Substance use and mental health before versus during COVID-19 pandemic among persons who inject drugs with HCV infection history—the HERO study

BACKGROUND: The COVID-19 pandemic adversely impacted mental health and substance use-related outcomes in the general population. However, few studies have compared specific substance use patterns and behaviors and mental health outcomes between the COVID-19 and pre-COVID-19 periods among persons who inject drugs with HCV infection. METHODS: This study included a secondary trend analysis using data from the HERO study. The pre-COVID-19 and the COVID-19 periods within the HERO study timeframe were compared on substance use and mental health outcomes, which were measured at multiple timepoints per participant. Substance use behaviors included the use, reuse, and sharing of drug injection equipment; the type of substance used; and mental health outcomes included depression and anxiety. Generalized linear mixed models were used to test changes in the study outcomes between the pre-COVID-19 and the COVID-19 periods. RESULTS: Compared to the pre-COVID-19 period, the COVID-19 period was associated with higher likelihoods of injecting drugs [aOR = 1.64; 95% CI (1.23, 2.17); p = 0.001], reusing one's injection equipment [aOR = 3.14; 95% CI (2.28, 4.32); p < 0.001], using benzodiazepines [aOR = 4.16; 95% CI (2.02, 8.58); p < 0.001] and other opiates/pills/painkillers [aOR = 1.72; 95% CI (1.01, 2.93); p = 0.047], and higher depression [estimated mean difference = 0.97; 95% CI (0.09, 1.85); p = 0.030]. There were no significant differences in sharing of drug injection equipment and anxiety between the pre-COVID-19 and COVID-19 periods. CONCLUSIONS: Compared to pre-COVID-19 period, injection drug use and reuse of drug injection equipment increased during the COVID-19 period. There was an increase in the use of certain drug types (benzodiazepines and opiates/pills/painkillers) and a rise in depression levels during COVID-19. Ensuring continuity of access to healthcare, including harm reduction services, treatment for substance use and mental health during health crisis times, is important for catering to the special healthcare needs of PWID. CLINICAL TRIAL: This research is a secondary analysis study based on data from the parent trial, the HERO study (Litwin et al., 2019; Litwin et al., 2022) registered at ClinicalTrials.gov (NCT02824640, 07/01/2016).