Time-Series Analysis of Presentations to Four Syringe Dispensing Machines and a Needle and Syringe Program During COVID-19 Lockdowns in Melbourne, Australia

Author: Daniel O'Keefe Michael Livingston Reece Cossar Phoebe Kerr David Jacka Paul Dietze

Theme: Epidemiology & Public Health Research Year: 2022

Australian harm reduction services are provided via a mix of modalities, including fixed-site needle
and syringe programs (NSP) and syringe dispensing machines (SDMs). SDMs are cost-effective and
provide 24-hour anonymous access to needles/syringes, often to underserved geographic areas, and
can attract clientele who may choose not to use NSPs. The introduction of COVID-19 control
measures saw disruptions and adaptations to the provision of harm reduction services. It is possible
that SDMs filled the gap in otherwise disrupted harm reduction services in Melbourne.
In this paper, we use data from four SDMs and an NSP to explore changes to harm reduction usage
during periods of COVID-19 lockdowns in Melbourne, Australia in 2020.
Our data spans September 2017 to December 2020. We analysed daily counts of SDM use and
monthly counts of NSP use, according to unique presentations to both. Auto-regressive integrated
moving average (ARIMA) time-series models were fitted to the data with the effects of lockdowns
estimated via a step function.
Across the study period, we estimated 85,851 SDM presentations and 29,051 NSP presentations.
Usage across both the SDMs and the NSP declined during the COVID-19 lockdowns, but only the
decline in SDM usage was significant in ARIMA analysis.
Along with declines in drug use, the slight, but significant decline in SDM use might suggest possible
barriers to access, though this may have been mitigated by SDM users acquiring needles/syringes
from other sources. The decline, however, may be a concern if it led to lowered needle/syringe
coverage and subsequent increase in injecting risk. Further work is needed to properly explore
potential changes in preference for needle/syringe acquisition site and associated barriers.
Importantly, this work adds to the body of literature around the impacts of COVID-19 on harm
reduction provision and potential areas of improvement.
Disclosure of Interest Statement:
PD is supported by NHMRC Research Fellowships (#1136908). PD has received investigator initiated
research funding from Gilead Sciences and an untied educational grant from Indivior unrelated to
this study. PD has served as an unpaid member of an advisory board for an intranasal naloxone
product. All other authors have nothing to declare.

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