Adapting harm reduction services during COVID-19: lessons from the supervised injecting facilities in Australia

Harm Reduct J. 2021 Feb 17;18(1):20. doi: 10.1186/s12954-021-00471-x.


The COVID-19 crisis has had profound impacts on health service provision, particularly those providing client facing services. Supervised injecting facilities and drug consumption rooms across the world have been particularly challenged during the pandemic, as have their client group-people who consume drugs. Several services across Europe and North America closed due to difficulties complying with physical distancing requirements. In contrast, the two supervised injecting facilities in Australia (the Uniting Medically Supervised Injecting Centre-MSIC-in Sydney and the North Richmond Community Health Medically Supervised Injecting Room-MSIR-in Melbourne) remained open (as at the time of writing-December 2020). Both services have implemented a comprehensive range of strategies to continue providing safer injecting spaces as well as communicating crucial health information and facilitating access to ancillary services (such as accommodation) and drug treatment for their clients. This paper documents these strategies and the challenges both services are facing during the pandemic. Remaining open poses potential risks relating to COVID-19 transmission for both staff and clients. However, given the harms associated with closing these services, which include the potential loss of life from injecting in unsafe/unsupervised environments, the public and individual health benefits of remaining open are greater. Both services are deemed 'essential health services', and their continued operation has important benefits for people who inject drugs in Sydney and Melbourne.

Keywords: COVID-19; Drug consumption rooms; Harm reduction; People who inject drugs; Supervised injecting facilities.

Publication types

  • Letter
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia
  • COVID-19 / prevention & control*
  • COVID-19 Testing
  • Delivery of Health Care
  • Drug Overdose / therapy
  • Harm Reduction*
  • Housing
  • Humans
  • Infection Control / methods*
  • Masks
  • Naloxone / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Needle-Exchange Programs*
  • New South Wales
  • Opiate Overdose / therapy
  • Opiate Substitution Treatment
  • Opioid-Related Disorders / rehabilitation*
  • Personal Protective Equipment*
  • Physical Distancing*
  • Referral and Consultation
  • Resuscitation / methods
  • SARS-CoV-2
  • Substance Abuse, Intravenous / rehabilitation*
  • Substance-Related Disorders
  • Victoria


  • Narcotic Antagonists
  • Naloxone