Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19.

Alison Munro,Jason Tang,Hazel Booth,Joan Love,Steve Macgillivray,Andrea R M Mohan,Nicola M Gray

doi:10.3390/ijerph18168470

Abstract

People who use drugs (PWUD) experience many social and health harms and are considered at greater risk of acquiring COVID-19. Little research has examined the impact of coronaviruses either on PWUD, or on services targeted to PWUD. We report the findings of a systematic review of empirical evidence from studies which have examined the impact of coronaviruses (Severe Acute Respiratory Syndrome (SARS-CoV-1) and Middle Eastern Respiratory Syndrome (MERS-CoV) and COVID-19) on PWUD or on service responses to them. Five databases were searched (MEDLINE, PsycINFO, CINAHL, ASSIA and EMBASE) as well as COVID-19 specific databases. Inclusion criteria were studies reporting any impact of SARS, MERS or COVID-19 or any service responses to those, published between January 2000 and October 2020. Weight of Evidence judgements and quality assessment were undertaken. In total, 27 primary studies were included and grouped by seven main themes: treatment/recovery services; emergency medical settings; low-threshold services; prison setting, PWUD/substance use disorder (SUD) diagnosis; people with SUD and HIV; ‘Sexual minority’ men. Overall, research in the area was scant, and of average/poor quality. More robust research is required to inform on-going and future responses to coronavirus epidemics for PWUD.

Highlights

Published: 11 August 2021Globally, there are an estimated 35.6 million people experiencing ‘drug use disorders’ [1] [2]
Six of the eight studies sought the views of people who use drugs (PWUD) regarding the impact of the COVID-19 pandemic [36,37,42,53,54,61]
This study demonstrated that urine drug test positivity in a population diagnosed with or at risk of substance use disorders increased significantly for illicit cocaine, fentanyl, heroin, and methamphetamine from the 4 months before the COVID-19 emergency declaration to the 4 months after the COVID-19 declaration

Summary

Introduction

There are an estimated 35.6 million people experiencing ‘drug use disorders’ [1] (defined as ‘intoxication by, dependence on, or regular, excessive consumption of psychoactive substances’) [2]. The most common used drug globally is cannabis and drug markets are changing in terms of increased use of amphetamines and of synthetic substances, those that are associated with most health-related harm are opioids [1]. As well as DRDs, people who use drugs (PWUD), experience multiple social and health harms, including blood borne viruses (BBV) infections and are, in general, at elevated risk of premature mortality compared to other groups [3]. Within the UK, Scotland has the highest rate of DRDs of any European country at 0.18 per 1000

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