Advocating for forgotten populations during COVID-19

May 4, 2020

Homelessness, incarceration and opioid use disorder present unique challenges for the nation during the COVID-19 pandemic, write three public health physicians in the April 21, 2020 American Journal of Preventive Medicine. As policymakers continue to work, “[p]lanning should incorporate dedicated efforts, funding, and policies/guidelines specific to individuals who experience homelessness, are incarcerated, or are coping with substance use disorders both because these populations deserve care and services, and because not doing so poses great risk to the broader community,” write Elizabeth M. Salisbury-Afshar, MD, MPH; Josiah D. Rich, MD, MPH; and Eli Y. Adashi, MD, MS.

The authors cite preliminary reports from post-exposure testing at a homeless shelter in Boston showing extremely high rates of COVID-19 infection compared to the general population: 46.3 cases per 1,000 compared with 1.9 cases per 1,000 adults in Massachusetts over the same 15-day period. The policy response, argue the authors, underscore the need for “safe places to quarantine and isolate.”

“Because of the crowded conditions in correctional facilities, this virus will spread rapidly once introduced, just like cruise ships, aircraft carriers and nursing homes,” said Rich, who works for the Rhode Island Department of Corrections. “There is an urgent need to prevent and delay introduction and then spread once it does enter a correctional facility, not only for the health of the people incarcerated, the staff and their families, but for the local hospitals where sick individuals will need to go. The necessary steps include reducing the population as much and as rapidly as possible, in collaboration with public health experts, implement widespread education , use of PPE and testing of both staff and detainees, physical distancing and frequent hand washing to the extent possible, and prompt identification and care of those infected.”

The authors also point to past national disasters such as Hurricanes Katrina and Sandy, which “have taught that illicit drug market disruptions place people who use drugs at risk for supply discontinuity, paraphernalia shortage, and social disconnection.” Not only does this call for “policies to make medications for addiction treatment as widely available as possible,” but also for proven harm reduction strategies such as access to sterile needles and syringes—a policy that the AMA has urged states also to adopt.

“Due to physical distancing recommendations and staff exposures, we’ve seen addiction treatment and harm reduction service providers reducing or adapting their delivery models,” said Dr. Salisbury-Afshar. “It is critical that we work to ensure that individuals with opioid and other substance use disorders receive the services needed to protect themselves against COVID-19, injection-related infections, overdose, and death.”

Learn more about the full range of AMA recommendations for patients with opioid use disorder, pain and support for harm reduction efforts.

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