COVID-19 vulnerability among people who use drugs: recommendations for global public health programmes and policies
COVID-19 vulnerability among people who use drugs: recommendations for global public health programmes and policies
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DOI：
10.1002/jia2.25551
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发表时间：
2020-07-01
影响因子：
6
通讯作者：
Frew, Paula M.
中科院分区：
文献类型：
--
作者：
Holloway, Ian W.;Spaulding, Anne C.;Frew, Paula M.
随着新型冠状病毒 (SARS-CoV-2) 引起的疾病 COVID-19 病例继续在全球蔓延，公共卫生专家警告说，这种流行病可能对社会最弱势群体造成破坏性影响 [1]。与此同时，另一场公共卫生危机——阿片类药物流行病——在美国各地肆虐[2, 3]。在世界其他地区，阿片剂和阿片类药物的使用保持相对稳定；然而，在东欧、俄罗斯和中亚阿片类药物的使用有所增加[4]。在这些地区，注射吸毒的流行率很高，注射吸毒者中艾滋病毒的流行率也很高——根据最近的估计，在俄罗斯主要城市，这一比例超过 40% [5]。 2015 年，全世界有近 50 万人因滥用药物而死亡；其中 168,000 人死于服药过量 [6]。 HIV 感染者 (PLWH) 比 HIV 阴性人群面临更高的阿片类药物滥用风险，部分原因是 PLWH 更有可能遭受慢性疼痛并接受阿片类镇痛治疗以缓解症状 [7, 8]。吸毒者 (PWUD) 在 COVID-19 时代面临着独特的脆弱性，包括无家可归现象增多以及与刑事司法系统频繁互动 [9]。仅在美国，就有大约四百万无家可归者在各种高风险环境中进出，包括街头营地、庇护所、看守所和监狱。这些情况都对限制 COVID-19 的传播提出了重大挑战。例如，在街道上，遵循世界卫生组织 (WHO) 推荐的手部卫生指南 [10] 所需的物资（包括清洁水、肥皂和洗手液）非常稀缺。监狱过度拥挤是新冠肺炎 (COVID-19) 爆发之前的一个国际健康问题[11]，现已达到危机点。惩教机构中的 COVID-19 检测有限、囚犯和工作人员的个人防护装备稀缺以及世界各地监狱中 COVID-19 的爆发，使得被监禁的囚犯特别容易受到 COVID-19 感染，并导致负面健康结果 [12]。
As cases of COVID-19, the disease caused by the novel coronavirus (SARS-CoV-2), continue to spread globally, public health experts have warned about the devastating impact this pandemic may have on society’s most vulnerable [1]. Meanwhile, another public health crisis, the opioid epidemic, rages on throughout the United States [2, 3]. In other parts of the world, the use of opiates and opioids has remained relatively stable; however, in Eastern Europe, Russia and Central Asia opiate use has increased [4]. In these regions, the prevalence of injection drug use is high, as is prevalence of HIV among people who inject drugs–over 40% in major Russian cities according to recent estimates [5]. Worldwide nearly half a million people died as a result of drug misuse in 2015; 168,000 of those deaths were due to overdose [6]. People living with HIV (PLWH) face higher risk of opioid misuse than HIV-negative people, in part because PLWH are more likely to suffer chronic pain and receive opioid analgesic treatment for symptom relief [7, 8].People who use drugs (PWUD) face unique vulnerabilities in the COVID-19 era, including elevated homelessness and frequent interaction with criminal justice systems [9]. In the United States alone, approximately four million people experiencing homelessness cycle in and out of a variety of high-risk settings, including street encampments, shelters, jails and prisons. Each of these contexts present significant challenges to limiting the spread of COVID-19. On the streets, for example, the very supplies needed to follow World Health Organization (WHO) recommended hand hygiene guidelines [10], including access to clean water, soap and hand sanitizer, are scarce. Prison overcrowding, which was an international health concern prior COVID-19 [11], has reached a crisis point. Limited COVID-19 testing in correctional settings, scarce PPE for inmates and staff and COVID-19 outbreaks in prisons across the world make incarcerated PWUD especially vulnerable for COVID-19 infection and resulting negative health outcomes [12].