Pandemic lockdown as policy window for street-level innovation of health and substitution treatment services for people who use drugs

Abstract

Purpose This paper aims to examine policy innovation among street-level bureaucrats at low-threshold services to people who use drugs during the COVID-19 pandemic in Denmark. Design/methodology/approach This paper builds on two research projects conducted during the first pandemic lockdown in Denmark. The first is a case study of how COVID-19 impacted on people who use drugs (PWUD) and services for PWUD at the open drug scene in the neighborhood of Vesterbro in Copenhagen. The second is an ethnographic study of how users of services at the intersection of drug use and homelessness were impacted by lockdown. Findings Drawing on Kingdon’s “multiple policy streams” approach, this study shows how lockdown opened a “policy window” for innovating services to people who use drugs. This paper further shows how the pandemic crisis afforded street-level bureaucrats new possibilities for acting as “policy entrepreneurs” in a context where vertical bureaucratic barriers and horizontal cross-sectoral silos temporarily collapsed. Finally, the authors show how this had more lasting effects through the initiation of outreach opioid substitution treatment. Social implications In Denmark, the emergence of a “policy window” for street-level bureaucrats to act as street-level “entrepreneurs” occurred in a context of rapid government response to the pandemic. For crises to act as “policy windows” for innovation depends on strong, preexisting institutional landscapes. Originality/value This paper adds to existing literature on policy innovation during COVID-19 in two ways: methodologically by contributing an ethnographically grounded approach to studying policy innovation and theoretically by examining the conditions that allowed policy innovation to occur.