Facilitators and barriers to accessing harm reduction services in a rural state

Introduction: The impact of social distancing policies during the COVID-19 pandemic on people who inject drugs (PWID) is not known. In rural states like Maine, there are several barriers to accessing harm reduction services, such as distance and lack of transportation, that preceded COVID-19. The objective of this study is to begin to address this research gap by describing the impact of the pandemic on PWID access to harm reduction services in Maine.

Methods: Thirty-four semi-structured interviews were conducted with rural and urban PWID, community partners, and providers in Maine. These interviews focused on facilitators and barriers and service changes during the pandemic. Interviews were audio-recorded and professionally transcribed prior to qualitative analysis. Four analysts read and open-coded transcripts, then independently identified themes related to facilitators and barriers of harm reduction services.

Results: Thirty-four stakeholders (n=9 community stakeholders, n=9 providers, n=16 PWID) were interviewed. We categorized facilitators and barriers by services impacted. Participants identified relaxed policies (for example, elimination of one-for one needle exchange), mobile outreach, mail delivery of drug equipment, community resilience and collaboration as important facilitators for accessing harm reduction services. On the other hand, lower capacity (restricted hours, staffing, supply shortages), lack of trust and non-adherence to relaxed policies, physical distancing and decreased privacy were barriers

Conclusions: Changes resulting from the COVID-19 pandemic have impacted access to harm reduction services among people who inject drugs in Maine. We identified several facilitators and barriers that should inform policies in order to maximally mitigate the negative impacts on people who inject drugs.

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