World Psychiatry ( IF 73.3 ) Pub Date : 2022-05-07 , DOI: 10.1002/wps.20995 Nora D. Volkow 1 , Susan Maua 1 , Giovanna Campello 1 , Vladimir Poznyak 1 , Dzmitry Krupchanka 1 , Wataru Kashino 1 , Anja Busse 1
Since 2015, the United Nations Office on Drugs and Crime (UNODC) – World Health Organization (WHO) Informal Scientific Network (ISN) has brought the voice of science to international drug policy discussions, especially at the Commission on Narcotic Drugs, the prime policy-making body of the United Nations (UN) for drug control matters. In recent years, the public health dimensions of the world drug problem, including prevention and treatment of substance use disorders (SUDs), have become prominent in policy debates within the UN system1.
Individuals with SUDs are at increased risk of contracting COVID-19 and, if infected, are more likely to experience negative outcomes2-4. This vulnerability reflects both the adverse effects of the non-medical use of psychoactive substances on health5, compounded by high rates of non-attended medical comorbidities3, 4, as well as associated psychosocial and structural factors. These may include situations of homelessness and incarceration, which increase the risk of acquiring COVID-19 through intermediate and direct factors (e.g., poverty, stigma, overcrowded settings) and decrease access to adequate care, ultimately worsening outcomes6. Several surveys have identified disruptions of services for people with SUDs during the COVID-19 pandemic7. Providing services for population groups with increased vulnerabilities is a key public health principle especially during a pandemic, also benefitting the general population as a whole4.
Evidence-based and human rights-based treatment of SUDs, including mental health and physical comorbidities, should be considered essential and integrated into existing health care services. The provision of remote services and digital health solutions for the treatment and care of SUDs, and medications to treat SUD and prevent overdose, should be accessible to those in need. Due to overlapping vulnerabilities, people who use substances with special treatment and care needs carry a disproportionate risk and require special attention8. Investment in evidence-based prevention and treatment of SUDs and comorbid health conditions, and attention to the impact of social determinants on the health of all age groups are now more necessary than ever. Global actions are needed to build health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond9.
- Support the timely collection and analysis of data to monitor the impact of the COVID-19 pandemic, including the role of policies and interventions targeting demand and supply of psychoactive substances. Also, on the unintended consequences of “lockdowns” on substance use, SUDs, overdoses, and treatment and care services.
- During the COVID-19 pandemic, ensure the ongoing provision of evidence-based treatment of SUDs along an integrated continuum of care in line with the UNODC-WHO International Standards for the Treatment of Drug Use Disorders.
- Ensure the meaningful inclusion of mental health and SUD experts in COVID-19 task forces and promote multi-stakeholder, integrated approaches to trainings that facilitate innovations in the health system by bringing together the scientific community, the private sector and international and civil society organizations.
- Increase resources, including trained workforce, to secure continued access to SUD prevention and treatment and care services, including for those infected with COVID-19.
- Populations in especially vulnerable circumstances with special needs (such as women, children, victims of violence, ethnic minorities and indigenous populations, refugees and migrants, the unhoused, the economically disadvantaged, those with mental illnesses, the elderly, socially isolated people, and people in contact with the justice system) should be provided adequate services in accordance with local resources, and especially in light of the COVID-19 pandemic.
- During the COVID-19 pandemic, existing socioeconomic disadvantages have increased. Recalling the ISN statement from 2019, the ISN recommends including people who use substances in priority strategies and interventions that minimize inequalities.
- Develop policies that promote and evaluate the use of information technologies, including mobile devices, to support digital health solutions for substance use screening, treatment and recovery, and develop solutions to address the existing digital divide. Every effort must be taken to ensure the confidentiality, privacy and safety of those who use remote/online services.
- Ensure that COVID-19 information, prevention, testing and vaccination is available for individuals with SUDs, and SUD treatment professionals.
- Give special consideration to addressing communicable and non-communicable disorder prevention and treatment, including prevention of the negative health and social consequences of substance use, as well as mortality due to overdose, and comorbid mental and physical health conditions, even when resources and attention are primarily focused on COVID-19.
- Stigma and discrimination are among the biggest challenges for people with SUDs, including those in contact with the criminal justice system, and they have been exacerbated during the COVID-19 pandemic. Strategies should be developed to ensure that SUDs are treated like any other chronic medical condition during this crisis and beyond, and that people with SUDs are not left behind.
- The ISN, especially now and in view of the increased risk for COVID-19 in closed settings, joins the global call for increased consideration of alternatives to conviction or punishment for people with SUDs and comorbid mental health conditions, in line with the UN Standard Minimum Rules for Non-Custodial Measures and the International Drug Control Conventions.
- Strengthen research on the impact of COVID-19 on substance use, SUDs and comorbid mental health conditions, and barriers to treatment during the pandemic, including ongoing monitoring and evaluation of policies that affect people who use substances and with SUDs.
The ISN recommends to ensure that, during and beyond the COVID-19 pandemic, people with drug use disorders are not left behind, and that quality substance use prevention, treatment and care services are accessible to those in need, including to those in most vulnerable circumstances.
中文翻译：
COVID-19 时期物质使用障碍的预防、治疗和护理
自 2015 年以来，联合国毒品和犯罪问题办公室 (UNODC) – 世界卫生组织 (WHO) 非正式科学网络 (ISN) 将科学的声音带到了国际毒品政策讨论中，特别是在主要政策麻醉药品委员会- 联合国（UN）药物管制事务的制定机构。近年来，世界毒品问题的公共卫生层面，包括物质使用障碍 (SUD) 的预防和治疗，在联合国系统内的政策辩论中变得突出1。
患有 SUD 的人感染 COVID-19 的风险增加，如果被感染，更有可能出现负面结果2-4。这种脆弱性反映了精神活性物质的非医疗使用对健康的不利影响5，以及高比例的未就诊医疗合并症3、4以及相关的社会心理和结构因素。这些可能包括无家可归和被监禁的情况，这会增加通过中间和直接因素（例如，贫困、耻辱、过度拥挤的环境）感染 COVID-19 的风险，并减少获得适当护理的机会，最终恶化结果6. 多项调查发现，在 COVID-19 大流行7期间，SUD 患者的服务中断。为脆弱性增加的人群提供服务是一项重要的公共卫生原则，尤其是在大流行期间，也有利于整个普通人群4。
对 SUD 的循证和基于人权的治疗，包括精神健康和身体合并症，应被视为必不可少的，并将其纳入现有的医疗保健服务中。为治疗和护理 SUD 提供远程服务和数字健康解决方案，以及治疗 SUD 和防止过量服用的药物，应该可供有需要的人使用。由于重叠的脆弱性，使用有特殊治疗和护理需求的物质的人承担着不成比例的风险，需要特别注意8. 现在比以往任何时候都更有必要对 SUD 和合并症的循证预防和治疗进行投资，并关注社会决定因素对所有年龄组健康的影响。需要采取全球行动来建立卫生系统在 COVID-19 大流行期间及以后的全民健康覆盖和卫生安全方面的复原力9。
- 支持及时收集和分析数据以监测 COVID-19 大流行的影响，包括针对精神活性物质需求和供应的政策和干预措施的作用。此外，关于“封锁”对物质使用、SUD、过量服用以及治疗和护理服务的意外后果。
- 在 COVID-19 大流行期间，确保按照联合国毒品和犯罪问题办公室-世卫组织国际药物使用障碍治疗标准，在综合连续护理过程中持续提供基于证据的 SUD 治疗。
- 确保将精神健康和 SUD 专家有意义地纳入 COVID-19 工作组，并通过将科学界、私营部门以及国际和民间社会组织聚集在一起，促进多方利益相关者的综合培训方法，以促进卫生系统的创新。
- 增加资源，包括训练有素的劳动力，以确保持续获得 SUD 预防、治疗和护理服务，包括那些感染 COVID-19 的人。
- 处于特别脆弱环境中且有特殊需要的人群（如妇女、儿童、暴力受害者、少数民族和土著居民、难民和移民、无住房者、经济上处于不利地位的人、患有精神疾病的人、老年人、社会孤立的人和人们与司法系统联系）应根据当地资源提供适当的服务，尤其是鉴于 COVID-19 大流行。
- 在 COVID-19 大流行期间，现有的社会经济劣势有所增加。回顾 2019 年的 ISN 声明，ISN 建议将使用物质的人纳入优先战略和干预措施，以最大限度地减少不平等。
- 制定政策促进和评估信息技术（包括移动设备）的使用，以支持用于物质使用筛查、治疗和康复的数字健康解决方案，并制定解决现有数字鸿沟的解决方案。必须尽一切努力确保使用远程/在线服务的人的机密性、隐私和安全。
- 确保为 SUD 患者和 SUD 治疗专业人员提供 COVID-19 信息、预防、检测和疫苗接种。
- 特别考虑解决传染性和非传染性疾病的预防和治疗，包括预防物质使用对健康和社会的负面影响，以及过量服用导致的死亡，以及合并的精神和身体健康状况，即使资源和注意力集中在主要关注 COVID-19。
- 污名和歧视是 SUD 患者面临的最大挑战之一，包括那些与刑事司法系统有联系的人，并且在 COVID-19 大流行期间更加严重。应制定策略以确保在此次危机期间及以后，SUD 与任何其他慢性疾病一样得到治疗，并且 SUD 患者不会被抛在后面。
- 鉴于在封闭环境中 COVID-19 的风险增加，ISN 加入了全球呼吁，根据联合国最低标准，更多地考虑对患有 SUD 和合并精神健康状况的人进行定罪或惩罚的替代方法非拘禁措施规则和国际药物管制公约。
- 加强对 COVID-19 对药物使用、SUD 和合并精神健康状况的影响以及大流行期间治疗障碍的研究，包括对影响药物使用者和 SUD 患者的政策的持续监测和评估。
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