Substance use policy and practice in the COVID-19 pandemic: Learning from early pandemic responses through internationally comparative field data

摘要

The COVID-19 pandemic has created an unprecedented naturalexperiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures andsocial safety nets around the world. Using qualitative data includingethnographic methods, questionnaires, and semi-structured interviewswith people who use drugs (PWUD) and Delphi-method with expertsfrom field sites spanning 13 different countries, this paper comparesnational responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of socialscientists, public health scientists, and community health practitionersconvened to identify and contextualise health service delivery modelsand social protections that influence the health and wellbeing of PWUDduring COVID-19. Findings suggest that countries with stronger socialwelfare systems pre-COVID introduced durable interventions targetingstructural drivers of health. Countries with fragmented social serviceinfrastructures implemented temporary initiatives for PWUD led by nongovernmentalorganisations. The paper summarises the most successfulearly pandemic responses seen across countries and ends by calling forgreater systemic investments in social protections for PWUD, diversionaway from criminal-legal systems toward health interventions, andintegrated harm reduction, treatment and recovery supports for PWUD.