The impact of COVID-19 public health measures on attendance and overdose at supervised injecting facilities in Australia

Abstract

Objectives: The COVID-19 pandemic disrupted service provision of harm reduction and drug treatment services for people who inject drugs in many countries. The two supervised injecting facilities (SIFs) in Sydney and Melbourne were differentially impacted by the pandemic, requiring local procedural changes in each service. We aimed to examine the impact of pandemic responses (including restrictions on movement, known as ‘lockdowns’) on service use and key parameters such as client reports of drug injected and recorded overdose rates. Study design: Time series analysis of weekly client visits and monthly overdoses occurring at each service. Methods: Administrative client data from the two SIFs (Sydney data from 1 January 2018 to 30 April 2022; Melbourne data from 1 July 2018 to 30 April 2022) were examined using interrupted time series analyses with lockdown dates in each state entered as interruption terms. We analysed weekly SIF visits overall and by drug type, and monthly rates of opioid overdose at each service. Results: Lockdowns resulted in decreased visits to both services. The number of weekly client visits decreased during the first national lockdown for both the Sydney (trend change = −57.9; 95% CI [−109.4, −6.4]) and Melbourne SIF (near sig trend change = −54.8 [−110.8, 1.05]). Trends in visit numbers increased after lockdowns were lifted in each city; however, visits in Sydney have not returned to the numbers recorded prior to the pandemic. Visits to the Melbourne SIF related to heroin use declined at each lockdown (trend 1 = −42.7 [−81.5, −3.9]; trend 2 = −56.1 [−94.6, −17.7]; trend 3 = −33.8 [−67.4, −0.2]); heroin visits to the Sydney SIF declined during the first lockdown and remained low (trend = −55.6 [−82.8, −28.3]). Methamphetamine visits to the Sydney SIF fluctuated, surpassing heroin visits at several timepoints. Rates of monthly opioid overdoses at both services declined immediately following the start of the first lockdown (Sydney = −16.6 [−26.1, −6.8]; Melbourne = −6.4 [−8.7, −4.1]), with increasing trends recorded at the end of the final lockdown in each jurisdiction (Sydney = 2.8 [0.6, 5.0]; Melbourne = 1.3 [0.72, 3.2]). Conclusions: Public health restrictions related to the COVID-19 pandemic were associated with reduced client visits to, and overdoses in, Australian SIFs. Variations were noted in the drugs injected, likely reflecting changes in local drug markets. Shifts to other drugs during these periods were evident: methamphetamine in Sydney; co-injection of heroin and diphenhydramine in Melbourne.