In January 2021, the Irish Government Economic and Evaluation Service (IGEES) published a report on the impact of the pandemic on services and people who use drugs.1 The report was prepared by staff in the Research Services and Policy Unit and Health Analytics Division in the Department of Health on behalf of the department’s Drugs Policy and Social Inclusion Unit. The report is based on two surveys undertaken in 2020. An article outlining the findings of the first survey, the Mini-European Web Survey on Drugs: Covid-19, was published in issue 76 of Drugnet Ireland.2 Data collection for the second, the Survey of Drug and Alcohol Services, was completed via an online survey and by email between August and September 2020.1

The Survey of Drug and Alcohol Services was undertaken to assess the impact of Covid-19 on these services. In particular, the survey sought to capture how services have altered their operations in response to the pandemic and also to describe the effect on clients of services. Information on this final aspect of the survey was provided by services staff and service users were not directly involved in the survey. An invitation to participate in the survey was sent to over 500 email addresses for drug and alcohol services in Ireland and participants were given two and half weeks to complete the survey.

A total of 157 completed responses were submitted. Community Drugs Projects (n=86), family support services (n=53), and counselling services (n=50) were well represented, particularly those based in Dublin.  Some respondents can be included in more than one of these categories. There were also responses from Drug and Alcohol Task Forces, low threshold services, peer support services, HSE Addiction Services, residential services, and general practitioners.

Effects of Covid-19 on clients

Regarding the direct effects of Covid-19, some 44 (28%) respondents said that clients were highly impacted by having to self-isolate or cocoon; 10 (7%) said a diagnosis of Covid-19 had highly impacted clients; with 4 (3%) saying that hospitalisation had had a high impact. The majority of services (n=133, 85%) had some experience of clients self-isolating in wave 1 of the pandemic, while just under one-half were aware of clients who had been diagnosed with Covid-19.

According to respondents, the most challenging aspects of the pandemic for clients were adhering to the restrictions concerning meeting people, self-isolating, restrictions on travel, and physical distancing. The majority of services responding (n=149, 96%) reported a negative impact on clients’ mental health, followed by the impact on family relationships (n=129, 83%). The numbers reporting a positive impact as a result of these factors was very small. Other negative effects reported by a majority of services were the physical health and financial situation of clients.

Most services (n=113, 77%) reported that social isolation impacted on clients to some extent, while 114 services (74%) said that increased domestic violence impacted on clients. Most services were also aware of the impact of increased drug-related intimidation and violence and increased overdoses. Fewer services (n=56, 37%) reported drug-related deaths among those using their services. Regarding the effect of the pandemic on particular population groups, 65% of services who responded said among those who were homeless that health and wellbeing was highly impacted, while 60% of services said women were highly impacted.

Increased alcohol consumption among clients was observed by 68% (n=104) of services, while 42% (n=61) of services reported increased drug use, with just 8% (n=14) reporting a reduction in drug use among clients. In relation to availability of drugs, 73% (n=108) of respondents had heard reports that clients were having difficulty getting drugs and had greater use of novel methods of acquisition such as online purchases, ‘drug drops’, and home deliveries.

Impact on services

Most of the survey respondents (n=116, 74%) said that their services had been highly impacted by Covid-19, with 25% (n=40) reporting lower levels of impacts. Nearly one-half of the services responding (n=70, 46%) said the numbers using their services had increased. Overall, harm reduction services had decreased for clients, with just 33% reporting increases. The majority of service types saw a reduction in face-to-face contact with clients. This was particularly true for Drug and Alcohol Task Forces, family support services, and peer support services. Most services are providing counselling and other supports by telephone or online. Residential treatment services were the type of service most likely to use video conferencing, an appropriate tool for group therapy sessions.

Drug and alcohol services adapted to a reduction in face-to-face contact, travel restrictions, and social distancing by prioritising the continuity of care for those who are opioid dependent; faster processing of clients into treatment; stabilisation of drug use in isolation; and providing Covid-19 prevention information as part of outreach services. Clients were enabled to access their medications by new methods provided under temporary changes to regulations and the vast majority of services have developed new ways of engaging with clients and providing for their needs.

The survey of services outlines the impacts of the Covid-19 pandemic on service capacity, staff, operations, and governance and reporting. Services described how they adapted to the challenges and communicated with their clients online or by telephone. There was detailed information on the typical responses of health services to the pandemic, including use of personal protective equipment and social distancing. Survey findings have also provided an indication of the negative impacts the pandemic has had on the health and wellbeing of clients and on their consumption behaviours.

1   Bruton L, Featherstone T and Gibney S (2021) Impact of COVID-19 on drug and alcohol services and people who use drugs in Ireland: a report of survey findings. Dublin: Government of Ireland. https://www.drugsandalcohol.ie/34128/

2   Mongan D (2021) Impact of Covid-19 on drug use in Ireland. Drugnet Ireland, 76 (Winter): 1–7.
https://www.drugsandalcohol.ie/33957/