COVID-19: New EMCDDA study highlights drop in availability of drug services in Europe but increase in innovation

As Europe grapples with the unprecedented public health threat posed by COVID-19, how is the outbreak affecting drug users and service providers? In a new study published today — Impact of COVID-19 on drug services and help-seeking in Europe — the EMCDDA reports signs of a drop in the availability of drug services during the pandemic and in the numbers of those seeking help. But the study also provides insight into how services have adapted and innovated during the fast-changing crisis in ways that could be carried forward into the future.

The report is the first in a series of briefings resulting from an EMCDDA ‘trendspotter’ study, launched in April to explore the impact of COVID-19 on the drug situation and responses to it. The agency’s trendspotter methodology explores emerging drug-related trends by rapidly collecting and triangulating data from a variety of sources to allow for timely assessments of topics of concern. Due to national emergency restrictions, the method was adapted to suit online investigation and the study designed to be carried out in successive waves (1). The findings released today stem from the first wave of the investigation which focused on drug services.

Results highlight that COVID-19 and national lockdowns have led to reduced availability and provision of treatment and harm-reduction services in most European countries. Emerging evidence suggests that, like other healthcare providers, drug services are facing a range of challenges including: staffing shortages; access to personal protective equipment; and managing infected clients and staff vulnerability to infection.

Preliminary findings from the study show that drug services are adapting and innovating during COVID-19, with similar characteristics reported across Europe. With face-to-face counselling curtailed during containment, telemedicine by phone or video has been embraced as an alternative across European drug services. Providers of opioid substitution treatment (OST) have also acted rapidly to change the way in which they provide medication (e.g. mobile OST) and respond to new treatment demands (e.g. new induction procedures), while most countries have relaxed regulations on take-home OST for stable patients (e.g. prescribing for larger quantities or longer periods).

Harm-reduction services have also been swift to adapt, playing a key role in providing frontline support during the crisis. This includes: increasing outreach work and needle- and syringe-exchange activities; providing shelter management for homeless and marginalised groups; maintaining drug consumption room services (in situ or mobile) and moving some interventions online (e.g. drug checking).

The briefing presents a snapshot of how the demand for specialised treatment evolved between January 2020 and March 2020, providing a first insight on the impact of COVID-19 on help-seeking behaviour. Data show that there was some drop in demand for treatment services during this period for reasons including closure or restricted access to treatment centres and clients’ inability to reach centres due to confinement measures. But this was partially compensated by remote technology and modified interventions.

When questioned on the ‘new normal’ for drug services in Europe post-COVID-19, many of the experts surveyed were in favour of maintaining some of the service changes rapidly introduced in recent months. The use of telemedicine was the most cited example, being seen as a useful complement to face-to-face services in the future. Coordination between public, private and non-governmental actors during the crisis was also welcomed by respondents and seen as particularly beneficial for services users.

As confinement procedures are eased, drug services will be expected to maintain a broad range of health protection measures, adapt their routines and reinforce contingency planning in case of a second wave. Negative economic forecasts for national economies raise particular concerns over potential budget cuts for drug services and greater marginalisation of certain social groups. Nevertheless, many survey respondents remained hopeful that the innovation and collaboration seen in recent months would remain positive features of drug services in Europe in the foreseeable future.