By Dainius Pūras, UN Special Rapporteur on the right to health / OHCHR

In the current COVID-19 context, people who use drugs face unique needs and risks, due to criminalisation, stigma, discrimination, underlying health issues, social marginalisation and higher economic and social vulnerabilities, including a lack of access to adequate housing and healthcare. Treatment and harm reduction services should continue to be provided to them.

16 April 2020 - COVID-19 is now a global public health emergency posing unprecedented challenges, creating new vulnerabilities, and exacerbating existing ones. The situation presented by the COVID-19 pandemic requires countries to take extraordinary measures to protect the health and well-being of the population. COVID-19 will impact each country differently depending on the health infrastructure, the spread of the virus, the political, economic and social context, as well as the country’s preparedness.

As COVID-19 spreads, all our efforts should be focused on slowing down its spread and ensuring that the most vulnerable people receive the protection and care they are entitled to. Preventing the spread of this virus requires outreach to all, and ensuring equitable and non-discriminatory access to information, prevention, medical care and treatment for all persons, irrespective of their citizenship, nationality or migratory status.

Everyone, without exception, has the right to life-saving interventions and this responsibility lies with the national authorities. It is essential that governments introducing measures to impede the spread of the COVID-19, undertake a range of additional actions to reduce the potentially negative impact such measures may have on people’s lives.

In accordance with the World Drug Report 2019 globally, some 35 million people, up from an earlier estimate of 30.5 million reported in 2016, are affected by drug use disorders and require treatment and harm reduction services. The latest available data indicates that the death toll has been also higher: 585,000 people died as a result of drug use in 2017. In the current COVID-19 context, people who use drugs face unique needs and risks, due to criminalisation, stigma, discrimination, underlying health issues, social marginalisation and higher economic and social vulnerabilities, including a lack of access to adequate housing and healthcare. Vulnerable groups of people who use drugs should be recognised as a high-risk population in order to mitigate the spread of the pandemic.

OHCHR: Statement by the UN expert on the right to health on the protection of people who use drugs during the COVID-19 pandemic

Harm reduction organizations, providers, experts and advocates from across the US are calling on government agencies to eliminate the notoriously burdensome restrictions imposed on medication-assisted treatment (MAT) for opioid use disorder—a move they say would mitigate the dual crises of overdose and coronavirus.

Led by the Urban Survivors Union (USU), a national drug users’ union, the vast coalition has published recommendations on MAT delivery, access and prescriptions during the coronavirus pandemic for the Substance Abuse and Mental Health Administration (SAMHSA), the Drug Enforcement Administration (DEA) and other agencies.

The coalition’s demands come as federal agencies have loosened their stringent MAT rules and guidelines. The DEA has green-lit the use of telemedicine for prescribing buprenorphine and the addition of off-site locations for methadone delivery by opioid treatment programs. SAMHSA has increased the availability of methadone take-home doses.

While the coalition describes these changes as “a step forward,” it notes that many methadone clinics have not implemented the new federal guidelines. 

 has described how clinics may deem that take-homes should only be offered to certain patients who meet stringent and problematic criteria. The coalition calls for all clinics to allow the maximum allowable take-home doses for methadone patients and also details several ways that these guidelines could be modified even further (for example, allowing methadone to be dispensed in non-clinic settings).

“Treatment on demand could end the overdose crisis as well as substantially help flatten the curve of new COVID-19 cases,” said Jess Tilley, a leader with USU. “Both continue to claim lives at a shocking rate every day in this country.”

Some people “are still attending [clinics] daily” USU member and methadone patient Nick Voyles told

 of Indiana, where he lives. By requiring frequent attendance, these clinics are still “putting patients at risk for exposure” he pointed out. “You can’t social distance and tell someone to go to a clinic everyday.”

Vast coalition issues demands for far-reaching MAT reform in the US

By Rick Lines, Naomi Burke-Shyne & Giada Girelli / 

“In every situation, where a number of people are crowded together, whether in ships, hospitals, or prisons, unless the strictest attention be paid to cleanliness, and to a free ventilation or circulation of air, a fever soon or later breaks out amongst them, of a very contagious nature, and attended with very fatal effects”.So begins the account of Dr James Carmichael Smyth of an outbreak of jail distemper (typhus) in Winchester prison in England in 1780. Over the course of three and half months, 268 Spanish prisoners of war died, with Smyth himself surviving two separate bouts of the disease while caring for the sick men.

The rapid spread of contagion and death among prisoners was not a new phenomenon. The first documented outbreak of ‘gaol fever’ in England took place in Newgate and Ludgate Prison in 1414, resulting in the deaths of 64 prisoners and gaolers. Almost 50 recorded outbreaks of fever in British prisons predate the Winchester events described by Dr Smyth, resulting in the deaths of thousands.

Nearly 250 years later, the prisons of the world are struggling to address a new ‘gaol fever’ that threatens to dwarf the impacts of previous historic contagions—COVID-19. With physical distancing core to the COVID-19 response—an impossibility in most places of detention—the health risks of congested prisons have again come to the fore. Poor and overcrowded conditions of detention, coupled with a detainee population that often suffers from multiple heath vulnerabilities, have long made prisons susceptible to rapid spread of disease and death. The highly contagious nature of the COVID-19, its global spread, and the worrying levels of mortality associated with it, have therefore raised widespread concern.

The relationship between prison health and public health is well established. In many of the historic cases of gaol fever the contagion spread beyond the prison walls into surrounding towns and villages.In more recent years, transmission of both HIV and TB has been documented in prisons, raising wider public health concerns about the role of incarceration in sustaining those epidemics. For this reason, protecting people in detention from the spread of COVID-19 must form an integral element of the global response to the virus.

Gaol fever: What COVID-19 tells us about the war on drugs

“Marijuana is the drug for which most kids get penalized in school settings,” Sheila Vakharia, deputy director of the Department of Research and Academic Engagement at the Drug Policy Alliance (DPA), tells 

The War on Drugs disproportionately impacts Black and Brown youth in schools, like it disproportionately impacts their older relatives and neighborhoods overall. But young people may have more to lose than adults because drug criminalization often leads to school suspension and expulsion, even in states with more progressive cannabis reform.

As recreational legalization measures sweep the nation and CBD-infused products proliferate, young people are still negatively impacted by cannabis policing. This is also true in states that have legalized pot. According to 2018 policing data compiled by the state of Colorado, drug-related infractions made up approximately 5-6% of all student suspensions, but cannabis accounted for about 70% of suspensions or expulsions for drugs, and almost 80% of law enforcement referrals for drugs in the 2017-2018 school year.

Young people don't seem to be consuming cannabis more widely these days. According to a 2018 DPA report, “Preliminary data suggest that youth marijuana use rates have remained stable and have actually gone down in some cases, both nationally and in states that have legalized marijuana for adults.” Additionally, despite the presumption that cannabis use among minors would increase as states passed recreational measures, research has shown that has not been the case. In Washington, where adult retail marijuana sales were legalized in 2012, the state’s largest metropolitan county saw a decline in marijuana use among students in grades 6, 8, 10, and 12, according to 2019 research from the Centers for Disease Control and Prevention.

United States: Black and Brown teens are still more likely to be punished for smoking weed

By Carrie Tait, Marcus Gee & Andrea Woo for The Globe and Mail

Physicians across the country are relaxing their prescribing practices around medical treatment for opioid addictions in a bid to bolster physical distancing by cutting down on urinary drug screens and increasing the amount of methadone they give patients to take at home without supervision.

Health care professionals specializing in drug addictions were already struggling to cope with an epidemic of overdoses that has claimed thousands of lives across Canada before the worldwide pandemic. Now, the novel coronavirus is upending years of medical tradition and adding another layer of risk.

Doctors, nurses and harm-reduction experts are concerned their clients will catch the virus and succumb to it, given the often shaky health of those who use drugs. Access to supervised consumption sites for illicit substances and detox centres is also contracting, putting people who use street drugs at greater risk of overdosing.

Health Canada last month relaxed prescribing rules for some controlled drugs, making it easier for doctors and pharmacists to give people access to opioids. The changes mean some patients in opioid agonist therapy (OAT) programs will not have to make as many trips to pharmacies and clinics. It also means some OAT patients will have more access to larger quantities of medicine like methadone that can be fatal if not taken properly.

Patients in OAT programs take controlled doses of drugs such as methadone and buprenorphine-naloxone, which is known as suboxone, to manage opioid-withdrawal symptoms and create stability in their lives. Patients, particularly those on methadone, often have to take their doses under supervision at pharmacies or clinics. Stable patients are, over time, permitted to take home a limited number of doses, known as carries, but even the most trusted generally return to the clinic or pharmacy once a week for a supervised dose.

Canada: Pandemic restrictions reshape opioid treatment as doctors sound alarm

The governor of the U.S. state of Virginia has approved a law that removes all criminal penalties for simple cannabis possession.

This is not legalisation, but decriminalisation. The new law (HB972), which will take effect from July 1, means that possession of up to one ounce of cannabis will no longer be a criminal offence and can only be met with a civil penalty – a fine of up to $25 (£20). Until now, a first-time cannabis possession offence could be punished by up to 30 days’ imprisonment and a $500 (£400) fine. Possession of more than an ounce, or the sale of any amount, remain criminal offences that can garner several years imprisonment.

The criminalization of cannabis has had a significant impact on the population of Virginia, particularly in recent years. According to the Virginia State Police, there were almost 29,000 arrests relating to cannabis in 2019 – of which more than 50 per cent involved people under the age of 24.

Perhaps the most disproportionate impact of criminalization has been that imposed upon Virginia’s Black communities. Despite making up less than 20 per cent of the state population, Black people make up 45 per cent of first-offence cannabis possession arrests in Virginia between 2007 and 2016. For subsequent cannabis possession offences, that proportion rises to a staggering 53 per cent.

It’s a similar story to the manifestation of the drug war across the U.S. As the Drug Policy Alliance has found, Black people and other people of colour use and sell drugs at similar rates to white people, yet “they are more likely to be stopped, searched, arrested, convicted and harshly sentenced, [and] they suffer most from the repercussions of a lifelong criminal record”.

Indeed, the impact of a drug conviction, however minor, can be wide-reaching in its harms beyond incarceration, creating barriers to education, housing, and employment. This can lead to a cycle of poverty, impacting people’s children and families, spurring ripple effects that harm entire communities.

Virginia passes cannabis decriminalisation amid huge racial disparity in arrests

Experts concerned heroin users will turn to more dangerous fentanyl

Drug treatment experts have raised concerns a drop in the supply of illicit drugs to the UK triggered by the lockdown is leading to an increase in the number of users turning to more dangerous alternatives.

A reduction in global travel, increased border restrictions and a slowdown in movement within the UK has resulted in a drop in the supply of illicit drugs, including heroin and the designer drug spice.

The Guardian understands that border guards have noted a recent drop in seizures as traffic into the country subsides, while senior police sources have noted the dip in supply.

But experts have warned that fewer drugs on the streets is not as positive as it sounds, as users are already turning to high-strength alternatives such benzodiazepines, while there is a significant risk of heroin users substituting with fentanyl, a lethal drug 50 to 100 times stronger than heroin.

The number of drug-related deaths is at a record high, according to the most recent official estimates, driven by deaths linked to drug misuse.

The reduced supply is also leading to an increase in the price of some substances, including cannabis, and decreasing the purity of others as dealers cut them with different chemicals to increase bulk, experts have told the Guardian.

Coronavirus triggers UK shortage of illicit drugs

In mid-March, as the Covid-19 pandemic was accelerating, Shantae Owens found a man unconscious in a public bathroom in Tompkins Square Park, in New York’s East Village. Owens wasn’t surprised at his discovery. He was on street outreach distributing naloxone, which helps reverse opioid overdoses, as well as syringes, condoms, and other health supplies. He administered naloxone and called 911. The ambulance took longer to arrive than usual.

Owens is an outreach worker with the Lower East Side Harm Reduction Center, which has temporarily stopped doing outreach due to Covid-19-related safety concerns. But he still covers the parks, public restrooms, and drug houses of the South Bronx, Washington Heights, and Lower Manhattan as a volunteer with VOCAL-NY, a grassroots organization that grew out of the AIDS epidemic and is staying open during the lockdown. Many harm reduction programs are still running as essential services, though others, such as those that operate out of county health departments, like Michigan’s, are now largely closed because of Covid-19. Owens is concerned about what the lockdown will mean for drug users—in particular, for people who use opioids and are at high risk of fatal overdose. “We fear that overdose is going to rise,” Owens told me, “because there’s not enough services. We’ve already lost so many people to the overdose crisis.”

Around the country, organizations that work to reduce drug-related harms such as overdose, HIV, and hepatitis C are now facing yet another devastating virus. And for active drug users, people in drug treatment, and people without stable housing, business closures and physical distancing mandates are causing a cascade of economic and practical difficulties that compound health dangers. “I worry for my community,” said Kelly Culbert, who works at NYHRE, an East Harlem harm reduction center that has closed temporarily. “They’re scared. They have very little access to equipment [for safer drug use]. And everything has become more problematic—from the ways people were making their money to locating a dealer and that person having an adequate supply. It’s all become riskier, less available.”

US: The challenge of treating 2 epidemics at once

В нынешнем контексте коронавирусной инфекции COVID-19 люди, употребляющие наркотики, сталкиваются с уникальными потребностями и рисками из-за криминализации, стигмы, дискриминации, сопутствующих проблем со здоровьем, социальной маргинализации и более высокой экономической и социальной уязвимости, включая отсутствие доступа к адекватному жилью и медицинскому обслуживанию. Необходимо продолжить предоставлять им услуги по лечению и снижению вреда.

16 апреля 2020 – В настоящее время коронавирусная инфекция COVID-19 является глобальной чрезвычайной ситуацией в области общественного здравоохранения, создающей беспрецедентные проблемы и новые уязвимости, а также усугубляющей уже существующие. Ситуация, вызванная пандемией COVID-19, требует от стран принятия чрезвычайных мер для защиты здоровья и благополучия населения. COVID-19 по-разному повлияет на каждую отдельную страну в зависимости от инфраструктуры здравоохранения, распространения вируса, политического, экономического и социального контекста, а также от подготовленности страны.

По мере распространения коронавирусной инфекции COVID-19 все наши усилия должны быть направлены на замедление ее распространения и обеспечение того, чтобы наиболее уязвимые люди получали защиту и уход, на которые они имеют право. Предотвращение распространения этого вируса требует всеобщего охвата и обеспечения справедливого и недискриминационного доступа к информации, профилактике, медицинскому обслуживанию и лечению для всех людей, независимо от их гражданства, национальности или миграционного статуса.

Заявление эксперта ООН по праву на здоровье о защите людей, употребляющих наркотики, во время пандемии COVID-19

By Eva Vergara & Maria Verza / Associated Press News

The spreading specter of the new coronavirus is shaking Latin America’s notoriously overcrowded, unruly prisons, threatening to turn them into infernos.

The Puente Alto prison in downtown Santiago, Chile, had the largest of Latin America’s largest prison virus outbreaks so far, with more than 300 reported cases. The prison’s 1,100 inmates are terrified. Social distancing is hard to practice in jail.

“They are all in contact with each other,” said prison nurse Ximena Graniffo.

Any efforts at reducing contact were blown away in El Salvador over the weekend when authorities crammed prisoners — albeit wearing masks — tightly together in prison yards while searching their cells. President Nayib Bukele ordered the crackdown after more than 20 people were murdered in the country Friday and intelligence suggested the orders came from imprisoned gang leaders.

Latin America’s prisons hold 1.5 million inmates, and the facilities are often quasi-ruled by prisoners themselves because of corruption, intimidation and inadequate guard staffs. Low budgets also create ideal conditions for the virus to spread: There is often little soap and water and cell blocks are crowded.

Virus spreads fear through Latin America’s unruly prisons

By Giada Girelli / Harm Reduction International

In a mere few weeks, COVID-19 has drastically reshaped our way of living and has brought to light the many limitations of how societies detain and incarcerate people.

With physical distancing in prisons nearly impossible, prisons have rightly become a central topic of conversation. Overcrowded and lacking in basic hygiene and sanitation, they are inadequate to protect the health of prisoners and staff, and are thus reservoirs for the spread of communicable diseases like COVID-19. Approaches to other detention settings, such as immigration or juvenile detention centres, are also being scrutinised.

But there is one detention setting that has been virtually absent from media coverage and policy discussion, despite imposing conditions of detention that are, in some cases, even worse than prison – drug detention and rehabilitation centres.

Drug Detention Centres Operate Around The World

Information on drug detention centres is disturbingly scarce. Over 450,000 people are estimated to be detained in government-run drug treatment facilities in Asia alone – that’s close to half a million people in just one continent, who we have little data about. And this figure doesn’t include private drug treatment and rehabilitation centres which operate around the world, in addition to or instead of public centres.

Most of the people at these drug detention and rehabilitation centres have ended up there involuntarily. Some have been mandated to be ‘rehabilitated’ after a conviction for drug use or drug possession, while others have been detained following mandatory drug testing or as a result of reporting by family members to the authorities


COVID-19 decarceration: The detention centres nobody is talking about

People being treated for opioid addiction risk relapsing without changes in their support and treatment during the COVID-19 pandemic.

Royal Australasian College of Physicians spokesman and president-elect of the Chapter of Addiction Medicine Professor Nicholas Lintzeris said the outbreak has had a huge impact on the 50,000 patients who use methadone or buprenorphine as treatment for their opioid dependence.

“Traditionally that usually meant patients got to a clinic, pharmacy or hospital, four, five, six, seven days a week in some cases,” he said.

“That might be fine under normal circumstances but in the context of COVID-19 that’s a model that doesn’t really work that well.”