We are also aware of the further dangers faced by socially excluded groups, already enduring poor health outcomes and having poor access to healthcare services. We know that restrictions in services and in contacts with vulnerable people are exacerbating the everyday life challenges faced by people with substance use problems. People who are homeless and people who use drugs often have multiple comorbidities and early mortality compared with the general population.1 The older cohort of opioid users are particularly vulnerable because of their high level of pre-existing health problems. There is a high prevalence of chronic obstructive pulmonary disease, asthma, and cardiovascular disease among people who inject drugs and use cocaine. These chronic medical conditions will put clients of drug treatment services at particular risk for serious respiratory illness if they become infected with Covid-19.
These are the marginalised groups most relevant to the concept of inclusion health. This is an approach to health service delivery and research that emphasises the need to arrange healthcare to improve outcomes for the most at-risk groups in society. At a time like this, we also recognise it is not just a social exclusion or human rights issue. The vulnerabilities of one group affect us all, and the current crisis will not pass until all are free from risk. The values that underpin the idea of inclusion health are essential to the idea of public health.
This is also a time in which we are keenly aware of the importance of accurate, scientifically based, and credible information. Evidence must be communicated freely and clearly so that all citizens can play their part in responding to the
crisis. International health institutions, monitoring agencies, and non-governmental organisations have produced guidelines, assessments of the situation, and advice that will prove valuable to all those who provide services to those most at risk of harm from drug use. These organisations have been enabled to produce these resources because they draw on a solid base of knowledge created by epidemiologists, treatment specialists, and others in the health, social science, and policy fields.2 Using this evidence effectively will be essential to achieving good outcomes for our most marginalised citizens in the days and weeks ahead.
1 Ní Cheallaigh C, Cullivan S, Sears J, et al. (2017) Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study. BMJ Open, 7(11). https://www.drugsandalcohol.ie/28307/
2. The National Drugs Library has combined all the Covid-19-related material in its repository and made these available through a
special link on the homepage of the library website. https://www.drugsandalcohol.ie/31779/
