The COVID-19 pandemic was especially hard for people in addiction in Philadelphia — and the frontline workers who care for them. But local harm-reduction and health-care workers are hopeful that some of the dramatic changes enacted in response to the pandemic might lead to better health policies, according to a new study from the University of Pennsylvania.
The study is based on a series of interviews conducted in July and August 2020, as the first wave of the pandemic ebbed. Researchers spoke with nearly two dozen harm-reduction advocates, community organizers, and clinicians — some of whom had previously dealt with substance use or homelessness themselves — about their experiences during the pandemic.
Shoshana Aronowitz, the study’s lead author and an assistant professor at Penn’s School of Nursing, said she began thinking about conducting the study in the early days of the pandemic, when she realized that long-held tenets of harm reduction — from never using drugs alone to encouraging bystanders to help overdose victims on the street — “fly in the face of COVID public health advice.”
“I think people kind of knew, right away, that this was really going to be difficult for lots of people,” she said.
She also wanted to highlight the voices of community advocates helping some of the city’s most vulnerable residents: “When we hear someone talk about substance use or housing, it’s often a recognized expert with lots of credentials. But the people who are doing this work every day on the ground are seeing things that some people don’t see.”
The hardships people with addiction experienced during the pandemic — from finding housing to getting adequate treatment to preventing overdose — weren’t necessarily new. But they were heightened.
Shuttered public spaces in Philadelphia during the pandemic, for example, made it hard for people experiencing homelessness to find “a safe space to spend time,” the study found. Case managers said they initially struggled to help people access basic services like getting an ID or a birth certificate while city services were closed.
“To not be able to refer someone to anywhere, because everywhere is closed and we have no idea when it’s gonna open again, was a very helpless period where I feel like a lot of people felt totally abandoned,” one study participant told researchers.
But many study participants were also encouraged by some of the new measures that were embraced to limit the spread of COVID — like using telehealth to prescribe the opioid addiction medication buprenorphine, or allowing methadone patients to take home more doses of the medication, a practice once reserved for only a few.
“I think that a lot of those barriers — and honestly, arbitrary systematic and bureaucratic hoops — have dropped a lot more. And what that’s indicated to me is that they are unnecessary,” one participant told researchers. “Why do we need to keep those things in place if, in a crisis, we can drop them?”
Harm reductionists and addiction health-care workers were heartened, too, by larger conversations taking place around housing, homelessness, and addiction — including discussion spurred by the protest encampments that sprang up on the Benjamin Franklin Parkway in summer 2020.
“Some participants shared that watching the protest encampments develop and being involved in other community-organizing efforts led them to think about social change and the potential of grassroots, ‘bottom-up’ movements differently,” the study authors wrote.
Aronowitz said the pandemic shows that it is possible to enact swift, dramatic changes in response to other public health crises like the overdose epidemic and the housing crisis.
“COVID did show us that rapid policy changes in these spaces are possible — even if they’re highly regulated spaces like substance use treatment,” she said. “As COVID wanes, these issues continue and also intensify. What will it take for us to be inspired to make innovative, important, rapid change so we can face these public health crises as well?”