The Covid-19 induced restrictions observed to have affected people who use drugs (PWUD) considerably. The apprehension of their facing withdrawals for not getting drugs and alcohol surfaced among concerned social activists. Media reports indicated that the situation prompted a lot of them to get their regular routine substances at a steep premium, and splashed pictures of long ques of people braving the heat and humidity to collect a rationed supply of alcohol from off-shops in cities and suburbs, once state administrations eased closure restriction of those shops. Simultaneously, with illicit drug supply getting affected, many users thronged the opioid substitution therapy centers for availing free buprenorphine to minimize their cravings for substances as reports from the north and western states came out in media.

Notably, the UN report published in 2019, indicated a 30 percent increase in drug use in India. Also, the National Drug Dependence Treatment Centre report published in the same year indicated that India had close to 2.6 crores people who have used or use opioids, more than 60 lakhs of them suffer from opioid use disorders. States like Punjab, Delhi, Uttar Pradesh, Maharashtra, Rajasthan, Andhra Pradesh, and Gujarati contribute to more than half of the people suffering from opioid use disorder. Again, sedative and inhalants affect around 1.18 crore people, including 4.6 lakhs children, hooked to inhalant use. Uttar Pradesh, Madhya Pradesh, Maharashtra, Delhi, and Haryana have a very high child population in need of help as a result of substance use. Injecting drug use through syringes and other mediums affect over 8.5 lakhs people, with an estimated 48% brown sugar/heroin use, 46% buprenorphine use, and rest of over-the-counter pharmaceutical drug use. Injecting drug use, reported early in the northeastern states at alarming proportion, but subsequently spread to Uttar Pradesh, Punjab, Delhi; and some extent in Gujarat and West Bengal. Alcohol use in India spread among 14.6% of the total population i.e. around 16 crore people, of whom nearly 6 crore people suffer or need the help of harmful/dependent alcohol use or in other words 1 out of 3 alcohol users affected. Though prevalent across, but states namely Uttar Pradesh, Chattisgarh, Tripura, Punjab, Goa, and Andhra Pradesh have the most prevalent alcohol use, the report indicated.

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The current public health crisis raises serious additional concerns for the wellbeing of PWUD, ensuring service continuity for those with drug problems, and the protection of those offering care and support for this population. While PWUD runs the same risks of infection by COVID-19 as the general population, they also face additional risks due to underlying chronic medical conditions associated with some forms of drug use and increase the risk of developing severe illnesses. The health status, needs, and behaviors of those who use illicit drugs leave them particularly vulnerable because of the high prevalence of chronic medical conditions among PWUD. Many will be at particular risk for serious respiratory illness if they get infected with COVID-19. Examples of this include the prevalence of chronic obstructive pulmonary diseases (COPD) and asthma among smokers of heroin, high incidence of cardiovascular diseases and septicemia among injecting drug users, methamphetamine users’ potential risk of blood vessels constriction led pulmonary damage. Studies have evidently proved the opioid use interference with the immune system, along with smoking of tobacco and nicotine dependence poses the potentiality of more negative outcomes.

Doctors attending de-addiction centers pointed out that the risk of a drug overdose may be increased among PWUD who are infected with COVID-19. The main life-threatening effects of an opioid, such as heroin or brown sugar, are to slow down and stop a person from breathing. Because COVID-19 (like any severe infection of the lung) can cause breathing difficulties, there may be an increase in the risk of overdose among opioid users. Sharing drug-using equipment may increase the risk of infection with blood-borne viruses, such as HIV and viral hepatitis B and C, the sharing of inhalation, vaping, smoking or injecting equipment contaminated with COVID-19 may increase the risk of infection and play a role in the spread of the virus, they added.

Health experts opine that essentially, the addict’s body is already fighting one war against toxins, and introducing a deadly virus is a recipe for disaster. Substance abuse and COVID-19 share a lot of the same underlying health conditions, which independently increase the risk of mortality in each. When these issues are combined, the overall mortality risk would be exponentially larger. Since pneumonia can be caused by opiate abuse, one who then contracted the virus would be at higher risk of mortality from it, as well as increased risk of overdose death from the opioids. Given the scenario, it only makes sense that one would consider substance abuse to be one of the underlying conditions, which makes COVID-19 more deadly. Evidentially most PWUD are generally not healthy and can often be malnourished. And when one considers opioids or its adulterated derivatives use in India, it makes it even worse. These drugs have a profound and direct impact on the respiratory system, reducing lung function up to the point of death, much like COVID-19.

Currently, those who might wish to seek treatment during this time are in quite a quandary. Reportedly, 25 government hospital set-ups are there for treating PWUD with around 378 Drug De-addiction cum rehabilitation centers run by NGOs under the aegis of Union ministry of social justice and empowerment function currently in 23 states, plus 2 union territories and national capital territory. But none of them pose the capacity to withstand a viral assault like COVID-19 because their model is the virtual antithesis of social distancing. People live in a near communal setting at inpatient facilities, and outpatient programs mainly consist of “group” where many patients gathered together for group therapy. In the light of the COVID-19 outbreak, many of these centers had withheld new admission for the first two months, but reportedly are admitting patients through screening. Ministry issued guidelines on Alcohol user and geriatric patients on its website, but no advisory and guidelines on other substance use patients. Resultantly, some of the Deaddiction centers spoken to had initially stopped the intake of new patients during March, and April but they are currently admitting patients gradually with their self-developed precautionary measures, as some the center managers of east and north-east India indicated. The state-level coordinating agency (SLCA) too failed to guide the NGOs, as learned.

Fortunately, a patient receiving Opioid Substitution Therapy, managed by the ministry of health and family welfare through National AIDS Control Organization wing issued detailed advisory and guidelines that allowed OST centers to dispense maximum seven days medicine dose to PWUD at one time – relaxing the DOTS norms to start ‘take-home dose’ policy to facilitate patients.

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In the perspectives of the above, things do not portend well for those struggling with substance use disorders. A pandemic like COVID-19 can and will expose the weaknesses in the nation’s major systems, such as healthcare. While many may think that this is the worst possible time to seek treatment, it could be more dangerous not to. Center for Disease Control suggested that people with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms. Given the outlook, it may also be safe to consider substance abuse as one of the “underlying conditions” that increase one’s risk during these trying times, making treatment potentially lifesaving in more ways than one. Thus, concerted efforts of all stakeholders required at the earliest to evolve methodologies as to how the existing functioning model of drug de-addiction centers of the country can manage at maintaining social distancing norms, in the interest of patients and their caregivers.

© The Eastern Herald

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The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Eastern Herald. Any content provided by our authors or writers are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual, or anyone or anything.

About author:

PhD (sociology), PG in Reproductive & Child Health. Research Scientist, ICMR National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata. Contributor to The Eastern Herald.

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