1811 Harvard Medical School, Boston, MA, USA.
124049 Harvard College, Cambridge, MA, USA.
Public Health Rep. 2021 May;136(3):301-308. doi: 10.1177/0033354921999396. Epub 2021 Mar 5.
The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of harm reduction programs to provide vital services to adolescents, young adults, and people who use drugs, thereby increasing the risk of overdose, infection, withdrawal, and other complications of drug use. To evaluate the effect of the COVID-19 pandemic on harm reduction services for adolescents and young adults in Boston, we conducted a quantitative assessment of the Community Care in Reach (CCIR) youth pilot program to determine gaps in services created by its closure during the peak of the pandemic (March 19-June 21, 2020). We also conducted semistructured interviews with staff members at 6 harm reduction programs in Boston from April 27 through May 4, 2020, to identify gaps in harm reduction services, changes in substance use practices and patterns of engagement with people who use drugs, and how harm reduction programs adapted to pandemic conditions. During the pandemic, harm reduction programs struggled to maintain staffing, supplies, infection control measures, and regular connection with their participants. During the 3-month suspension of CCIR mobile van services, CCIR missed an estimated 363 contacts, 169 units of naloxone distributed, and 402 syringes distributed. Based on our findings, we propose the following recommendations for sustaining harm reduction services during times of crisis: pursuing high-level policy changes to eliminate political barriers to care and fund harm reduction efforts; enabling and empowering harm reduction programs to innovatively and safely distribute vital resources and build community during a crisis; and providing comprehensive support to people to minimize drug-related harms.
2019 年冠状病毒病（COVID-19）大流行对减少伤害计划为青少年、年轻成年人和吸毒者提供重要服务的能力提出了挑战，从而增加了过量用药、感染、戒断和其他药物使用并发症的风险。为了评估 COVID-19 大流行对波士顿青少年和年轻成年人减少伤害服务的影响，我们对社区关怀扩展（CCIR）青年试点计划进行了定量评估，以确定该计划在大流行高峰期（2020 年 3 月 19 日至 6 月 21 日）关闭期间造成的服务差距。我们还在 2020 年 4 月 27 日至 5 月 4 日期间对波士顿的 6 个减少伤害计划的工作人员进行了半结构化访谈，以确定减少伤害服务中的差距、物质使用行为和与吸毒者接触模式的变化，以及减少伤害计划如何适应大流行条件。在大流行期间，减少伤害计划努力维持人员配备、物资供应、感染控制措施以及与参与者的定期联系。在 CCIR 流动服务暂停的 3 个月期间，CCIR 估计错过了 363 次接触，分发了 169 个纳洛酮单位和 402 个注射器。根据我们的发现，我们提出了以下建议，以在危机期间维持减少伤害服务：寻求高层政策变革，消除护理方面的政治障碍，并为减少伤害工作提供资金；使减少伤害计划能够在危机期间创新和安全地分配重要资源并建立社区；并为人们提供全面支持，以最大程度地减少与毒品有关的伤害。
