By Ernst Wisse et al. / International Journal of Drug Policy

COVID-19 holds the world in a tight grip. In these unprecedented times, health and health-system capacities have been on the top of the global agenda for several months. Many countries have rolled out far-reaching prevention measure such as physical distancing and ‘lock- downs’ to prevent (further) overwhelming of health system capacities.

In many contexts, people who use drugs are a vulnera- ble population, prone to poor access to health services com- pounded by criminalization, and stigmatisation in health-care settings.( UNAIDS, 2019 ) , ( Van Boekel, Brouwers, Van Weeghel & Garretsen, 2013 ) This is illustrated in poor health outcomes and persisting high risk of infectious diseases. For instance, people who inject drugs are left behind in the progress of the global HIV re- sponse with less than 1% living in a country with high level of critical prevention services, such as access to sterile syringes and low-threshold opioid treatment programmes or opioid agonist therapy (OAT).

Marginalised and criminalised communities have greater challenges accessing health services.( UNAIDS, 2019 ) Consequently, a health sys- tem under too much pressure would likely disproportionally impact peo- ple with already established barriers, such as people who use drugs. Looking back at the conceptual building block framework, the notion of equity has been explicitly integrated in the goals of improved health outcome. This underlines that perhaps health systems have a tendency to ‘serve the mass’, and additional attention is needed to ensure equi- table access for all, including criminalised and marginalised communities such as people who use drugs.