Syringe Service Programs Across the U.S. Have Been Impacted by the COVID-19 Pandemic, Study Finds

Across the U.S., there are currently over 400 syringe service programs, including the Miller School of Medicine’s Infectious Disease Elimination Act (IDEA) Exchange. These programs are crucial to the community as they offer social and medical services to people who inject drugs, including access to sterile and clean injection equipment, onsite and referrals to substance use treatment, HIV, and Hepatitis C (HCV) testing, as well as overdose prevention through naloxone distribution.

With the unprecedented developments of COVID-19 this year, experts at the University of Miami Miller School of Medicine and Columbia University’s Mailman School of Public Health examined operational and service delivery changes in a new study published in the June issue of the International Journal of Drug Policy.

“Persons with substance use disorder, particularly persons who inject drugs, are at higher risk of suffering complications from COVID-19 due to poor pulmonary health from smoking, HIV and TB infection, and overall compromised immune systems,” said study lead author Tyler Bartholomew, a Ph.D. in Prevention Science and Community Health candidate in the Miller School of Medicine’s Department of Public Health Sciences. “With increased stress, anxiety, and the resurgence of mental health comorbidities with the implementation of social distancing, coupled with the existing social determinants, such as poverty and homelessness, the need for substance use disorder prevention and harm reduction services has increased. However, these venues, particularly syringe service programs, may experience severe disruption in services due to COVID-19.”

Data were collected from 65 syringe service programs in 44 states across the U.S., including 14 sites in New York City, in a one-week period in March 2020. The findings showed disruption of services provided at the programs amid COVID-19. Findings included the following:

• 6 percent program sites remained open, with 15.4 percent discontinuing operations due to COVID-19
• 6 percent have switched to mobile delivery of new injection equipment
• The 10 programs that discontinued services represented nine different states, suggesting no geographical concentration of closures
• Programs that remained open implemented COVID-19 prevention measures to protect on-site staff operating the programs, as well as to protect participants of the syringe service programs
• The 72.3 percent of programs that have remained open are operating under restricted hours of operation
• Only 26.1 percent of programs have continued to provide HIV/HCV testing onsite, with the majority discontinuing their medical services

 Another important finding is that the majority of syringe service programs have ceased their provision of HIV/HCV testing. The study suggests that innovative strategies must be developed in order to provide HIV and HCV testing during the COVID-19 era of social distancing, including provisional temperature and symptom screenings for COVID-19 alongside rapid HIV/HCV testing. 

“Syringe service programs have become medial homes for PWID, providing wraparound services such as wound care, linkage to substance use treatment, and, in particular, onsite HIV/HCV testing and linkage to care,” said Bartholomew. “With the disruption in these services, there will be an increased risk of silent HIV and HCV outbreaks, masked by the COVID-19 pandemic.”

Syringe service programs can be utilized in the public health response to COVID-19 in this vulnerable and underserved population, which can mitigate demand on hospital systems. The study also highlights the need for program support in providing education, prevention, and strategies to avoid emerging infectious disease outbreaks, such as:

• Diagnosing and conducting surveillance of COVID-19 in people who inject drugs
• Integrating prevention through mask provision and health promotion through education, hand sanitizer, and food distribution
• Educating participants on the increased risks of overdose through disruptions and deterioration of the drug supply and should include recommendations to cautiously increase personal supply in the case of a shortage, if the action is feasible due to personal use patterns and safety as well as legal ramifications
• Practice a needs-based syringe distribution to account for program service disruptions and provision of fentanyl testing strips and naloxone for overdose prevention
• Adapt social distancing guidelines that include innovative strategies, such as scheduling a phone check-in after use for people who are using alone
• Implementation of telehealth delivery systems, such as buprenorphine and antiretroviral, initiation at program sites to reduce physical physician visits, maintain access to lifesaving medications, and prioritizing meeting people who inject drugs where they are

“The COVID-19 pandemic has dramatically changed how we deliver and serve those at SSPs. However, SSPs will remain critical venues for our agile public health response to COVID-19 among this vulnerable population,” said Bartholomew.

Co-authors of the study also included Nobuyo Nakamura, a candidate in the Master of Science in Biomedical Sciences at the Miller School of Medicine, and Lisa R. Metsch, Ph.D., professor at Columbia University’s Mailman School of Public Health. Hansel E. Tookes, M.D., M.P.H., assistant professor at the Miller School of Medicine’s and founder of the IDEA Exchange, served as senior author.

Written by Amanda Torres

Published on June 29, 2020