CONCERNS HAVE BEEN raised about the impact the Covid-19 pandemic could have on people who are addicted to drugs amid growing concerns about overdose risks and the spread of the virus among homeless people.
Drug users, in particular those who are homeless, are at an increased risk of contracting the virus – many suffer from underlying health conditions and don’t have a safe place to self-isolate or cocoon if needed.
Measures have been put in place to protect homeless people from Covid-19 as much as possible, including providing temporary accommodation, as well as a focus on testing vulnerable groups.
A subgroup of the National Public Health Emergency Team (NPHET) is focused on actions to protect vulnerable groups affected by Covid-19, including people who are homeless and/or use drugs.
The main policy response to minimise the spread of Covid-19 among people who use drugs is to maximise access to opioid substitution treatment (OST) – typically methadone – via GPs and addiction services.
Dozens of extra people have joined methadone programmes in Dublin in recent weeks and waiting lists have been virtually eliminated.
Prior to the crisis, people often had to wait for 12-14 weeks to get access to methadone. Individuals are now being accepted onto programmes in as little as two to three days.
Nationally, over 10,000 people are on OST and arrangements are being put in place to ensure continuity of supply during the crisis. Access to clean syringes and needles is also being provided.
Tony Duffin, CEO of the Ana Liffey Drug Project (ALDP) in Dublin, said the organisation has had to “quickly adapt how we deliver our services to help to reduce the spread of the Covid-19, and to respond to the increased drug-related risks our clients have faced – particularly the increased risk of an overdose”.
The ALDP has been doing outreach work and providing harm-reduction interventions in recent weeks.
“The group of people who use drugs that we work with are a particularly vulnerable group and are at a higher risk of contracting Covid-19,” Duffin told TheJournal.ie.
“As Covid-19 is transmitted through droplets, the sharing of syringes, crack pipes, tooters etc is risky and increases the chance of infection.”
If a vulnerable drug user contracts the virus, Duffin said it’s likely “they will require hospitalisation as many have underlying health issues which put them at greater risk of complications”.
Smoking crack or heroin can cause and/or exacerbate respiratory conditions, he noted as an example.
Methadone waiting lists eliminated
Dr Austin O’Carroll, a GP who founded Safetynet Ireland and is leading the Dublin Homeless Covid-19 Response team, said a holistic approach is needed to help homeless people, particularly those with addiction issues, during the pandemic.
He said providing temporary accommodation to vulnerable drug users so they can self-isolate or cocoon is a “waste of time” unless they are also given access to methadone.
“About 60 people have started on methadone in the last four weeks. The vast majority of them were rough sleepers, people who were waiting to join a programme,” O’Carroll noted.
He said the “dramatic” reduction in wait times is “a really positive development” and proves services can and should be improved after the pandemic and not just during it.
In a similar way to how rent freezes have been brought in and the government has temporarily taken over private hospitals – scenarios that were deemed unthinkable just a couple of months ago – questions are being asked about how the country will treat homeless people and those who have addiction issues post-pandemic.
Getting access to methadone within a couple of days is not unusual in many other countries, and O’Carroll wants to see this situation replicated across Ireland.
“It’s the norm in other countries to get methadone within two or three days. I don’t think there’s any reason we can’t have the same thing here,” he said.
‘Unethical’
However, he noted many doctors outside Dublin are unwilling to treat methadone users, meaning people often don’t get the help they need or have to travel to Dublin – if they can – to access services.
O’Carroll said he understands the concerns some GPs have but said it is not right to “abandon” vulnerable patients whose needs are often greater than other people’s.
He said some GPs “fear they will get a reputation they take on drugs users” but it is “unethical not to provide care” for those who need it most.
O’Carroll said this situation is “primarily an issue outside Dublin” adding that, in most small towns, only a very small number of people need access to methadone and if every GP took on one or two patients, there would be no backlog.
When a person gets access to methadone, the benefits are obvious.
“80% of people who are put on methadone, their accommodation situation improves in two to three months, their overall health improves, their relationship with the family improves,” O’Carroll told us.
Prior to the Covid-19 crisis, about 40 people were on Safetynet’s waiting list for methadone. O’Carroll said people who are told they’ll have to wait 12 weeks to join a programme often walk away and don’t reenage. It’s just too long to wait.
“In the 12 weeks people are waiting, they keep using drugs – increasing their risk over overdosing and other risks like contracting Hepatitis C,” O’Carroll said.
‘If someone wants drugs, they’ll get them’
The HSE has warned that people who substitute drugs with other substances they’re not familiar with face an increased overdose risk.
Local and international travel restrictions mean the chain supply of drugs will likely be impacted for people, some of whom will turn to other substances – the contents of which may not be known.
Graham Ryall, treatment services coordinator at the Rialto Community Drug Team (RCDT) in Dublin 8, said it’s too early into the crisis to tell if and how the drug supply chain will be affected by the pandemic.
People substitute one drug for another “all the time”, he noted, but this may be more likely in the coming weeks and months.
Anecdotally he’s hearing that less open dealing and street use is happening in Dublin, but if someone wants to get drugs they still can.
“If someone wants to go out and get drugs, they’ll go out and get drugs. If a dealer wants to sell drugs, he’s going to go and sell them. He doesn’t want to be out of pocket and there is someone above him demanding money,” Ryall told TheJournal.ie.
One reason for a drop in drug use may be the fact homeless people are not getting as much money as usual from passersby on the street, Ryall noted – fewer people are around and, of those who are, many are paying for items via card rather than having change in their pockets.
Increased garda patrols could also be having an impact, he added.
Drug debts being called in
Ryall said people in the community are worried that more drug debts will start to be called in if dealers’ other sources of income are affected by the crisis.
“It’s a bit too early to see if there is going to be a drought. If this is still happening two, three or four months down the line, then we’ll know if the supply chain is going to be affected. Then the trickle-down effect may be seen in communities.
This is all about economics – dealers do not like losing out on money, losing out on customers.
Most of RCDT’s services are currently being conducted online or over the phone – staff regularly check in with clients and support groups are happening via video calls.
“It’s not going to beat being in a room with someone, but it’s a little bit more per that a phone call – people taking up that option,” Ryall said.
The service “remains very busy”, he said, and “substantial support and advocacy” is being offered to “individuals and families at various states of addiction and recovery, crisis and progress”.
Methadone clinics and clean needles
RCDT’s methadone clinic still takes place three times a week. Only two clients are allowed into the centre at a time and the two-metre minimum social distancing rule is obeyed “at all times”, Ryall said.
The clinic takes place in a large room and clients are asked if they are displaying any symptoms before entering. If so, they’re advised to contact their GP and told their script can be sent directly to a pharmacy if needed.
People sanitise their hands when both entering and exiting the clinic. Twenty-eight people are currently signed up to the programme, usually attending weekly or fortnightly depending on their needs.
“People can’t go without their methadone,” Ryall explained. He said service users are generally doing “really, really well” in terms of taking Covid-19 precautions.
“They’re really conscious of the situation – many are long-term patients and have underlying health issues. People are genuinely minding themselves,” Ryall told us.
An opportunity to change
As well as their regular service users, the RCDT centre gets about six to 10 new referrals a week.
Ryall said some people are viewing the current situation as “an opportunity to address where they’re at” and seek help for drug or alcohol use.
“Off licences are open but pubs and clubs are closed so people can’t go out and about. People are actually questioning themselves, ‘Is this an opportunity to address my behaviour?’”
Ryall said house parties and chemsex parties are still happening but many people are now “more conscious” of the risks involved.
“A number of people have said ‘I’m taking myself off the scene for a period until this blows over.’ Unfortunately there are others who continue to engage with the scene, that’s the nature of addiction. Parties are still going on.”
About 20 people were referred to the Club Drugs Clinic, part of the National Drug Treatment Centre in Dublin, to detox from drugs like GHB and crystal meth in the first three months of this year. No referrals have been made so far in April.
Supporting people to maintain their sobriety is another element of RDCT’s work. “That’s the thing with addiction and recovery, it’s not that you get clean or sober and then it’s ‘thanks very much’ and you’re done,” Ryall said.
Workers from the centre regularly check in with clients, some of whom may have recently relapsed, to give them support.
“It’s about stability and people knowing that they can reach out,” Ryall said.
‘Addiction does not stop’
Health Minister Simon Harris earlier this month said he is “acutely aware of the significant challenges facing both drug and alcohol service users and service providers at this difficult time”.
He said his department and the HSE are “pro-actively monitoring and responding to the impact of Covid-19 on people who use drugs”.
“Addiction does not stop during a pandemic. If anything, it can become more of a problem for many and its impacts can be much more confined,” Harris said.
In response to a recent parliamentary question, Harris said drug users and service providers should be “especially vigilant as there is an increased risk of overdose at this time, because of the nature of the Covid-19 virus and the possible contamination of drug supplies”.
Harris added that the requirement to stay indoors as much as possible “can be a challenge for people who use drugs and their families”.
“I want to assure people that there are supports available for families through the National Family Support Network and local services.
“Mental health supports are also available. People who use drugs are among the most vulnerable in society and we must ensure services and supports continue to be provided for them,” he stated.
Support services:
If you’d like to speak to me about your experience of addiction, email orla@thejournal.ie or contact me anonymously via my Threema ID ZVHKV6VD.
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