COVID-19 and Substance Use Disorders: Recommendations to a Comprehensive Healthcare Response. An International Society of Addiction Medicine (ISAM) Practice and Policy Interest Group Position Paper

Abstract:Coronavirus disease 2019 (COVID-19) is escalating across the world with higher morbidities and mortalities in certain vulnerable populations. People who use drugs (PWUD) are a marginalized and stigmatized group with lower access to health care services, weaker immunity responses, vulnerability to stress, poor health conditions, and high-risk behaviors that put them at greater risk of COVID-19 infection and its complications. In this paper, an international group of experts on addiction medicine, infectious disease and disaster psychiatry explore the possible concerns raised and provide recommendations to manage the overlaps between COVID-19 and Substance Use Disorder (SUD).

Highlights

● Health care providers in treatment and harm reduction settings must always have PPE.

● Screening of PWUD with COVID-19 is a priority with respects to human rights.

● Creative, evidence based and realistic approaches are needed for the current situation.

● Virtual context and mobile base platforms could facilitate mainstream interventions.

● Different clinical manifestations and drug interactions are major issues in PWUD with COVID19.

Plain Language Summary

The new coronavirus created a complex situation for all sections of the communities around the world.

Health care providers are in the frontline of intervening to stop the spread of COVID-19. Meantime people who use drugs (PWUD) are at increased risk during this pandemic since they are a stigmatized and marginalized populations. Health service providers who are providing different needs for PWUD in treatment and/or harm reduction settings should always keep themselves safe with using standard PPE based on the WHO recommendations. Additionally PWUDs live in crowded locations and so screening and early identification of COVID-19 patients are important to break the cycle of transmission. It is recommended that protocols for opioid substitution therapy modify with complete adherence to patients' safety regarding both opioid drug risks and COVID-19 infections. It is important to have in mind that different stages of OST needs different approaches. PWUDs are more vulnerable to stress and other mental health problems.

This makes psychological interventions such as cognitive-behavioral therapy and other modalities very important to

have for PWUDs during these difficult and challenging times to assist and sustain treatment. Medical conditions such

as respiratory illness, renal insufficiency, chronic pain and cardiovascular disorders are also important medical conditions that should be addressed appropriately among PWUDs with COVID-19. Health service providers in both fields of addiction treatment and COVID-19 treatment and prevention systems should be aware regarding special situations arising in the overlap of drug use and COVID-19 illness.