COVID-19 restrictions and increased risk of overdose for street-based people with opioid dependence in South Africa

Abstract

To the Editor: The placement of street-based people in temporary shelters as part of South Africa (SA)'s lockdown efforts to mitigate the COVID-19 epidemic increases the risk of overdose among people who are dependent on heroin. The number of street-based heroindependent people is unknown, eople with opioid dependence develop tolerance after repeated use, and an increased dose is essential to maintain a required effect. Tolerance reverses within several days of abstinence, and the opioid system up-regulates and resensitises to pre-use levels. Failure to moderate dosing to accommodate reduced tolerance after periods of abstinence is a significant cause of overdose following release from prison or inpatient rehabilitation and after periods of drug supply interruption. Globally, opioid overdoses are the leading cause of drug-related deaths, inducing respiratory depression and hypoxia that can be fatal. pioid substitution therapy (OST), using methadone or buprenorphine at a correct dose as long-term maintenance, is the gold standard for managing opioid dependence. OST improves health and reduces overdose mortality. Overdose is also mitigated through community awareness and training, and wide distribution of naloxone. part from efforts across Pretoria to provide access to OST as maintenance and one shelter in Durban providing methadone as part of managed withdrawal, the majority of the heroin-dependent population who remain in shelters will have an extended, involuntary period of abstinence.