ABSTRACT
Purpose The COVID-19 pandemic has posed major challenges to OST (opioid substitution treatment). Therefor the legal basis (BtM-VV), which is often regarded as restrictive, was temporarily amended to give treatment providers more options in adapting therapies to the specific situation. Extensive flexibility was introduced in the areas of take-home prescriptions, consultative treatment and delegation. Additionally, new reimbursement options were created (EBM). An evaluation of the temporary changes of the legal and remuneration regulations was carried out through guided interviews with physicians providing OST. Methods In 2021, 16 qualitative interviews were conducted with OST providing physicians from ten different federal states of Germany. Interviewees were asked about their experiences regarding Corona-related temporary legal and remuneration changes. Questions focused on whether the temporary flexibilities should be adopted permanently in post-pandemic regular practice. The interview guide also included questions on structural barriers, lack of junior staff, and stigmatization. Results Most physicians extended take-home prescriptions. Subsequently only one person experienced purely negative consequences. Overall, interviewees reported either no and/or positive changes in the course of the therapy. The physicians used most of the temporary legal and remuneration flexibilities to adapt the treatment design. Predominantly interviewees have been in favour of adopting the temporary regulations in their post-pandemic practice. Controversial opinions were found on legal changes regarding the removal of the capacity limit in consultative regulation and expanded delegation. Conclusion The results support the adoption of the temporary legal and remuneration changes in post-pandemic practice. Changes facilitate the adaptation of therapy to individual circumstances of practitioners and patients. This might help to address current bottlenecks in the supply and to offer high-quality OST to more people with opioid use disorder. An identification and elimination of structural barriers should not be forgotten in the process of implementation. As legal flexibilization inevitably transfers more responsibility to the individual physician increased support via training and networking should be offered.
ABSTRACT
The article considers health and human rights implications for people deprived of liberty during the COVID-19 crisis. The health risks of incarceration for individual and community health, particularly in overcrowded and under-resourced prisons and detention centres, are well known, but with the COVID-19 pandemic have become a public health emergency. Physical distancing in prisons is hardly manageable, and protective means are poor or lacking. Emergency releases have been shown to be feasible in terms of public safety but lack sustainability in reducing the number of people living in detention, and, globally, only a small proportion of them have been released. Without controlling the infection inside prisons, global efforts to tackle the spread of the disease may fail. People living in detention are not only more vulnerable to infection with COVID-19 but they are also especially vulnerable to human rights violations induced by inappropriate restrictions under the pretext of infection control. Therefore, alternatives for detention should be promoted and the number of incarcerated people radically decreased, an approach realizing health objectives that simultaneously promotes human rights. The article calls on policymakers and all professionals involved in public health and criminal justice not to waste the opportunities provided by the crisis but to act now. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Introduction Vaccinations are one of the most powerful preventive tools discovered by modern medicine. Although expanded programmes of immunization are well established in EU/EEA, significant immunity gaps and suboptimal coverage are registered among specific populations, including people living in prisons (PLP). PLP are also at increased risk to vaccine-preventable diseases (VPD) with potential outbreak in prison, e.g. flu, COVID-19, as well as other VPDs such as HBV. The EU-funded project RISE-Vac, aimed at collecting models of care developed during the pandemic to design tailored vaccine delivery strategies that could be extended beyond the sole COVID-19 vaccine. Methods Through a survey to healthcare staff working in prisons in six countries of the EU/EEA (Cyprus, France, Germany, Italy, Moldova, UK) we collected information on the implementation of COVID-19 vaccination program. The following areas were investigated: challenges & barriers encountered, workload distribution, education & training activities for prison staff and PLP, referral strategies after release, immunization information system. Results The respondents reported that in prisons COVID-19 programs have been implemented efficiently. Strategies for optimal management of the vaccination campaign included: week-day dedicated to vaccination services when vaccines were delivered and immediately administered to overcome cold chain challenges;new staff recruitment & task shifting;administration of booster doses within prison premises for released individuals;distribution of informational material both to PLP & prison staff. Conclusions Our results show that universal immunisation campaigns are feasible, acceptable and effective in places of detention when there is commitment to implementing them. Evidence from the pandemic situation may inform future provision of expanded immunization programmes.