Background and concerns

The current national drugs strategy¹ aims to reduce harms arising from substance misuse and to reduce the prevalence of blood-borne viruses among people who inject drugs (PWID) through the expansion of needle exchange. In Ireland, this service is delivered in a number of ways, including fixed-site locations, such as clinics or community pharmacies, and novel interventions, such as Backpacking Outreach programmes.

In Ireland, the Health Service Executive (HSE) has noted that just as the sharing of injecting material increases the risk of infection with blood-borne viruses, such as HIV and viral hepatitis B and C, the sharing of injecting equipment contaminated with Covid-19 may also increase the risk of infection and play a role in the spread of the virus. In addition, the Covid-19 outbreak may present additional risks currently not widely recognised. These may include the sharing of cannabis joints, cigarettes, vaping or inhalation devices, or
drug paraphernalia.

With regard to needle exchange provision in Ireland, the HSE notes that disruption to the supply of, and access to, equipment is likely to occur for a number of reasons. These may include staff shortages, service disruption and closure, self-isolation, and restrictions placed on free movement.

Recommendations and processes

With these concerns in mind, the HSE has made a number of recommendations.² These include:

A broader harm reduction approach in the current Covid-19 pandemic should be considered by services when they deliver interventions.

• Harm reduction advice should include information on the risk of Covid-19 transmission through all forms of intake, including sharing of cannabis joints, cigarettes, vaping, and injecting equipment.

• Contingency plans should be developed to ensure continuity of provision of drug use paraphernalia. Scaling up the level of equipment provision for individuals in self-isolation is likely to be necessary.

• The utilisation and training of additional staff from Section 39 agencies involved in the provision of care for PWID should be considered to deal with staff shortages in community healthcare organisation areas. The phone number of the harm reduction service should be available and circulated widely among the community targeted for injecting equipment.

• If an individual is in self-isolation and requires needle exchange, requests for equipment should be made by phone and amounts and equipment should be prepacked and then delivered to the specific location.

• Staff members should ensure that the intended target is in receipt of the package and that the package is not left unattended.

• At fixed-site location services, requests should be made by phone and equipment should be prepacked and handed out at the front door.

• All HSE staff and allied professionals delivering harm reduction services and injecting equipment should be provided with clear guidelines in relation to minimising contact with individuals, dealing with issues over the phone, and maintaining personal safety.

1  Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health.
https://www.drugsandalcohol.ie/27603/

2  Health Service Executive (2020) Needle exchange provision in COVID-19 pandemic. Dublin: Health Service Executive.
    https://www.drugsandalcohol.ie/32048