News Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs. Kesten JM, Holland A, Linton MJ, Family H, Scott J, Horwood J, Hickman M, Telfer M, Ayres R, Hussey D, Wilkinson J, Hines LA. Int J Drug Policy. 2021;98:103391. Read full paper. This qualitative study reports on the analysis of 28 semi-structured telephone interviews with people who inject drugs (PWID) in Bristol between June and August 2020. They go into some detail on the impact of the pandemic and the resulting changes to services. These will be familiar to most people who worked in services: the move to remote consulting; limited access to services such as residential rehab; moving to rapid provision of opioid substitute therapy (OST) and reduced requirements for supervision; homeless night shelters closing and the street homeless moved into temporary accommodation as part of ‘Everyone In’. The results are presented under three thematic areas. First, they reported on Attitudes to COVID-19 which showed a varied response with some fatalistic responses mixed with concern from people who recognised their increased vulnerability: “I was really paranoid about it because I’ve got bad lungs anyway”. Others had concerns around accessing drugs when lockdown restrictions made it harder to get out discreetly. They also reported in the Sense of Support theme how many of the research participants recognised and appreciated the efforts of the services during lockdown. Similarly, the quick access to OST was popular and the reduced pick-ups were also appreciated. The ‘Everyone In’ scheme was welcomed but the actual experience of being in the accommodation was not always good with significant noise and poor food noted by some and being accommodated with other people who were using drugs could be problematic. Finally, they also commented on the Sense of Loss. Many participants lacked any daily activities, lost connections, and the pandemic made worse the existing difficulties in their lives. Commentary: We are clearly a considerable distance from being finished with the Covid-19 pandemic and this is a valuable addition to the evidence. It has been difficult to get good quality evidence and we've been relying on opinion, extrapolation, and small-scale local evaluations up to this point. A high-quality qualitative study that documents and explores the experiences of Covid-19 among people who inject drugs is very welcome. I don’t think there is a huge amount to surprise anyone and, of course, one needs to be careful about generalising from a qualitative study in these circumstances. Much of what is here fits with my own experience of services in the lockdown. The mixed messages struck me: for some the freedom from the daily tyranny of pharmacy OST supervision was entirely welcome; yet, for others the daily structure and routine was missed. The effects of the pandemic are complex and while there are lessons to learn there are also many caveats. All of that is a natural consequence of the complexity of helping people with drug and alcohol problems. As one participant highlighted, even the much publicised ‘Everyone In’ campaign is not the complete answer. They pointed out, wisely, how tackling homelessness needs more than whacking people into a place with a roof over their head. It’s a fabulous start, of course, but they need many other processes and services to make it stick and to help people for the long term. Many of the measures during the first lockdown were immediate fixes for a short-term problem and we now face the challenging task of shaping future clinical practice while incorporating often contradictory experiences. Article taken from our latest Clinical Update, edited by Dr Euan Lawson (Editor of the British Journal of General Practice). To read the full Clinical Update please become a Premium CPD Member. If you would like to see more from Euan Lawson, he is starting a new free newsletter looking at addiction issues. More Information here. Sign up to the free newsletter.