for unmet physical and healthcare needs. In other cases, researchers conducting the interviews have been able to signpost participants to specialist health care services.
These unanticipated benefits demonstrate the importance of striving to connect with marginalised groups, and the value of rapid research during health crises.
LUCID-B is supported by the Elizabeth Blackwell Institute, University of Bristol, with funding from the University’s alumni and friends.