The perfect storm: COVID-19, mass incarceration and the opioid epidemic
The perfect storm: COVID-19, mass incarceration and the opioid epidemic
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DOI：
10.1016/j.drugpo.2020.102819
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发表时间：
2020-09-01
影响因子：
4.4
通讯作者：
El-Bassel, Nabila
中科院分区：
文献类型：
--
作者：
Mukherjee, Trena I.;El-Bassel, Nabila
过度拥挤、卫生条件差和医疗服务不足使惩教设施特别容易受到COVID-19的影响。截至2020年5月15日，美国有7671例实验室确诊病例，103名囚犯和惩教人员死亡（Wallace，Hagan，& Curran，2020），全球有超过56，000例病例和987例死亡（巴基斯坦司法项目，2020）。在美国，监狱和监狱是大部分COVID-19感染的原因，迄今为止有超过25，000例与惩教设施有关（纽约时报，2020年）。患有阿片类药物使用障碍（OUD）的人被不成比例地监禁，并患有许多预先存在的疾病，为COVID-19爆发创造了“完美风暴”。此外，COVID-19利用了不平等（Wang & Tang，2020），大规模监禁的流行导致了许多社会，经济和卫生不平等。惩教设施内的条件使其无法实施世界卫生组织建议的许多COVID-19预防战略（世界卫生组织，2020年）。在人口密集的监狱和监狱中，大多数囚犯共用牢房和其他公共空间，社交距离，洗手和隔离等感染控制措施几乎是不可能的。惩教设施也是出了名的不卫生，缺乏足够的通风或清洁用品，囚犯经常无法获得肥皂和自来水。在美国，超过四分之一的刑事司法涉及的人口被指控犯有毒品罪（Rabuy，2016年），据估计，65%的美国监狱人口有物质使用障碍（“铁窗背后II：药物滥用和美国监狱人口纽约，NY：”，2010）。在全球范围内，据估计，六分之一的人因持有毒品而服刑（Burki，2020），10%至60%的人患有药物使用障碍（Carpentier，Royuela，Montanari和Davis，2018）。最易受COVID-19影响的人群包括老年人和任何年龄的患有严重基础疾病（如肺病、心脏病和糖尿病）的人。在使用药物的人群中，COVID-19感染可能会恶化阿片类药物使用和戒断对呼吸的影响，因为阿片类药物在脑干中起作用以减缓呼吸，导致呼吸抑制和潜在的过量（Boom et al.，2012年）。那些患有物质使用障碍的人也经历更大的合并症，包括心血管疾病（Thylstrup，Clausen &黑森，2015），或由于HIV而免疫功能低下（Azbel & Altice，2015）。
Overcrowding, poor hygiene, and inadequate access to medical care make correctional facilities particularly vulnerable to COVID-19. As of May 15, 2020, there have been 7671 laboratory confirmed cases, and 103 deaths among inmates and correctional staff in the United States (US)(Wallace, Hagan, & Curran, 2020), and over 56,000 cases and 987 deaths, globally (Justice Project Pakistan, 2020). In the US, jails and prisons are responsible for a large proportion of COVID-19 infections, with over 25,000 cases connected to correctional facilities to date (New York Times, 2020). People with opioid use disorders (OUDs) are disproportionately incarcerated and suffer from a number of pre-existing conditions, creating a ‘perfect storm’for a COVID-19 outbreak. Furthermore, COVID-19 capitalizes on inequity (Wang & Tang, 2020), and the epidemic of mass incarceration has resulted in a number of social, economic and health inequities. The conditions within correctional facilities make it infeasible to enact many of the World Health Organization's recommended COVID-19 prevention strategies (World Health Organization, 2020). Infection control measures like social distancing, hand washing, and quarantine are near impossible in densely populated jails and prisons, where the majority of inmates share cells and other communal spaces. Correctional facilities are also notoriously unsanitary, lack adequate ventilation or cleaning supplies, and inmates often have restricted access to soap and running water.Over a quarter of criminal justice involved populations in the US are charged with a drug offense (Rabuy, 2016), and it is estimated that 65% of the US prison population has a substance use disorder (“Behind Bars II: Substance Abuse and America’s Prison Population. New York, NY:,” 2010). Globally, it is estimated that one in six are serving time for drug possession (Burki, 2020), and between 10 and 60% have a substance use disorder (Carpentier, Royuela, Montanari, & Davis, 2018). Populations most vulnerable to COVID-19 include older adults and persons of any age with serious underlying medical conditions such as lung disease, heart disease, and diabetes. Among people who use drugs, COVID-19 infection may worsen the respiratory impact of opioid use and withdrawal, as opioids act in the brainstem to slow breathing, leading to respiratory depression and potential overdose (Boom et al., 2012). Those with substance use disorders also experience greater comorbidities, including cardiovascular disease (Thylstrup, Clausen & Hesse, 2015), or be immunocompromised due to HIV (Azbel & Altice,