My career has focused on advocating for the health of some of the most marginalized and ostracized people in our society.
I helped establish a center for women, the majority engaged in sex work, in southwest Baltimore called SPARC. The center has offered a number of basic services - like a place to shower, socialize and receive medication-assisted treatment. It provides syringe services, legal services, a food pantry, even yoga. I also sit on the board of the Harm Reduction Coalition, an organization that advocates and builds the capacity of community organizations to address the health needs of drug users in a way that emphasizes dignity and respect.
Many people have a visceral reaction to the idea that sex workers or people who use drugs deserve practical support. There is a tendency to see such populations through the prism of "otherness" - people who have just made bad choices and are really distinct from the communities where we live, work, socialize and raise our children.
Now the threats posed by an outbreak of a dangerous infectious disease are presenting a stark choice. It's testing our public health policies and, on a more fundamental level, our humanity.
We can allow the COVID-19 pandemic to greatly intensify the isolation of marginalized people in ways that will just further endanger their health and, to be blunt, likely kill many of them at higher rates than the general population. Alternatively, we can tap into the sense of communal responsibility generated by this pandemic and extend the boundaries of compassion. By doing so we can help drive support for practical interventions in the same way many of us are now seeking new measures to protect other vulnerable people in our midst - like our parents, grandparents and people with compromised immune systems.
For example, there has been a decadeslong effort to improve access to buprenorphine to treat opioid addiction. There are still far too many barriers, despite the abundance of evidence of efficacy. But the need today has never been greater. While it may not have made the list of many people's COVID-19 concerns, it soon could become a lot harder for users to obtain opioids like fentanyl. The option is either treatment, if available, or expand the hunt for drugs.
It turns out the center of the coronavirus outbreak, Wuhan, has also been a hub for fentanyl that has driven the opioid epidemic in America. On the face of it, this could slow its flow into the U.S., which is good. But it could also intensify the pursuit of drugs in ways that create larger concentrations of people seeking to purchase and use together. When staving off the agony of withdrawal, social distancing is likely to be the least of your concerns.
Governments can act now to expand access to safe opioids - notably methadone and buprenorphine. They can allow access to methadone outside of special methadone clinics and lift restrictions on providers that limit the number of patients they can support with a buprenorphine prescription. In leveling the playing field for all members of society, now is a good time to approach medications for treating opioid use disorders the same way we treat all other medications - as something to be prescribed and supervised by medical professionals, but not administered by them.
But we must also accept that not everyone is ready to seek treatment. And if we want to reduce infection risks, we need to ramp up other harm reduction interventions like syringe services, overdose prevention sites and access to things like food stamps and Medicaid - and without requiring drug testing. Currently, at least 15 states require some level of drug testing or screening for public assistance programs.
Meanwhile, sex workers and people who use drugs are highly mobile and often hidden populations. Effective interventions require mobile services that use vans equipped with everything from food to safe injection equipment to hygiene kits. In this current environment, our SPARC Center has established a hotline to connect people with necessary services. We're also focused on mental health and stress relief. We provide yoga and twerk workshops, online virtual services that help maintain a connection with people in need and normalcy.
The COVID-19 pandemic is demanding a lot from all of us and exposing weaknesses across society that have been allowed to fester for decades. But it's also an opportunity to embrace our better selves, both to reduce the spread of this disease and to affirm a more expansive sense of community. Many people have a hard time accepting the idea of services without judgement. The COVID-19 outbreak can help us all understand that this outlook is neither practical nor humane.
ABOUT THE WRITER
Susan Sherman (firstname.lastname@example.org) is a professor at the Johns Hopkins Bloomberg School of Public Health. Her work is focused on improving the health of marginalized populations, particularly that of sex workers and people who use drugs.
Visit The Baltimore Sun at www.baltimoresun.com
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