Syringe Services Programs and the COVID-19 Pandemic: Innovations from the Field
Local health departments (LHDs) are on the frontlines of the opioid crisis, working to prevent substance use, overdoses, and the spread of HIV and viral hepatitis. A critical part of this work involves supporting or implementing syringe services programs (SSPs), which provide a range of services to prevent the spread of infectious diseases and promote the health of people who inject drugs (PWID). SSP services include distribution and disposal of syringes and other injection equipment; vaccination, testing, and linkage to care for HIV and hepatitis B (HBV) and C (HCV); distribution of the overdose reversal medication naloxone; linkage to substance use disorder treatment; and referrals to other health and social services, such as recovery support, housing and legal services. LHDs are uniquely positioned to implement comprehensive SSPs due to their expertise in the prevention and control of infectious diseases and delivery of health services, and their cross-sector and community partnerships, which enable them to engage hard-to-reach populations and connect clients to a variety of health and social services.
LHDs are leading the response to the COVID-19 pandemic at the local level. Their SSP operations have been impacted, as many staff are needed to support the COVID-19 response and others implement social distancing guidelines to protect staff and clients. The National Association of County and City Health Officials (NACCHO) recently queried and heard from more than 50 LHDs about the impact of COVID-19 on their HIV, STI, and hepatitis programs—including SSPs. Many have suspended outreach and education efforts, and a few have suspended their SSPs entirely due to staffing limitations. Many have reduced their services, often focusing on syringe access and disposal and forgoing HIV and viral hepatitis testing and linkage to treatment. A recent study revealed similar trends among SSPs across the country.
LHDs expressed concern for clients, noting that SSPs work with some of their communities’ most vulnerable populations. They also noted that the stress associated with the pandemic may encourage people to adopt unhealthy coping strategies, such as substance use, and that limited access to SSPs may put communities at risk for HIV or HCV outbreaks or surges in overdose deaths. As first responders and hospitals are overwhelmed by influxes of COVID-19 patients, PWID may be afraid or unable to access treatment for overdoses and complications associated with injection drug use. PWID experiencing unstable housing or homelessness often do not have a safe place to quarantine and are at high risk for COVID-19 due to the high positivity rates seen at shelters across the country.
Innovations from Local Health Departments
During Hepatitis Awareness Month, NACCHO is highlighting strategies used by LHDs across the country to ensure clients can access these critical, lifesaving services during the COVID-19 pandemic. Some of these strategies are shared below:
- increasing the number of syringes and other supplies distributed per visit,
- establishing hotlines so clients can access counseling over the phone,
- pre-packing and delivering syringes and other equipment, and/or
- establishing hygiene or handwashing stations.
Increasing the Number of Syringes and Other Supplies Distributed Per Visit
Many local health departments reported increasing the number of syringes and other supplies distributed to clients during each visit. Several report transitioning from 1:1 exchanges, in which clients return used syringes in order to access sterile syringes, to needs-based exchanges, in which clients can obtain as many syringes as they need in one visit. Mount Rogers Health District in Bristol, VA, is now offering clients a monthly supply of syringes, instead of a weekly supply. The transition from a weekly to monthly supply has been well received by the community, leading to an influx of new SSP clients. Washington County Public Health in Oregon has expanded the hours of operation for their mobile SSP and is now encouraging clients to take multiple naloxone kits and other supplies.
Establishing Hotlines to Provide Virtual Counseling and Support Services
Mount Rogers Health District in Virginia launched a hotline shortly after the start of the pandemic to enable SSP clients to access counseling, education, and support services over the phone. The hotline is staffed by harm reduction program specialists who provide referrals and connect clients to health and social services and by peer recovery specialists who provide peer mentoring or coaching, connect clients to community resources, and provide other forms of support. Several other LHDs reported that they have established hotlines to enable clients to place orders for syringes and other supplies over the phone. These strategies enable SSPs to continue to operate and meet the needs of their clients while limiting in-person contact.
Pre-packing and Delivering Syringes and Other Supplies
Frederick County Health Department in Maryland has begun pre-packing and delivering sterile syringes, naloxone, and other supplies. This has enabled them to implement social distancing, while making services more accessible despite limited hours of operation, and building trust with clients and the community. Clients can place orders over the phone and the SSP will deliver to residences or other locations. To ensure safe delivery, clients can meet SSP staff in-person to obtain the supplies or confirm receipt of supplies by text or phone.
Establishing Hygiene or Handwashing Stations
As businesses have closed and as homeless shelters are experiencing outbreaks of COVID-19, access to public restrooms has declined. Public Health Seattle/King County and the City of Minneapolis Health Department are opening hygiene and handwashing stations to enable people experiencing homelessness or unstable housing to access public restrooms, wash their hands, and use other hygienic practices. A decline in access to public restrooms was previously connected to outbreaks of hepatitis A in southern California, demonstrating the importance of these measures to prevent the spread of infectious diseases such as COVID-19. These efforts also enable LHDs to remain connected and engaged with priority populations during the COVID-19 pandemic.
To learn more about how LHD HIV, STI, viral hepatitis, and syringe services programs are adapting programs and services during COVID-19, check out this post on NACCHO’s blog.