Table 1 Summary of harm reduction service changes during COVID-19

Syringe service programs (SSP)/safer use equipment

One highly accessed SSP, closed temporarily early in the pandemic, then re-opened with limited hours

Several on-site SSPs reported equipment shortage early in the pandemic

One on-site SSP shifted to outdoor location

Temporary allowance of the mail and mobile delivery of equipment

Temporary elimination of the one-for-one needle exchange policy

Safe drug supply

Reports of more contaminated supply

People who inject drugs report purchasing drugs from new dealers

Increased drug use in setting of contaminated supply

Peer support

Closure of in-person services from a highly accessed recovery center in the state

COVID-19 protocol restrictions result in outreach workers being unable to connect in person with justice-involved individuals

Basic services (shelter, food security, restrooms

COVID-19 screening (e.g., temperature checks), testing, physical distancing policies and quarantine protocols in shelters

Closure of several on-site food services; shift to mobile services

Lack of access to public restrooms

Low barrier medication for opioid use disorder treatment

Clinic and protocol changes as a result of

relaxed telemedicine regulations