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Expert Q&A

Vital Strategies Releases Guidance to Reduce Both COVID-19 and Overdose Deaths: Q&A with Daliah Heller

Vital Strategies

Daliah Heller is the Director of Drug Use Initiatives at Vital Strategies.

How has COVID-19 impacted people who use drugs?

As we know, the negative impacts of COVID-19 are widespread among people in the United States. People who use drugs are especially vulnerable because the coronavirus pandemic has exacerbated the already-existing drug-related health and social harms they face.  An estimated two-thirds of people incarcerated in jails meet the clinical definition for substance use disorder, and these settings have seen some of the largest clusters of COVID-19 infection in the country. Low-income people who use drugs often experience precarious housing, staying in rooming and halfway houses, shelters, and other congregate settings where close contact with others increases risk of infection. Physical distancing and stay-at-home orders have increased social isolation, and the psychological stress of this experience produces anxiety and depression, triggering people to use drugs, and use more drugs, to feel some comfort and escape from this traumatic reality. The CDC recently reported that 13% of US adults have started or increased substance use during the pandemic.


Are overdose deaths increasing during COVID and why?


The US is already in the midst of an overdose epidemic, and data sources indicateoverdose deaths have further spiked by almost 20% during the outbreak. In addition to increases in drug use, the pandemic has influenced overdose risk in several specific ways. COVID mitigation measures encourage social isolation, but using drugs alone means there is nobody there to respond if you are overdosing. Drug markets, already unstable because they operate in a shadow economy, have been disrupted by international border closures and transportation slow-downs. Facing the pain of drug withdrawal, people who use drugs are forced to make drug purchases from unknown or shifting sources, making drug use an even riskier prospect. Meanwhile, access to services and treatment has been hampered by stay-at-home orders and confusing and contradictory messaging from authorities.


How can states and organizations encourage harm reduction during this pandemic?


Many states have declared harm reduction services and medication treatment for opioid use disorder essential services, ensuring they can continue to reach people who use drugs during the pandemic. National public health emergency measures have enabled the relaxation of federal regulations governing medication treatment for opioid use disorder, reducing unnecessary travel to clinics and potential exposure to the virus. Individuals can now begin buprenorphine treatment via telephonic intake with a provider, and can be prescribed up to 30 days’ worth of medication at the first visit. Methadone programs can dispense take-home doses of up to 28 days for stable participants. A growing number of states are promoting mail-order harm reduction supplies for their residents, including naloxone, the opioid overdose antidote, and syringe services; several organizations have made these resources available via on-line platforms. Decarceration measures have been adopted in some jurisdictions, including early release for prisoners, and reductions in custodial arrest and jail incarceration for low-level charges, but far more is neededto significantly reduce COVID-19 risk in detention settings. Upon release, re-entry services must ensure immediate access to safe housing, supportive services, and naloxone and medication treatment for opioid use disorder, as appropriate.


Why are there disturbing disparities in Black and Latinx communities contracting COVID?


The rates of COVID-19 infection and death are two and three times greater for Black and Latinx populations, respectively, than for white populations in the US. The devastating toll of the virus experienced by these communities reflects the enduring conditions of racism in the US. Access to quality healthcare is impeded for Black and Latinx people due to their lower rates of health insurance coverage, in turn a consequence of higher unemployment and low-wage jobs, distinct features of structural racism. The low-wage jobs are often essential worker jobs, including healthcare, grocery, and food delivery workers, increasing risk of exposure. Economic disparities force Black and Latinx communities to rely on public transportation and reside in more crowded, less secure living conditions, in already-segregated neighborhoods. Incarceration rates, which are disproportionately high for Black and Latinx populations, drive infections from crowded detention settings into crowded communities as people are released. Chronic health conditions such as diabetes and hypertension, which increase the severity of COVID-19 infection, are more prevalent in Black and Latinx populations. All of these situations and settings shape COVID-19 risk and the critical disparities in infection and death we are witnessing in Black and Latinx communities with this pandemic. For Black and Latinx people who use drugs, these contexts also compound the risk of overdose.


Can you tell us about the Vital Strategies toolkit, COVID-19 Resources for People Who Use Drugs and Other Vulnerable Communities” and why you created this resource?


As the COVID-19 outbreak began to surface in areas of the US in the early months of 2020, we immediately recognized the additional risk this posed to people who use drugs, already facing a dire and worsening overdose epidemic. We hope this toolkit and its components will be helpful for this population and the groups who work with them, to recognize and reduce the harmful impact of COVID-19 on drug use and overdose risk, and prevent further suffering during these remarkably challenging times.