Addressing co-occurring public health emergencies: The importance of naloxone distribution in the era of COVID-19.

Until recently, the overdose crisis has been at the forefront of public health efforts in the United States (US). However, with the COVID-19 pandemic and rapid rise in cases across the country, attention has quickly shifted at the federal and state levels from overdose response to minimizing the spread of COVID-19. Rapid public health approaches have been implemented across jurisdictions, including widespread business closures, transitions to telemedicine, temporary closures of parks, and social distancing orders. While necessary to flatten the epidemiological curve of the pandemic, these public health approaches have largely failed to account for the unintended consequences such policies have on structurally vulnerable populations, including people who use drugs (PWUD). Since 1999, there have been almost 450,000 overdose deaths in the US, with over 67,000 fatal overdoses in 2018 alone (2020). Despite the ongoing severity of the overdose crisis, relatively little attention has been afforded to the impact of the now dual public health emergencies on PWUD as state governments focus on measures to address COVID-19. This oversight of co-occurring public health crises is concerning, given the ways in which social and structural factors, such as housing and work conditions, poverty, and criminalization are driving the impacts of both the overdose crisis and the COVID-19 pandemic for PWUD (Dasgupta, Beletsky & Ciccarone, 2018; North, 2020). Structurally vulnerable PWUD are more likely to be precariously housed, face barriers to accessing health care, and are more likely to be living with underlying chronic conditions that can exacerbate the severity of a COVID-19 infection, such as chronic obstructive pulmonary disease and HIV. It is therefore imperative that the COVID-19 response happens in tandem with the overdose response rather than in lieu of.