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Rivista Italiana di Medicina Legale e del Diritto in campo sanitario

Rivista: Rivista Italiana di Medicina Legale (e del Diritto in campo sanitario)
Anno: 2020
Fascicolo: n. 2
Editore: Giuffrè Francis Lefebvre
ISSN: 1124-3376
Autori: Brevi Leonardo, Pelletti Guido, Pelotti Susi
Titolo: PANDEMIA DA COVID-19 E ABUSO DI SOSTANZE STUPEFACENTI. LE NUOVE FRONTIERE DELLA RIDUZIONE DEL DANNO
Pagine: pp. 875-874
Keywords: COVID-19, droghe d’abuso, disturbo da uso di sostanze, riduzione del danno, EMCDDA, prevenzione

Il modello di riduzione del danno (RdD), una misura sanitaria già diffusa in Europa dall’inizio degli anni ’80, ha come principale obiettivo quello di tutelare la salute dell’individuo che fa uso di sostanze stupefacenti. La diffusione del COVID-19 ha creato nuove aree di vulnerabilità ed esacerbato quelle preesistenti, ponendo sfide senza precedenti in ambito sanitario, tra cui la tutela delle persone che consumano droghe. Per le persone che utilizzano sostanze stupefacenti sono state diffuse buone pratiche, che si aggiungono alle raccomandazioni standard. Non di meno, le attuali politiche di RdD dovranno essere potenziate alla luce della nuova pandemia COVID-19, come previsto in questi mesi dalle principali società scientifiche ed associazioni nazionali ed internazionali. I messaggi sulla RdD incentrati sui rischi associati all’iniezione dovranno essere rimodulati alla luce del contagio attraverso droplets, tipico di pratiche considerate fino ad oggi “meno a rischio”, come la condivisione di sigarette, strumenti per la vaporizzazione e l’inalazione. L’assistenza territoriale dovrà essere potenziata con l’ausilio su larga scala della telemedicina, percorso già avviato nei primi due mesi della pandemia, nonché per mezzo di screening tossicologici ed infettivologici a domicilio, sulla base del modello applicato nella provincia di Hubei (Cina). L’attività dei laboratori di tossicologia forense e clinica e l’attivazione di ulteriori sistemi di allerta rapida saranno indirizzati alla prevenzione e alla tempestiva segnalazione delle possibili variazioni del mercato in termini di modifica della domanda, sostituzione e contraffazione delle sostanze.

PANDEMIA DA COVID-19 E ABUSO DI SOSTANZE STUPEFACENTI. LE NUOVE FRONTIERE DELLA RIDUZIONE DEL DANNO


*) corresponding author. Email: guidopelletti@gmail.com.
1) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2017). Health and social responses to drug problems. Publications of the European Union, Luxembourg. Disponibile su http://www.emcdda.europa.eu/publications/manuals/health-and-social-responses-to-drug-problems-a-european-guide_en. Visionato il 12 maggio 2020.
2) International Drug Policy Consortium (IDPC) (2020) Una rete globale per promuovere obiettivi e dibattiti sulle politiche riguadanti droga. Disponibile su https://idpc.net/it/politica-e-supporto/globale/coerenza-del-sistema/riduzione-del-danno. Visionato il 12 maggio 2020.
3) Kar SK, Arafat SMY, Sharma P, Dixit A, Marthoenis M, Kabir R. COVID-19 pandemic and addiction: Current problems and future concerns. Asian J Psychiatr. 2020 Apr 10;51:102064.
4) Rhodes T, Hedrich D (2010) Harm reduction: evidence, impacts and challenges. Luxembourg: Publications Office of the European Union. Disponibile su http://www.emcdda.europa.eu/publications/monographs/harm-reduction. Visionato il 12 maggio 2020.
5) Harm Reduction International (HRI) (2010). Cosa è la riduzione del danno? La Posizione dell’Associazione Internazionale di Riduzione del Danno. Disponibile su: https://www.hri.global/files/2010/06/01/Briefing_What_is_HR_Italian.pdf. Visionato il 12 maggio 2020.
6) Gatti RC (2004). Droga. Architettura e materiali per le nuove reti di intervento. Franco Angeli Edizioni, Milano.
7) Hasin DS, O’Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, Compton WM, Crowley T, Ling W, Petry NM, Schuckit M, Grant BF (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry;170(8):834-51.
8) Rhodes T, Hedrich D, op. cit. sub. 4.
9) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 1.
10) Ibid.
11) McCrae K, Hayashi K, Bardwell G, Nosova E, Milloy MJ, Wood E, Ti L (2020). The effect of injecting alone on the use of drug checking services among people who inject drugs. Int J Drug Policy; 79:102756.
12) Harm Reduction International (HRI), op. cit. sub 5.
13) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 1.
14) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2020). Update on the implications of COVID-19 for people who use drugs (PWUD) and drug service providers. Luxembourg: Publications of the European Union. Disponibile su: http://www.emcdda.europa.eu/publications/topic-overviews/covid-19-and-people-who-use-drugs_en. Visionato il 12 maggio 2020.
15) Gazzetta Ufficiale dell’Unione Europea, Informazioni provenienti dalle istituzioni, dagli organi e dagli organismi dell’Unione Europea, Piano d’azione dell’UE in materia di lotta contro la droga 2017-2020 (2017/C 215/02).
16) Harm Reduction International (HRI) (2019). Global State of Harm Reduction: 2019 updates. Disponibile su: https://www.hri.global/global-state-of-harm-reduction-2019. Visionato il 12 maggio 2020.
17) International Network of Drug Consumption Rooms. Disponibile su http://www.drugconsumptionroom-international.org/#. Visionato il 12 maggio 2020.
18) Harm Reduction International (HRI), op. cit. sub. 16.
19) Ibid.
20) European Monitoring Centre for Drugs and Drug Addiction (2019), European Drug Report 2019: Trends and Developments, Publications Office of the European Union, Luxembourg.
21) Ibid.
22) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2017) Drug-related infectious diseases in Europe. Update from the EMCDDA expert network. Luxembourg, Publications Office of the European Union, 2017.
23) Day E, Hellard M, Treloar C, Bruneau J, Martin NK, Øvrehus A, Dalgard O, Lloyd A, Dillon J, Hickman M, Byrne J, Litwin A, Maticic M, Bruggmann P, Midgard H, Norton B, Trooskin S, Lazarus JV, Grebely J; International Network on Hepatitis in Substance Users (2019). Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework. Liver Int; 39(1):20-30.
24) Des Jarlais DC (2017). Harm reduction in the USA: the research perspective and an archive to David Purchase. Harm Reduct J; 14(1):51.
25) Liu J, Liu S (2020). The management of coronavirus disease 2019 (COVID-19). J Med Virol; May 5, in press.
26) Harm Reduction International (2020). Call to action COVID-19 - Special Rapporteur on the Right to Health. Disponibile su: https://www.hri.global. Visionato il 12 maggio 2020.
27) Karamouzian M, Johnson C, Kerr T (2020). Public health messaging and harm reduction in the time of COVID-19. Lancet Psychiatry; 7(5):390-391.
28) Marsden J, Darke S, Hall W, Hickman M, Holmes J, Humphreys K, Neale J, Tucker J, West R (2020). Mitigating and learning from the impact of COVID-19 infection on addictive disorders. Addiction; Apr 6, in press.
29) Karamouzian M, Johnson C, Kerr T, op. cit. sub. 27
30) Wu Z, McGoogan JM (2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA; Feb 24, in press.
31) Volkow ND (2020). Collision of the COVID-19 and Addiction Epidemics. Annals of Internal Medicine; Apr 2, in press.
32) Ibid.
33) Istituto Superiore di Sanità (ISS), Epicentro (2020). Consumo di sostanze stupefacenti durante l’emergenza COVID-19. Dispinibile su https://www.epicentro.iss.it/coronavirus/sars-cov-2-dipendenze-droghe. Visionato il 12 maggio 2020.
34) Snenghi R, Pelletti G, Frigo AC, Forza G, Nalesso A, Montisci M, Favretto D (2018). The Dangerous Pattern of Concurrent Use of Alcohol and Cocaine Among Drunk-Drivers of Northeast Italy. Alcohol Alcohol; 53(6):735-741.
35) Schwartz BG, Rezkalla S, Kloner RA (2020). Cardiovascular effects of cocaine. Circulation; 122(24):2558-69.
36) Thylstrup B, Clausen T, Hesse M (2015). Cardiovascular disease among people with drug use disorders. Int J Public Health; 60(6):659-68.
37) Berlin I, Thomas D, Le Faou AL, Cornuz J (2020). COVID-19 and smoking. Nicotine Tob Res; Apr 3, in press.
38) Pelletti G, Verstraete AG, Reyns T, Barone R, Rossi F, Garagnani M, Pelotti S (2019). Prevalence of therapeutic drugs in blood of drivers involved in traffic crashes in the area of Bologna, Italy. Forensic Sci Int; 302:109914.
39) Palmer F, Jaffray M, Moffat MA, Matheson C, McLernon DJ, Coutts A, Haughney J (2012). Prevalence of common chronic respiratory diseases in drug misusers: a cohort study. Prim Care Respir J; 21(4):377-83.
40) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 14.
41) Marsden J, Darke S, Hall W et al., op. cit. sub. 28.
42) Volkow ND, op. cit. sub. 31.
43) Istituto Superiore di Sanità (ISS), Epicentro (2020). Servizi per le dipendenze (SER.D.) durante l’emergenza COVID-19. Dispinibile su https://www.epicentro.iss.it/coronavirus/sars-cov-2-dipendenze-droghe-serd. Visionato il 20 maggio 2020.
44) Cousins G, Boland F, Courtney B, Barry J, Lyons S, Fahey T (2016). Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study. Addiction; 111(1):73-82.
45) Sun Y, Bao Y, Kosten T, Strang J, Shi J, Lu L (2020). Editorial: Challenges to Opioid Use Disorders During COVID-19. Am J Addict; 29(3):174-175.
46) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2020) Impact of COVID-19 on drug services and help-seeking in Europe, May 12. Disponibile su https://www.emcdda.europa.eu/system/files/publications/13073/EMCDDA-Trendspotter-Covid-19_Wave-1-2.pdf. Visionato il 12 maggio 2020.
47) Marsden J, Darke S, Hall W et al., op. cit. sub. 28.
48) Substance Abuse and Mental Health Services Administration (SAMHSA) (2020). Opioid treatment program (OTP) guidance. Disponibile su: www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf on 18 March 2020. Visionato il 12 maggio 2020.
49) Istituto Superiore di Sanità (ISS), Epicentro, op. cit. sub. 33.
50) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 46.
51) International Network of People who Use Drugs (INPUD), International Drug Policy Consortium (IDPC), Harm Reduction International (HRI) (2020) A l’ère du Covid-19: Déclaration de la société civile sur le Covid-19 et les personnes usagères drogues. Disponibile su: https://www.inpud.net/sites/default/files/Covid%20PWUD%20Statement%20-%20FR.pdf. Visionato il 15 maggio 2020.
52) Ibid.
53) Sun Y, Bao Y, Kosten T et al., op. cit. sub. 45.
54) Ibid.
55) Ibid.
56) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 14.
57) Mini-European Web Survey on Drugs (EWSD): Impact of COVID-19 on patterns of drug use, harms and drug services in the European Union. Disponibile su https://ec.europa.eu/eusurvey/runner/Mini-EWSD-COVID-19. Visionato il 12 maggio 2020.
58) Italian Network of People who Use Drugs (ITANPUD), International Network of People who Use Drugs (INPUD), European Network of People who Use Drugs (EURONPUD) (2020). COVID-19: Consigli alle persone che usano droghe. Disponibile su: https://itanpud.org/2020/03/28/nuove-indicazioni-su-covid-19-per-le-persone-che-usano-sostanze-o-in-ost-trattamento-sostitutivo-euronpud-inpud-itanpud/. Visionato il 12 maggio 2020.
59) Ibid.
60) Ibid.
61) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2020), op. cit. sub. 46.
62) International Network of People who Use Drugs (INPUD)op. cit. sub. 51.
63) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2020), op. cit. sub. 46.
64) Istituto Superiore di Sanità (ISS), Epicentro, op. cit. sub. 33.
*) corresponding author. Email: guidopelletti@gmail.com.
1) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2017). Health and social responses to drug problems. Publications of the European Union, Luxembourg. Disponibile su http://www.emcdda.europa.eu/publications/manuals/health-and-social-responses-to-drug-problems-a-european-guide_en. Visionato il 12 maggio 2020.
2) International Drug Policy Consortium (IDPC) (2020) Una rete globale per promuovere obiettivi e dibattiti sulle politiche riguadanti droga. Disponibile su https://idpc.net/it/politica-e-supporto/globale/coerenza-del-sistema/riduzione-del-danno. Visionato il 12 maggio 2020.
3) Kar SK, Arafat SMY, Sharma P, Dixit A, Marthoenis M, Kabir R. COVID-19 pandemic and addiction: Current problems and future concerns. Asian J Psychiatr. 2020 Apr 10;51:102064.
4) Rhodes T, Hedrich D (2010) Harm reduction: evidence, impacts and challenges. Luxembourg: Publications Office of the European Union. Disponibile su http://www.emcdda.europa.eu/publications/monographs/harm-reduction. Visionato il 12 maggio 2020.
5) Harm Reduction International (HRI) (2010). Cosa è la riduzione del danno? La Posizione dell’Associazione Internazionale di Riduzione del Danno. Disponibile su: https://www.hri.global/files/2010/06/01/Briefing_What_is_HR_Italian.pdf. Visionato il 12 maggio 2020.
6) Gatti RC (2004). Droga. Architettura e materiali per le nuove reti di intervento. Franco Angeli Edizioni, Milano.
7) Hasin DS, O’Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, Compton WM, Crowley T, Ling W, Petry NM, Schuckit M, Grant BF (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry;170(8):834-51.
8) Rhodes T, Hedrich D, op. cit. sub. 4.
9) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 1.
10) Ibid.
11) McCrae K, Hayashi K, Bardwell G, Nosova E, Milloy MJ, Wood E, Ti L (2020). The effect of injecting alone on the use of drug checking services among people who inject drugs. Int J Drug Policy; 79:102756.
12) Harm Reduction International (HRI), op. cit. sub 5.
13) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 1.
14) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2020). Update on the implications of COVID-19 for people who use drugs (PWUD) and drug service providers. Luxembourg: Publications of the European Union. Disponibile su: http://www.emcdda.europa.eu/publications/topic-overviews/covid-19-and-people-who-use-drugs_en. Visionato il 12 maggio 2020.
15) Gazzetta Ufficiale dell’Unione Europea, Informazioni provenienti dalle istituzioni, dagli organi e dagli organismi dell’Unione Europea, Piano d’azione dell’UE in materia di lotta contro la droga 2017-2020 (2017/C 215/02).
16) Harm Reduction International (HRI) (2019). Global State of Harm Reduction: 2019 updates. Disponibile su: https://www.hri.global/global-state-of-harm-reduction-2019. Visionato il 12 maggio 2020.
17) International Network of Drug Consumption Rooms. Disponibile su http://www.drugconsumptionroom-international.org/#. Visionato il 12 maggio 2020.
18) Harm Reduction International (HRI), op. cit. sub. 16.
19) Ibid.
20) European Monitoring Centre for Drugs and Drug Addiction (2019), European Drug Report 2019: Trends and Developments, Publications Office of the European Union, Luxembourg.
21) Ibid.
22) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2017) Drug-related infectious diseases in Europe. Update from the EMCDDA expert network. Luxembourg, Publications Office of the European Union, 2017.
23) Day E, Hellard M, Treloar C, Bruneau J, Martin NK, Øvrehus A, Dalgard O, Lloyd A, Dillon J, Hickman M, Byrne J, Litwin A, Maticic M, Bruggmann P, Midgard H, Norton B, Trooskin S, Lazarus JV, Grebely J; International Network on Hepatitis in Substance Users (2019). Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework. Liver Int; 39(1):20-30.
24) Des Jarlais DC (2017). Harm reduction in the USA: the research perspective and an archive to David Purchase. Harm Reduct J; 14(1):51.
25) Liu J, Liu S (2020). The management of coronavirus disease 2019 (COVID-19). J Med Virol; May 5, in press.
26) Harm Reduction International (2020). Call to action COVID-19 - Special Rapporteur on the Right to Health. Disponibile su: https://www.hri.global. Visionato il 12 maggio 2020.
27) Karamouzian M, Johnson C, Kerr T (2020). Public health messaging and harm reduction in the time of COVID-19. Lancet Psychiatry; 7(5):390-391.
28) Marsden J, Darke S, Hall W, Hickman M, Holmes J, Humphreys K, Neale J, Tucker J, West R (2020). Mitigating and learning from the impact of COVID-19 infection on addictive disorders. Addiction; Apr 6, in press.
29) Karamouzian M, Johnson C, Kerr T, op. cit. sub. 27
30) Wu Z, McGoogan JM (2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA; Feb 24, in press.
31) Volkow ND (2020). Collision of the COVID-19 and Addiction Epidemics. Annals of Internal Medicine; Apr 2, in press.
32) Ibid.
33) Istituto Superiore di Sanità (ISS), Epicentro (2020). Consumo di sostanze stupefacenti durante l’emergenza COVID-19. Dispinibile su https://www.epicentro.iss.it/coronavirus/sars-cov-2-dipendenze-droghe. Visionato il 12 maggio 2020.
34) Snenghi R, Pelletti G, Frigo AC, Forza G, Nalesso A, Montisci M, Favretto D (2018). The Dangerous Pattern of Concurrent Use of Alcohol and Cocaine Among Drunk-Drivers of Northeast Italy. Alcohol Alcohol; 53(6):735-741.
35) Schwartz BG, Rezkalla S, Kloner RA (2020). Cardiovascular effects of cocaine. Circulation; 122(24):2558-69.
36) Thylstrup B, Clausen T, Hesse M (2015). Cardiovascular disease among people with drug use disorders. Int J Public Health; 60(6):659-68.
37) Berlin I, Thomas D, Le Faou AL, Cornuz J (2020). COVID-19 and smoking. Nicotine Tob Res; Apr 3, in press.
38) Pelletti G, Verstraete AG, Reyns T, Barone R, Rossi F, Garagnani M, Pelotti S (2019). Prevalence of therapeutic drugs in blood of drivers involved in traffic crashes in the area of Bologna, Italy. Forensic Sci Int; 302:109914.
39) Palmer F, Jaffray M, Moffat MA, Matheson C, McLernon DJ, Coutts A, Haughney J (2012). Prevalence of common chronic respiratory diseases in drug misusers: a cohort study. Prim Care Respir J; 21(4):377-83.
40) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 14.
41) Marsden J, Darke S, Hall W et al., op. cit. sub. 28.
42) Volkow ND, op. cit. sub. 31.
43) Istituto Superiore di Sanità (ISS), Epicentro (2020). Servizi per le dipendenze (SER.D.) durante l’emergenza COVID-19. Dispinibile su https://www.epicentro.iss.it/coronavirus/sars-cov-2-dipendenze-droghe-serd. Visionato il 20 maggio 2020.
44) Cousins G, Boland F, Courtney B, Barry J, Lyons S, Fahey T (2016). Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study. Addiction; 111(1):73-82.
45) Sun Y, Bao Y, Kosten T, Strang J, Shi J, Lu L (2020). Editorial: Challenges to Opioid Use Disorders During COVID-19. Am J Addict; 29(3):174-175.
46) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2020) Impact of COVID-19 on drug services and help-seeking in Europe, May 12. Disponibile su https://www.emcdda.europa.eu/system/files/publications/13073/EMCDDA-Trendspotter-Covid-19_Wave-1-2.pdf. Visionato il 12 maggio 2020.
47) Marsden J, Darke S, Hall W et al., op. cit. sub. 28.
48) Substance Abuse and Mental Health Services Administration (SAMHSA) (2020). Opioid treatment program (OTP) guidance. Disponibile su: www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf on 18 March 2020. Visionato il 12 maggio 2020.
49) Istituto Superiore di Sanità (ISS), Epicentro, op. cit. sub. 33.
50) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 46.
51) International Network of People who Use Drugs (INPUD), International Drug Policy Consortium (IDPC), Harm Reduction International (HRI) (2020) A l’ère du Covid-19: Déclaration de la société civile sur le Covid-19 et les personnes usagères drogues. Disponibile su: https://www.inpud.net/sites/default/files/Covid%20PWUD%20Statement%20-%20FR.pdf. Visionato il 15 maggio 2020.
52) Ibid.
53) Sun Y, Bao Y, Kosten T et al., op. cit. sub. 45.
54) Ibid.
55) Ibid.
56) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), op. cit. sub. 14.
57) Mini-European Web Survey on Drugs (EWSD): Impact of COVID-19 on patterns of drug use, harms and drug services in the European Union. Disponibile su https://ec.europa.eu/eusurvey/runner/Mini-EWSD-COVID-19. Visionato il 12 maggio 2020.
58) Italian Network of People who Use Drugs (ITANPUD), International Network of People who Use Drugs (INPUD), European Network of People who Use Drugs (EURONPUD) (2020). COVID-19: Consigli alle persone che usano droghe. Disponibile su: https://itanpud.org/2020/03/28/nuove-indicazioni-su-covid-19-per-le-persone-che-usano-sostanze-o-in-ost-trattamento-sostitutivo-euronpud-inpud-itanpud/. Visionato il 12 maggio 2020.
59) Ibid.
60) Ibid.
61) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2020), op. cit. sub. 46.
62) International Network of People who Use Drugs (INPUD)op. cit. sub. 51.
63) European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2020), op. cit. sub. 46.
64) Istituto Superiore di Sanità (ISS), Epicentro, op. cit. sub. 33.
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