Policies initiated to control the COVID-19 pandemic increased the difficulties for people who use drugs when seeking health treatment, leading drug experts to conclude that treatment programmes need to be integrated into community care.

Ruth Dreifuss, former President of Switzerland and founding member of the Global Commission on Drug Policy, noted that people who use drugs were discriminated against directly during the AIDS epidemic of the 1980s and indirectly in the COVID-19 pandemic.

People who use drugs are considered a “key population” group to be targeted for treatment in the AIDS response and there is inherent discrimination in that phrase, she said. 

“The discrimination and the associated prohibition against key populations contributed to the AIDS pandemic,” she told the Geneva Health Forum’s session on Drugs and drug policies in times of Covid-19: obstacles and implications for health and human rights.

For COVID-19, however, she said the lockdown measures indirectly disenfranchised drug users.

“Lockdowns made them invisible and denied access to services. We believe the new pandemic made it difficult to keep the gains of the past 30 years,” she added.

Tensions heightened between public health and criminal injustice  

Judy Chang, Executive Director of the International Network of People who Use Drugs (INUD), added that policies such as the mass incarceration of people who use drugs highlighted tensions between public health and criminal injustice.

For instance, social distancing that is essential in reducing the spread of COVID-19 is in sharp contrast to mass incarceration. Harm reduction services were shut down during lockdowns, leaving no access to health and social services for drug users, said Chang.

Drugs also increased in price and were reduced both in quality and quantity. 

“Authorities had no idea of what to do with people who use drugs during a pandemic,” said Chang. 

With lockdowns and other forms of movement restrictions forming the initial core of the global COVID response, global health players are now increasingly leaning towards prioritizing strengthening community-led approaches.

Earlier, Health Policy Watch reported that The Global Fund now sees integrated health systems as key to preparing for future pandemics. 

This also holds true for harm reduction interventions targeting drug users. Naomi Burke-Shyne, Executive Director of Harm Reduction International, noted that identifying harm reduction as an essential social service is crucial for stakeholders developing drug policies to ensure they are applicable in pandemics.

“These conversations are so interesting because we can look at policy in terms of how harm reduction services can benefit from stepping up community leadership,” she added.

Pandemic gains in Switzerland and Prague

But in the wake of the COVID-19 pandemic, Switzerland’s drug policy reform crusaders achieved gains they’d been requesting for about 20 years, according to Professor Daniele Zullino, from the Division of Addictology at Geneva University Hospitals’ Department of Psychiatry.

“Regarding physical visitation, we were able to negotiate with the Federal Office of Public Health to reduce this from twice daily to once weekly. There is now a realisation that the over-incarceration of people who use drugs is fuelling this pandemic and other pandemics,” he said.

Pavel Bém, former mayor of Prague and a member of the Global Commission on Drug Policy, said that the Czech government also came to understand that its initial COVID-19 law that directed citizens and residents to stay at home with their families could not be obeyed by homeless drug users who had no relatives.

“We’ve seen the flexibility of civil societies and movements, and the emergence of new services including provisional outdoor shelters for homeless people using substances,” he said.

Doctors are also now treating drug users via online consultations and they are now providing comorbidity services for clients. 

There is also the introduction of street medicines that benefits homeless drug users in the country.

“I’m aware of the negative effects of this crisis but I’ve seen enormous progress,” he said.

Next steps

Antons Mozalevskis, Technical Officer for Key Populations at WHO’s Global HIV, Hepatitis and STI Programmes, said the global drug problem will need to be addressed “in a more unison way via collaborations with relevant organizations”.

Chang asked the global health body to step up and take a leading role that enthrones evidence in the enactment and update of drug policies.

She noted that drug use is complex and multifaceted, and the billions of dollars spent on the drug war are multiple times more than what is spent on harm reduction services. While governments send drug users to prisons, harm reduction services in prisons are still lagging behind.

She also called COVID-19 an “opportunity for community-led engagement.”

“Relying on health systems is not enough. Look at health within the bigger frame of dignity. COVID exposed the rigidity and lack of flexibility in health systems. We should not rollback progress made with COVID but see it as an opportunity to move forward,” she concluded.

Image Credits: Paul Adepoju/HPW.