Mail-based harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA

Abstract Background: Harm Reduction (HR) policies for People Who Use Drugs (PWUD) have a significant positive impact on their health. Such approaches limit the spread of infections and reduce opioid overdose mortality. These policies have led to the opening of specialized centers located mainly in big cities and urbanized zones. The COVID-19 pandemic reduced access to HR centers in locations undergoing lockdown. Before the pandemic, HR services in France and in the USA were complemented by the development of remote HR programs: HaRePo (Harm Reduction by Post) for France, implemented in 2011, and NEXT Distro for the USA founded in 2017. These programs are free and specifically designed for people who have difficulties accessing HR tools and counseling in-person. PWUD can access HaRePo program by phone and/or email. NEXT Distro users can access the program through its dedicated website. The COVID-19 pandemic and the associated lockdowns have drastically impacted the HR services in both countries and many HR centers were forced to adapt their activities. Methods: Here, we analyzed how lockdowns impacted the number of new users entering the programs, the numbers of parcels sent and naloxone distributed using the records of both structures. With the ability to reach PWUD remotely, HaRePo and NEXT Distro were particularly effective at maintaining service continuity and scaling up services to meet the needs of PWUD during the COVID-19 pandemic.Results: By comparing previous year’s data average with a 95% confidence interval, we showed that the activity of both programs were significantly impacted by the pandemic. Both show an increase in new users joining the programs as well as the number of parcels sent per month. It shows that remote HR was able to partially compensate for the reduced HR activities due to COVID-19. We also observed that the distribution of naloxone per parcel tends to increase for both structures. Conclusion: By studying two independent structures in France and in the USA sharing similar objectives (remote HR), we showed that this approach can be a key solution to crises that impact classical HR structures despite various differences in operating procedures between countries.