Preliminary indications of the burden of COVID-19 among people who inject drugs in England and Northern Ireland and the impact on access to health and harm reduction services

Public Health. 2021 Mar;192:8-11. doi: 10.1016/j.puhe.2021.01.004. Epub 2021 Jan 15.


Objective: The aim of the study was to describe the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on people who inject drugs (PWID) in England, Wales and Northern Ireland.

Study design: This is a cross-sectional Unlinked Anonymous Monitoring (UAM) Survey of PWID.

Methods: People who had ever injected psychoactive drugs were recruited to the UAM Survey by specialist drug/alcohol services in England, Wales and Northern Ireland. From June 2020, in addition to providing a dried blood spot sample and completing the UAM behavioural questionnaire, participants were asked to complete an enhanced coronavirus disease 2019 (COVID-19) questionnaire. Preliminary data are presented to the end of October and were compared with data from the 2019 UAM Survey, where possible.

Results: Between June and October, 288 PWID were recruited from England and Northern Ireland. One in nine (11%; 29/260) PWID reported testing positive for SARS-CoV-2 or experiencing COVID-19 symptoms. Fifteen percent (26/169) reported injecting more frequently in 2020 than in 2019; cocaine injection in the preceding four weeks increased from 17% (242/1456) to 25% (33/130). One in five PWID (19%; 35/188) reported difficulties in accessing HIV and hepatitis testing, and one in four (26%; 47/179) reported difficulties in accessing equipment for safer injecting.

Conclusions: Our preliminary findings suggest that PWID have experienced negative impacts on health, behaviours and access to essential harm reduction, testing and treatment services owing to the COVID-19 pandemic. Continued monitoring through surveillance and research is needed to understand the subsequent impact of COVID-19 on blood-borne virus transmission in this population and on health inequalities.

Keywords: COVID-19; Infectious disease; Outbreak; People who inject drugs; SARS-CoV-2; United Kingdom.

MeSH terms

  • Adult
  • COVID-19 / psychology*
  • Cross-Sectional Studies
  • England / epidemiology
  • Female
  • Harm Reduction*
  • Health Services Accessibility*
  • Humans
  • Male
  • Middle Aged
  • Northern Ireland / epidemiology
  • Pandemics
  • Public Health Surveillance
  • SARS-CoV-2
  • Substance Abuse, Intravenous / complications
  • Substance Abuse, Intravenous / epidemiology*
  • Surveys and Questionnaires
  • Wales / epidemiology