Aronowitz Shoshana V, Engel-Rebitzer Eden, Lowenstein Margaret, Meisel Zachary, Anderson Evan, South Eugenia
University of Pennsylvania School of Nursing, Department of Family and Community Health, 418 Curie Blvd, Room 419, Philadelphia, PA, 19104-6021, USA.
University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
SSM Qual Res Health. 2021 Dec;1:100013. doi: 10.1016/j.ssmqr.2021.100013. Epub 2021 Sep 28.
The COVID-19 pandemic and ensuing service delivery interruptions had serious impacts on people who use drugs (PWUD) and people experiencing homelessness, including instability in the drug supply, decreased access to substance use disorder (SUD) treatment and harm reduction supplies, increased substance use and relapse due to stress and isolation, inability to properly isolate and quarantine without stable housing, and risk of COVID-19 spread in congregate living spaces. At the same time, many have noted a potential opportunity for rapid change in health, housing, and drug policy despite previous stagnation-referred to as a "punctuated equilibrium" by Baumgartner and Jones-in response to the pandemic. The pandemic forced some important policy interventions in the United States at both national and local levels, including eviction moratoriums and loosening of drug policy related to substance use treatment. However, to what extent some of these changes will be sustained past the current COVID-19 crisis is still unclear, as is how drug and housing related policy shifts have impacted the work of frontline overdose prevention, substance use treatment, and homelessness advocacy workers. In this qualitative study, we used semi-structured interviews to assess how Philadelphia's harm reduction advocates, community organizers, and SUD treatment clinicians have responded to the overdose and homelessness crises during COVID-19, and how they predict the pandemic and ensuing policy changes will impact the future of overdose prevention, harm reduction efforts, and homelessness advocacy. We interviewed 30 eligible participants during July and August 2020. The analysis of these data yielded three themes: 1/"None of it should be new to anybody": COVID-era issues impacting PWUD and people experiencing homelessness are extensions of existing problems; 2/"An opportunity to actually benefit in some way from this crisis": Possibility for innovation and improved care for PWUD and people experiencing homelessness; and 3/"Nothing we've tried has worked, so we have to be uncomfortable and creative": The uncertain path forward. Despite the many barriers that participants faced to promoting the health and well-being of marginalized communities during the pandemic, they also believed that the pandemic presented an important opportunity for positive policy change that has the potential to promote drug user health into the future, including a continuation of loosened federal restrictions on substance use disorder treatment, legalization of safe consumption spaces, safe supply of substances, and progressive, creative housing solutions.
新冠疫情及其带来的服务提供中断对吸毒者和无家可归者产生了严重影响，包括毒品供应不稳定、物质使用障碍（SUD）治疗及减少伤害用品的获取机会减少、因压力和隔离导致物质使用增加及复吸、没有稳定住房就无法进行适当的隔离和检疫，以及新冠病毒在集体生活空间传播的风险。与此同时，许多人指出，尽管此前一直停滞不前，但疫情可能为健康、住房和毒品政策带来迅速变革的机会——鲍姆加特纳和琼斯将其称为“间断性均衡”。疫情在美国国家和地方层面都促使了一些重要的政策干预措施出台，包括暂停驱逐令以及放宽与物质使用治疗相关的毒品政策。然而，这些变化在当前新冠疫情危机过后能在多大程度上持续尚不清楚，毒品和住房相关政策的转变对一线过量用药预防、物质使用治疗及无家可归者权益倡导工作产生了怎样的影响也不明确。在这项定性研究中，我们通过半结构化访谈来评估费城减少伤害倡导者、社区组织者和物质使用障碍治疗临床医生在新冠疫情期间对过量用药和无家可归危机的应对方式，以及他们预测疫情及随之而来的政策变化将如何影响过量用药预防、减少伤害工作及无家可归者权益倡导的未来。我们在2020年7月和8月采访了30名符合条件的参与者。对这些数据的分析得出了三个主题：1/“这对任何人来说都不应该陌生”：新冠疫情时代影响吸毒者和无家可归者的问题是现有问题的延伸；2/“从这场危机中切实受益的机会”：为吸毒者和无家可归者进行创新和改善护理的可能性；3/“我们尝试过的都没用，所以我们必须突破舒适区并发挥创造力”：前途未卜。尽管参与者在疫情期间为促进边缘化社区的健康和福祉面临诸多障碍，但他们也认为疫情为积极的政策变革提供了重要机会，有可能在未来促进吸毒者健康，包括联邦政府继续放宽对物质使用障碍治疗的限制、安全消费空间合法化、物质的安全供应以及渐进式、创新性的住房解决方案。
