The impact of COVID-19 on overdose risk behaviors among people who use drugs in Rhode Island

Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation. A Study Review

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Objective: The objective of this study was to learn about the experiences of people who use drugs in Rhode Island during the COVID-19 pandemic. Specifically, we were interested in the pandemic’s influence on increases in overdose risk behaviors.

Methods: From July to October 2021, we interviewed 18 people who use drugs who self-reported any increase in behaviors associated with overdose risk during the pandemic. These risk behaviors were defined as: increased drug use, change in drug type, and/or more solitary drug use. We analyzed the interview transcripts for common themes and found that participants shared multi-level on their drug use patterns during the pandemic era. Guided by a social-ecological model, we categorized these influences into four nested levels: (1) individual-level influences, relating to emotions and coping; (2) network-level influences, relating to friend groups and community dynamics; (3) institutional-level influences, relating to service organizations; and (4) policy-level influences, relating to local, state, and national public policy.

Results: During the pandemic, individual-level influences on risky drug use behaviors included coping with boredom, anxiety, depression, and isolation. At the network level, changes in the local drug supply and housing-related social network changes influenced risky drug use behaviors during the pandemic. At the institutional level, drug use patterns were influenced by reduced access to harm reduction or treatment services. At the policy level, increased overdose risk behaviors were related to financial changes, job loss, and business closures. All participants identified factors influencing overdose risk behaviors that corresponded to several nested social-ecological levels.

Takeaway: Interviews with 18 people who use drugs in Rhode Island in 2021 suggest that overdose risk behaviors increased during the COVID-19 pandemic due to factors at several nested, interacting levels of influence. These findings suggest that, during large-scale crises like the ongoing pandemic, policies and programs to promote safer drug use should address multiple levels of influence concurrently.

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