The impact of COVID-19 restrictions on needle and syringe programme provision and coverage in England

BACKGROUND: The restrictions introduced in response to COVID-19 present many challenges, particularly for vulnerable and marginalised populations. These include maintaining access to Needle and Syringe Programmes (NSPs) to reduce the harms associated with injecting drugs. NSPs effectiveness is coverage dependent, but lockdowns and social distancing limit NSP access and availability. The impact on NSP provision in England is explored using enhanced monitoring data. METHOD: Data collected through an established comprehensive regional monitoring system from five four-week periods, centred on the implementation of restrictions in the UK in mid-March 2020, are examined. Weekly averages are compared to allow for public holidays and weekly variation in activity. RESULTS: The restrictions resulted in the number of NSP clients decreasing by 36%, visits by 36%, and needles distributed by 29%. NSP coverage for those injecting psychoactive drugs halved, declining from 14 needles per-week during the 4-weeks to 15(th) March 2020 to 7 needles per-week by mid-April, and coverage has remained at this level since then. CONCLUSIONS: Though it is currently unclear if there has been a decline in injecting, the decline in NSP coverage is so marked that it almost certainly reflects decreased utilisation among those in need, indicating increased equipment reuse and risk.