"We have to be uncomfortable and creative": Reflections on the impacts of the COVID-19 pandemic on overdose prevention, harm reduction & homelessness advocacy in Philadelphia.
"We have to be uncomfortable and creative": Reflections on the impacts of the COVID-19 pandemic on overdose prevention, harm reduction & homelessness advocacy in Philadelphia.
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DOI：
10.1016/j.ssmqr.2021.100013
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
South E
中科院分区：
文献类型：
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作者：
Aronowitz SV;Engel-Rebitzer E;Lowenstein M;Meisel Z;Anderson E;South E
2019冠状病毒病大流行和随后的服务提供中断对吸毒者和无家可归者产生了严重影响，包括药物供应不稳定，获得药物使用障碍治疗和减少伤害用品的机会减少，由于压力和隔离而导致的药物使用和复发增加，在没有稳定住房的情况下无法适当隔离和检疫，以及COVID-19在聚集居住空间传播的风险。与此同时，许多人注意到，尽管之前的停滞--鲍姆加特纳和琼斯称之为“间断平衡”--在应对大流行病时，卫生、住房和药物政策存在快速变化的潜在机会。这一流行病迫使美国在国家和地方两级采取一些重要的政策干预措施，包括暂停驱逐和放松与药物使用治疗有关的药物政策。然而，在当前的COVID-19危机之后，这些变化将在多大程度上持续，以及与药物和住房相关的政策变化如何影响前线过量预防，药物使用治疗和无家可归倡导工作者的工作，仍不清楚。在这项定性研究中，我们使用半结构化访谈来评估费城的减少伤害倡导者，社区组织者和SUD治疗临床医生如何应对COVID-19期间的过量和无家可归危机，以及他们如何预测大流行和随后的政策变化将影响过量预防，减少伤害工作和无家可归倡导的未来。我们于2020年7月至8月期间访问了30名合资格参与者。对这些数据的分析产生了三个主题：1/“对任何人来说都不应该是新的”：影响残疾人和无家可归者的新冠病毒时代问题是现有问题的延伸; 2/“以某种方式从这场危机中实际受益的机会”：创新和改善对残疾人和无家可归者的照顾的可能性; 3/“我们尝试过的方法都没有奏效，所以我们必须要有创造力和不舒服感”：不确定的前进道路。尽管在大流行期间，与会者在促进边缘化社区的健康和福祉方面面临许多障碍，但他们也认为，大流行为积极的政策变革提供了一个重要机会，这种政策变革有可能在未来促进吸毒者的健康，包括继续放松联邦对药物使用障碍治疗的限制，使安全消费场所合法化，安全供应药物，和进步的、创造性的住房解决方案。
The COVID-19 pandemic and ensuing service delivery interruptions had serious impacts on people who use drugs (PWUD) and people experiencing homelessness, including instability in the drug supply, decreased access to substance use disorder (SUD) treatment and harm reduction supplies, increased substance use and relapse due to stress and isolation, inability to properly isolate and quarantine without stable housing, and risk of COVID-19 spread in congregate living spaces. At the same time, many have noted a potential opportunity for rapid change in health, housing, and drug policy despite previous stagnation—referred to as a “punctuated equilibrium” by Baumgartner and Jones—in response to the pandemic. The pandemic forced some important policy interventions in the United States at both national and local levels, including eviction moratoriums and loosening of drug policy related to substance use treatment. However, to what extent some of these changes will be sustained past the current COVID-19 crisis is still unclear, as is how drug and housing related policy shifts have impacted the work of frontline overdose prevention, substance use treatment, and homelessness advocacy workers. In this qualitative study, we used semi-structured interviews to assess how Philadelphia’s harm reduction advocates, community organizers, and SUD treatment clinicians have responded to the overdose and homelessness crises during COVID-19, and how they predict the pandemic and ensuing policy changes will impact the future of overdose prevention, harm reduction efforts, and homelessness advocacy. We interviewed 30 eligible participants during July and August 2020. The analysis of these data yielded three themes: 1/“None of it should be new to anybody”: COVID-era issues impacting PWUD and people experiencing homelessness are extensions of existing problems; 2/“An opportunity to actually benefit in some way from this crisis”: Possibility for innovation and improved care for PWUD and people experiencing homelessness; and 3/“Nothing we’ve tried has worked, so we have to be uncomfortable and creative”: The uncertain path forward. Despite the many barriers that participants faced to promoting the health and well-being of marginalized communities during the pandemic, they also believed that the pandemic presented an important opportunity for positive policy change that has the potential to promote drug user health into the future, including a continuation of loosened federal restrictions on substance use disorder treatment, legalization of safe consumption spaces, safe supply of substances, and progressive, creative housing solutions.