What specific risks are people who use drugs (PWUD) likely to face during the COVID-19 pandemic? What services will they need? How will professionals working with this group need to adapt on the frontline? These are among the questions raised in a new EMCDDA update published today.
The update is the work of an EMCDDA taskforce of experts and reviewers, set up by Director Alexis Goosdeel. Its aim was to assess the emerging COVID-19 risks for this population and, where necessary, to encourage the planning, review and adaptation of frontline and specialist drug interventions. The Director also invited audiences via social media to post or submit questions, testimonies and experiences on the perceived risks for PWUDs, the associated challenges for healthcare systems and solutions found COVID19_PWUD@emcdda.europa.eu).
The EMCDDA recognises that services working with PWUD are faced with the same challenges as other health and care providers to ensure continuity of care, whilst adapting their working practices to reflect international and national guidelines on reducing COVID-19 infection risks and promoting good hygiene practices. However, some additional considerations also need to be highlighted that are important for reducing risks and responding to the needs of this population.
People who use drugs, particularly Europe’s ageing cohort of opioid users, may be particularly vulnerable to poor outcomes linked to pre-existing health problems and lifestyle factors. Some drug use behaviours, as well as poor socio-economic conditions and marginalisation, may also pose additional risks that are important to take into account.
The EMCDDA notes in the update that some of the underlying chronic medical conditions experienced by some PWUD could increase the risk of developing severe illness, if infected with COVID-19. It also highlights the potentially greater risk of opioid-related deaths (if aggravated by breathing difficulties caused by COVID-19) and the prospect of problems linked to sharing drug using equipment (for inhalation, vaping, smoking or injecting).
According to the update, the type of settings used by PWUD may put them at an increased risk of exposure to COVID-19. It underlines the importance of prevention measures in settings frequented by PWUD (e.g. drug services, homeless shelters and prisons) and the need for protocols to respond to PWUD who show signs of COVID-19 infection.
‘It will be crucial to guarantee the continuity of core health services to drug users’, adds the paper. ‘In this context, it is vital to ensure that services are properly resourced, staff protection measures are in place and service planning is prioritised. Drug treatment services and low-threshold harm reduction services for PWUD are essential health services, which will need to stay in operation under restricted conditions’.
It goes on to state that: ‘Ensuring the ongoing provision of drug treatment services, including opioid substitution medications and other essential medicines to clients, will therefore be a paramount consideration. Contingency plans will be needed for potential medication and equipment shortages’.
Finally, COVID-19 and related restrictions on movement in some localities may lead to the disruption of drug markets and a reduced supply of illicit drugs. This could have a range of repercussions, especially for dependent drug users and could potentially result in an increased demand for drug services.