It can mean two things for people who use illicit drugs (PWUD) as they weather the COVID-19 storm along with the general population.

First, the supply of illicit drugs has dwindled, causing prices to hike across the world. The closure of international borders has changed the market of illicit drugs, forcing restrictions on the supply and distribution of these drugs.

For people who inject drugs, sharing of drug-use equipment in the context of limited drugs raises concern on the spread of COVID-19 through close contact and respiratory droplets.

Moreover, advocates in countries with a higher number of drug overdose deaths have cautioned about the possibilities of violence and tension, especially when there is an unmet need for drug use treatment and support services.

Some may perceive that this is the perfect time for PWUD to discontinue their drug use. Reduced supplies of illicit drugs and social distancing that leads to disruption of social networks of PWUD seem like valid opportunities to change the habit.

While this may work for certain sub-groups of PWUD, such conditions may not apply to those who experience drug dependence.

Harm-reduction programmes

​

A fundamental understanding of the PWUD population is that there is a clear difference between people who use drugs and people with drug-use disorders. Not everyone who uses drugs will experience drug-use disorders, by which they become dependent on drugs to function and, at this point, may require treatment and support.

The United Nations Office on Drugs and Crime (UNODC) has estimated that among the 271 million users of any type of drugs, some 35 million, or almost 13 per cent, are estimated to suffer from drug-use disorders.

This time of COVID-19, instead, is the perfect time to explore opportunities to step up our game in our harm-reduction programmes and support services for PWUD, especially those who are experiencing drug dependence. The Movement Control Order (MCO) periods, however, have posed challenges for the continuity of care for PWUD in need of these services.

For instance, the provision of methadone treatment for opioid-users, particularly, can be challenged by service disruption or closure, travelling difficulties to health facilities, and even trying to meet higher priorities such as securing income to support families.

Similarly, the number of PWUD receiving clean needles and syringes has declined, thus increasing the risk of not only blood-borne virus transmissions which may add to the burden of healthcare systems, but also COVID-19 itself among this population through shared equipment.

Exposure to additional risks

Second, the COVID-19 pandemic means that PWUD are exposed to additional risks. The prevalence of underlying medical conditions, including cardiovascular diseases and common infections such as HIV, viral hepatitis and liver cancers, which may compromise the immune system, is high among PWUD. Being infected with COVID-19 can place them at greater risk for developing severe illness, particularly among ageing PWUD.

Ensuring PWUD have non-interrupted access to their medications is important during these periods. As PWUD may encounter additional barriers in accessing healthcare compared to the general population, even before COVID-19, there is a need for a multi-sectoral, collaborative approach to develop a strategy to assist PWUD.

Additional risks can also be linked to closed settings, such as in prisons and drug rehabilitation centres that are frequented by PWUD.

In Malaysian overcrowded prisons, at least 60 per cent of the total number of prisoners is imprisoned due to minor drug-related offences.

Overcrowding in prisons also makes social distancing measures difficult to apply, with inadequate infrastructure to cater for those who are infected with COVID-19.

The current outbreak of COVID-19 cases in US prisons should serve as a lesson for us to quickly come up with contingency plans for PWUD in prisons. We should bear in mind that COVID-19 should not be a death sentence for incarcerated key populations.

Compassion, not judgement

The government is continually stressing that “no one is left behind” in our attempts to flatten the curve.

Critical times like these call for innovative, low-threshold services, including treatment continuity, housing, food, income stability as well as mental health and counselling support, targeted specifically for PWUD.

Discussions on current policies to suspend arrests and detention for non-violent offences such as drug use or consumption should be initiated, in order to avert serious outbreaks within overcrowded prison settings.

Our frontline workers are working tirelessly to fight the disease. A plan to minimise the risks of PWUDs in the context of COVID-19 in this country is highly needed to reduce their burden.

The cornerstone of this plan is to treat PWUD with compassion, not judgement. After all, no one should be left behind.

-- BERNAMA

Dr Iqa Mohd Salleh is a senior lecturer at the Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, KualaLumpur.