Marginalised groups are among people the hardest hit by the COVID-19 pandemic, and yet are among the least protected from it by governmental actions to date. Indeed, the COVID-19 crisis has brought into sharp focus the stark inequities that exist in access to health and social support services for marginalised people who live precariously in Europe, often outside formal healthcare systems and social, labour and legal protection measures.
The Nobody Left Outside coalition has developed this briefing paper for the WHO European Office for Investment for Health
(C-EHRN) report on the impact of COVID-19 on vital
harm reduction services seeks to bring these voices
of front-line workers at drug consumption rooms
(DCR’s), harm reduction outreach teams and
PWUD themselves to highlight their experiences
during the COVID-19 pandemic.
Prevalence studies of current smoking, among hospitalized COVID-19 patients, demonstrated an unexpectedly low prevalence among patients with COVID-19. The aim of the present study was to evaluate the effect of smoke from cigarettes on ACE-2 in bronchial epithelial cells. Normal bronchial epithelial cells (H292) were exposed to smoke by an air-liquid-interface (ALI) system and ACE-2 membrane protein expression was evaluated after 24 hours from exposure. Our transcriptomics data analysis showed a significant selective reduction of membrane ACE-2 expression (about 25%) following smoking exposure. Interestingly, we observed a positive direct correlation between ACE-2 reduction and nicotine delivery. Furthermore, by stratifying GSE52237 as a function of ACE-2 gene expression levels, we highlighted 1012 genes related to ACE-2 in smokers and 855 in non-smokers. Furthermore, we showed that 161 genes involved in the endocytosis process were highlighted using the online pathway tool KEGG. Finally, 11 genes were in common between the ACE-2 pathway in smokers and the genes regulated during endocytosis, while 12 genes with non-smokers. Interestingly, six in non-smokers and four genes in smokers were closely involved during the viral internalization process. Our data may offer a pharmaceutical role of nicotine as potential treatment option in COVID-19.
In some countries, there has been a positive recognition to the needs of people sleeping rough and their vulnerabilities during a public health emergency. It is incumbent upon governments to work with local partners to ensure that rapid responses to the housing of people sleeping rough addresses the often complex needs of such people through an interdisciplinary approach so that their immediate and longer-term medical, psycho-social and economic needs are integrated into the provision of accommodation. This can be accomplished through partnerships built with other stakeholders during normal times and by having multidisciplinary teams, that include mental health staff, working on the streets with people sleeping rough. Such responses to homelessness and rough sleeping during a public health emergency is an opportunity to advocate at all levels of government for a longerterm strategy to comprehensively and holistically address such issues, together with long-term sustainable funding to implement such a plan. Furthermore, it is vital to ensure that there is a buffer stock of vital medicines already in-country for at least the forthcoming 3-6 months; this applies to all sectors of society and particularly those medications most in need by vulnerable and marginalised individuals and communities – including the treatment of TB and HCV (especially Direct-Acting Antivirals) as well as for HIV (antiretrovirals) and Opioid Substitution Therapy (OST, meaning methadone and/or buprenorphine), as well as naloxone for opioid overdose.
Please note: there are various version of this report if you click on the file!
This is the second civil society-led monitoring report produced by Correlation – European Harm Reduction Network (C-EHRN) within the context of our operational grant from the European Commission. The purpose of this report is to enrich the information and knowledge base of harm reduction interventions in Europe from the viewpoint of civil society organisations. We believe that this approach is a necessary, and useful, contribution to the development of drug policy in the region. We learned a lot from the former process and the 2019 edition and modified the approach, the focus and certain questions to enable respondents to report closer to their own experiences. Consequently, the information provided in this report sometimes represents the situation in a particular city or region and informs us as to the experiences of a specific organisation in the field. Such ‘real life’ information can contribute significantly to an understanding of the advantages, barriers and challenges of drug policy. Even stronger, we directly approached representatives of networks and organizations of people who use drugs to share their view on the developments with us. 2020, however, was not a regular year and the world wide pandemic had its influence on people, organisations and the care system in general. Accordingly, we added a section on the impact of COVID-19 on harm reduction services and we will continue to measure this impact. We will use the insights and information collected in this report within our advocacy efforts to strengthen harm reduction policies in Europe and, we hope, our partners and contributors will do the same in their environment at a regional and national level. More than one hundred organisations and individuals from 34 European countries have contributed to the collection of data with an amazingly high response rate; we thank all contributors for their great work and commitment. Without their engagement, this work would never have been undertaken at all. In particular, we would like to thank the authors of this report, Rafaela Rigoni, Tuukka Tammi, Daan van der Gouwe, and Victoria Oberzil, who were supported by the coordinators of the expert groups and the reviewers of this report. We are also grateful to HRI and Robert Czack for contributing with a chapter to this report. A special thanks to Dagmar Hedrich and her EMCDDA colleagues for their ongoing and patient support. We thank the European Commission, DG Sante, for their financial support and to the Regenboog Groep, Amsterdam, for their ongoing support of Correlation – European Harm Reduction Network
A growing number of highly potent substances that pose a high risk of acute poisoning are also being reported. These include synthetic cannabinoids, opioids, benzodiazepines and a range of other substances.
The COVID-19 pandemic has brought into sharp focus the importance of ‘complex, transboundary, multifactorial’ approaches to tackling health challenges, the need to strengthen health security and the interconnected nature of health in our globalised world.
The effect of the pandemic on the drug situation, including the new psychoactive substances market, is likely to become increasingly important as countries in Europe face the second wave of the outbreak during autumn and winter 2020 and into 2021.