Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): a qualitative study of experiences of COVID-19 among people who inject drugs

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Abstract

Background

: People who inject drugs (PWID) are a high-risk group for COVID-19 transmission and serious health consequences. Restrictions imposed in the UK in response to the pandemic led to rapid health and housing service alterations. We aimed to examine PWID experiences of: 1) challenges relating to the COVID-19 public health measures; 2) changes to opioid substitution therapy (OST) and harm reduction services; and 3) perceived effects of COVID-19 on drug use patterns and risk behaviour.

Methods

: Telephone semi-structured interviews were conducted with 28 PWID in Bristol, Southwest of England. Analysis followed a reflexive thematic analysis.

Results

: Concern about COVID-19 and adherence to public health guidance varied. Efforts made by services to continue providing support during the pandemic were appreciated and some changes were preferred, such as less frequent OST collection, relaxation of supervised consumption and needle and syringe programmes (NSP) home delivery. However, remote forms of contact were highlighted as less beneficial and more difficult to engage with than in-person contact. Public health guidance advising people to ‘stay home’ led to increased isolation, boredom, and time to ruminate which impacted negatively on mental health. Lockdown restrictions directly impacted on sources of income and routine. Changes in drug use were explained as a consequence of isolation and fewer interactions with peers, problems accessing drugs, reduced drug purity and reduced financial resources.

Conclusion

: This study captures the significant impacts and challenges of the COVID-19 pandemic on the lives of PWID. While rapid adaptations to service delivery to help mitigate the risks of COVID-19 were appreciated and some changes such as relaxation of supervised daily OST consumption were viewed positively, barriers to access need further attention. Going forwards there may be opportunities to harness the positive aspects of some changes to services.

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Most cited references 34

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One size fits all? What counts as quality practice in (reflexive) thematic analysis?

Virginia Braun, Victoria Clarke (2020)

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Challenges posed by COVID‐19 to people who inject drugs and lessons from other outbreaks

Tetyana I. Vasylyeva, Pavlo Smyrnov, Steffanie Strathdee … (2020)

Abstract Introduction In light of the COVID‐19 pandemic, considerable effort is going into identifying and protecting those at risk. Criminalization, stigmatization and the psychological, physical, behavioural and economic consequences of substance use make people who inject drugs (PWID) extremely vulnerable to many infectious diseases. While relationships between drug use and blood‐borne and sexually transmitted infections are well studied, less attention has been paid to other infectious disease outbreaks among PWID. Discussion COVID‐19 is likely to disproportionally affect PWID due to a high prevalence of comorbidities that make the disease more severe, unsanitary and overcrowded living conditions, stigmatization, common incarceration, homelessness and difficulties in adhering to quarantine, social distancing or self‐isolation mandates. The COVID‐19 pandemic also jeopardizes essential for PWID services, such as needle exchange or substitution therapy programmes, which can be affected both in a short‐ and a long‐term perspective. Importantly, there is substantial evidence of other infectious disease outbreaks in PWID that were associated with factors that enable COVID‐19 transmission, such as poor hygiene, overcrowded living conditions and communal ways of using drugs. Conclusions The COVID‐19 crisis might increase risks of homelessnes, overdoses and unsafe injecting and sexual practices for PWID. In order to address existing inequalities, consultations with PWID advocacy groups are vital when designing inclusive health response to the COVID‐19 pandemic.

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Predicting Social Distancing Intention and Behavior During the COVID-19 Pandemic: An Integrated Social Cognition Model

Martin S. Hagger, Stephanie R. Smith, Jacob Keech … (2020)

Abstract Background Social distancing is a key behavior to minimize COVID-19 infections. Identification of potentially modifiable determinants of social distancing behavior may provide essential evidence to inform social distancing behavioral interventions. Purpose The current study applied an integrated social cognition model to identify the determinants of social distancing behavior, and the processes involved, in the context of the COVID-19 pandemic. Methods In a prospective correlational survey study, samples of Australian (N = 365) and U.S. (N = 440) residents completed online self-report measures of social cognition constructs (attitude, subjective norm, moral norm, anticipated regret, and perceived behavioral control [PBC]), intention, action planning, habit, and past behavior with respect to social distancing behavior at an initial occasion. Follow-up measures of habit and social distancing behavior were taken 1 week later. Results Structural equation models indicated that subjective norm, moral norm, and PBC were consistent predictors of intention in both samples. Intention, action planning, and habit at follow-up were consistent predictors of social distancing behavior in both samples. Action planning did not have consistent effects mediating or moderating the intention–behavior relationship. Inclusion of past behavior in the model attenuated effects among constructs, although the effects of the determinants of intention and behavior remained. Conclusions Current findings highlight the importance of subjective norm, moral obligation, and PBC as determinants of social distancing intention and intention and habit as behavioral determinants. Future research on long-range predictors of social distancing behavior and reciprocal effects in the integrated model is warranted.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Drug Policy

Journal ID (iso-abbrev): Int J Drug Policy

Title: The International Journal on Drug Policy

Publisher: Published by Elsevier B.V.

ISSN (Print): 0955-3959

ISSN (Electronic): 1873-4758

Publication date PMC-release: 20 July 2021

Publication date (Electronic): 20 July 2021

Electronic Location Identifier: 103391

Affiliations

[a ]NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol, BS8 2BN

[b ]NIHR Applied Research Collaboration (ARC) West, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT

[c ]Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield Grove, Clifton, Bristol, BS8 2BN

[d ]School of Education, 35 Berkeley Square, Bristol, BS8 1JA

[e ]Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN

[f ]Dept Pharmacy & Pharmacology. University of Bath, Claverton Down, Bath, BA2 7AY

[g ]Bristol Drugs Project, 11 Brunswick Square, Bristol BS2 8PE

[h ]Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN

Author notes

[* ]Corresponding author.

Article

Publisher Item ID: S0955-3959(21)00296-6 Publisher ID: 103391

DOI: 10.1016/j.drugpo.2021.103391

PMC ID: 8289673

PubMed ID: 34343945

SO-VID: 86f15a0a-0845-4b32-840d-9119310efbbf

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): a qualitative study of experiences of COVID-19 among people who inject drugs

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Novel Coronavirus Disease COVID-19

Most cited references 34

One size fits all? What counts as quality practice in (reflexive) thematic analysis?

Challenges posed by COVID‐19 to people who inject drugs and lessons from other outbreaks

Predicting Social Distancing Intention and Behavior During the COVID-19 Pandemic: An Integrated Social Cognition Model

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