New Mexico, a sparsely populated minority-majority state in the southwestern United States, has consistently placed at the bottom of most population health scales (NM IBIS, 2018.). Among its many challenges, the state has high rates of opioid, alcohol and methamphetamine use disorders, extreme rurality, and very limited healthcare infrastructure (NM IBIS, 2018-2019.). Opioid-related deaths have been endemic in New Mexico dating back to 1999 and is considered a multi-generation problem in some areas of the state (NIDA 2020., Nmhealth, 2020., Garcia, 2010.). Recent data demonstrate that overall, New Mexico has approximately 24 opioid overdose deaths per 100,000, with several counties having rates of 40-90 per 100,000 (NM IBIS, 2019.). In a survey of New Mexico residents done by the New Mexico Department of Health (NMDOH), 63% of respondents indicated they knew someone who “is or has been addicted to opioids” (NMDOH, 2019). With such high prevalence of opioid use disorder (OUD) and related deaths, the NMDOH became a leader in Harm Reduction (HR), with a state-operated syringe exchange program started in 1997 (NMSA 1978 24-2C Harm Reduction Act). HR sites are defined as organizations that provide syringe exchange, overdose prevention, and/or HIV/STI testing for communities impacted by substance use disorders (SUD) with a primary goal to reduce the adverse health, social, or economic consequences of drug use without necessarily reducing drug consumption (Principles, 2019.). HR programs are an effective way of reducing injection-related HIV and hepatitis C infections, syringes discarded in public areas, and overdose deaths (organize references) (Irwin, et al. 2017.; Greenburg, 2019.; Wood, et al. 2006.; Saloner, et al., 2018.; Aspinall, et al., 2013.). According to the NMDOH, New Mexico currently accounts for 7-8% of all syringe services in the United States, with a 50% increase in syringe service program enrollments since 2012. Current HR services offered in New Mexico include, but are not limited to, syringe services, overdose prevention training, naloxone distribution, social services referrals, primary medical care referrals etc. In New Mexico, there are 12 state-contracted HR sites and 38 Public Health Offices that provide HR services; these sites are especially crucial to fighting the opioid epidemic in rural areas (NMDOH).
SARS-CoV-2 arrived in New Mexico on March 11th, 2020 with four travelers returning from international vacations. Given the poor baseline health of the state’s population, unequal distribution of hospital beds, and limited infrastructure for intensive care surge capacity, the state government recognized the potential for catastrophe and moved quickly to prevent spread of the virus. On March 23rd, New Mexico Governor Michelle Lujan Grisham announced a statewide ‘stay-at-home’ order. The order required that all schools, universities, and non-essential businesses in the state close, and that people leave their homes only for outings “necessary for their health, safety, or welfare” (CABQ, 2020.). Harm reduction sites were allowed to stay open as they were deemed essential in alignment with the American Medical Association’s (AMA) position statement recommending that syringe exchange and naloxone distribution be maintained and prioritized during such closures (AMA, 2020). Medical practices in the state were referred to the Center for Disease Control (CDC) guidance for COVID-safe practice changes. The CDC guidelines recommended maximization of telehealth services; limiting number of visitors and daily appointments; physical distancing of six feet or more; increased screening and sanitizing practices; and visual aids indicating the new guidelines and encouraging hand hygiene (CDC, 2020).
Despite the lock-down, by mid-April, McKinley and San Juan counties became a national virus hotspot with per-capita infection and death rates comparable to and eventually surpassing New York City (Silverman, 2020). The Native American communities in these counties, particularly individuals from the Navajo Nation, were especially hard-hit with 8,837 confirmed cases and 434 deaths in July (Navajo Nation DOH, 2020). The SARS-CoV-2 pandemic has been especially harmful for individuals from minority groups, with minority death rates over two-fold higher than for white individuals reported in many states (Kaur, 2020; Dorn, et al. 2020). Similarly, the virus appears to be especially harmful for those with SUD. Preliminary research findings have demonstrated high infection rates and mortality among people with SUD (Wei, et al. 2020). Given that New Mexico has large numbers of people using HR services particularly in rural and minority populated areas, we wished to investigate the impact of the pandemic on HR. Our study uses cross-sectional survey methods to investigate the impact of the SARS-CoV-2 pandemic on HR services in New Mexico.