To date, 29-3-20, Pub Med has 1181 references on COVID 19 (1) and 45,569 references on drug users, (2) but if the two terms are crossed, there is no result (3) .
As in other fields linked to this recent epidemic, there is no evidence in the use of non-legal drug or drug users without a prescription. But it is certain that in the coming days care staff in contact with confined drug users will ask for instructions on how to care for this population in the period of mobility limitation.
Foundations of the proposals
The order of confinement is for the entire population, but active consumers prioritize their daily consumption. Therefore they will not non-conflictingly comply with the confinement if the needs of their consumption are not resolved.
The relationship should be non-conflict because expulsion is not an alternative when confinement is ordered and negotiation must be prioritized.
It is very important to maintain confinement, because turning to the black market – which does not adhere to rules or confinement – is extremely dangerous at the moment. There is no guarantee that the recommended distance between people and hygiene will not be maintained, as is usually very bad. A consumer who becomes infected in the black market can, after and during the asymptomatic phase, infect healthcare staff and others cared for on the same device where he or she resides.
The most effective negotiation on the topic of medication and dosage is rescue, which is quite common in hospital practice. Based on a fixed basic guideline and the possibility of changing it at the patient’s request.
To make the rescue pattern more objective, the pain measurement scale, commonly known as EVA, could be adapted to a medication comfort level.
Proposals
1. Avoid conflict
2. Rescue policy. It is easy to verify that users are infringed and accustomed to taking the medication given by their doctors and completing it
3. Facilitate initiation of methadone treatments
4. Try to reduce polyconsumption.
a) Replace Heroin with methadone, proposing to start low-dose treatment. Initial doses of methadone 20mgs and repeated doses of 20mgs on demand can be used to a) mitigate the withdrawal syndrome and b) meet the daily needs. Higher startup needs may need informed consent.
5. Convenience of reducing psychoactive drugs. A possible shortlist may be clonazepam (Rivotril), alpazolam (Trankimazin), gabapentin (Neurontin), and pregabalin (Lyrica). Convenience to slow down the dispersion
6. Enable smoking areas, inhaled and smoked drugs and consumption areas
7.In these times of exceptionality, the areas of intravenous consumption should not require the presence of health personnel. Reserved areas that consumers use under their responsibility can be enabled. Mainly outdoors and spacious.
8.All centers that qualify for consumer care should have naloxone kits, and caregivers – at least one per shift – should be given urgent training in morbid overdose care.
9. Cocaine use is not at risk of respiratory depression, but usually causes acute uncomfortable handling reactions that improve with diazepam under the tongue. (4)
10. The usual treatment of people infected with COVID 19, Hydroxychloroquine, Azithromycin, Kaletra has few interactions.
