Effects of COVID-19 on Overdose Risk Behaviors Among People Who Inject Drugs in Wisconsin.

Background: The United States is currently experiencing the worst epidemic of drug overdose in the country's history. We sought to understand whether changes in drug use behavior and access to prevention services during the COVID-19 pandemic may have contributed to increased drug overdose.

Methods: We recruited adults with a history of injection drug use to complete an online survey during March through June 2021 to assess whether overdose experiences, drug use behaviors, and access to prevention services changed due to the pandemic.

Results: Diminished social support during the pandemic was correlated with reporting disrupted access to harm reduction services ( = 0.006) and experiencing an overdose ( = 0.005). Disrupted access to harm reduction services also was correlated with being female ( = 0.03) and reporting feeling pressure to share drugs or equipment ( = 0.01), worrying about withdrawal ( = 0.03), and changes to how and where individuals got their drugs, drug price and availability, with whom and where drugs were used, and the quantity or properties of drugs purchased (all  < 0.01).

Discussion: The cumulative impact of COVID-19-related disruptions may have resulted in heightened risk for overdose, as these findings suggest that, in many cases, experiencing one risk factor was suggestive of experiencing several risk factors.