Calls are growing for people with drug addictions to get urgent access to life-saving treatment and prescriptions to help them self-isolate, keeping themselves – and others – safe during the Covid-19 pandemic.
It comes amid evidence gathered by The Ferret of critical problems for drug users trying to access help. They include long waits for methadone prescriptions, with some areas offering it for existing patients only and turning away others.
New UK-wide legislation will be passed this week giving chemists “discretion” to supply methadone, but it will impact on existing users.
Glasgow’s Heroin Assisted Treatment programme has been suspended with those using it offered methadone prescriptions instead, The Ferret has learned.
Also in Glasgow, one homeless adviser said he had spoken to people accommodated after sleeping rough, who were struggling with addiction. He claimed some were breaking self-isolation – and risking police fines – to beg in the city centre for money to buy a dwindling supply of drugs.
Prices are said to be rising as a result of supply issues, though purity is falling.
Some using benzodiazepines – or so-called street valium – are being told by services that nothing can be done to help them, the worker alleged. Many services are now only available by phone or online.
Charity Scottish Families Affected by Alcohol and Drugs agreed many statutory services had been slow to respond. In the initial week of lockdown it received “harrowing” calls from users whose drug services had shut and who did not know where to turn, it said.
Although some “low risk” drug users are increasingly being given seven-day prescriptions of methadone to take home, others still have to queue daily to receive their agreed dose.
But national advisory organisation, the Scottish Drugs Forum, said it had received reports that some pharmacies were operating separate queues for those getting methadone, with fights breaking out due to escalating tensions.
Dr John Budd, a GP at the Edinburgh Access Practice, which deals with homeless patients, said he was concerned that many Scots with serious addiction issues were not able to access services. But he is trying to ensure his patients are not among them.
Since lockdown restrictions came into place he and his team have stepped up outreach work, visiting Edinburgh’s temporary homeless accommodation and offering immediate access to Opioid Replacement Therapy (ORT) wherever required.
Medical students are doing a home delivery service of methadone for self-isolating patients around the city. Other plans include proposals to deliver alcohol to alcoholics, allowing them to continue to self-isolate.
Budd said a similar approach must be adopted across Scotland as part of the NHS’s Covid-19 response.
He told the Ferret: “Working as a GP with homeless people many of our patients are in high levels of need at the moment. With the lockdown they are not necessarily going to be able to come to us so we are going out to where they are, particularly with many of the rough sleepers being moved into hotel accommodation.”
Many have significant health issues, such as chronic obstructive pulmonary disease, coronary heart disease, liver disease, putting them at risk of complications if they contract Covid-19.
“We are trying to offer as many people as possible opioid replacement treatments like methadone because people can’t isolate if they have an untreated addiction and they are having to run around trying to source drugs or alcohol,” Budd added.
“We need to make provision for those folk to keep themselves safe. It’s also about infection control to enable them not to be out and mixing.”
He called on clinicians around Scotland to ensure it was as easy as possible to access same day ORT treatments, which can then be delivered to someone at home.
“It’s not an easy thing for people to get on to ORT in my experience,” he said. “We make people jump through hoops. And now it’s all the more difficult.
“Meanwhile illicit drugs are becoming less and less available and for many of our patients that use them as a means of coping that’s going to dry up and we’ll see more and more desperate people.”
Drug charities have warned that drugs may be increasingly cut with dangerous substances. There have been reports that drug users, who may have funded their habit through begging, are becoming increasingly desperate offering games consoles, televisions and even cars in exchange for heroin.
“We need to have a really low threshold for initiating on to ORT just now,” added Budd. “We are looking closely at treatment for those on benzodiazepines. If there is a harm reduction reason to do so, then we will prescribe them.
“That is what we are doing and we are trying to persuade our addiction specialist colleagues to do likewise but there seems to be a resistance to that.
“How can we expect people with drug and alcohol problems to isolate or keep themselves safe if we don’t help them to address their addiction issue? We are risking lives – theirs and others – if we do not.”
The Scottish Drugs Forum had identified a number of concerns. “Pharmacies are under significant strain,” said chief executive, Dave Liddell.
“Some of the pressure points are around queues – in some areas fights have even broken out. We’ve heard that some pharmacies are operating two queues with one for those on methadone and one for the general public and this had led to a lot of tension.
“We also need to be prepared for what happens if we have less pharmacy provision. This needs to be planned for.”
Liddell added: “Then there’s the issue of how people access services as street drug supply reduces. We have major concerns that we lead to a further escalation in polydrug use, which is key factor in fatal overdoses – people using a cocktail of depressant drugs together.
“That means that we need to be trying to get more people on to OST but the challenge is that some areas are restricting services to existing patients only.”
Justina Murray, of Scottish Families Affected by Alcohol and Drugs, said in the later part of March the charity’s helpline was taking distressing calls from those with addiction issues and their family members.
When helpline staff signposted callers to addiction services, she claimed people phoned back after finding phones were ringing out, key workers were off sick and service hubs closed.
While third sector organisations such as Addaction have plugged some of the gaps with phone and web chat services, Murray admits that it’s still a “very patchy” picture, which will see many fall through the net.
“I think good services are still good services and some are finding innovative ways to reach people,” she added.
“But a lot of the statutory services are really clunky anyway and so you have a real postcode lottery. If you are unlucky you could be living in an area where services have imploded.”
Needs of drug users ‘at risk of being forgotten’
Peter Krykant, a former outreach worker and drugs activist who plans to set up a safer injecting site in Scotland, said that he was “deeply concerned” about the difficulties people were facing in getting drug treatment.
On 3 April he co-ordinated a letter to the chief medical officer, health secretary Jeane Freeman and public health minister Joe FitzPatrick. It was co-signed by leading politicians, doctors and activists including Dr Roy Robertson, whose Muirhouse practice first worked with drug addicts in the 1980s, human rights lawyer Aamer Anwar and Canadian drugs activist Garth Mullins.
Mullins was part of a campaign, which in March led to guidelines being drawn-up in British Colombia, allowing drug users access to a safe supply of drugs throughout the crisis.
Krykant’s letter called for drug users to be able to replace illicit and licit substances with prescribed or regulated ones, for same day prescribing and for take-home naloxone kits to be provided and used in case of overdose.
He said that with services experiencing staff shortages GPs should be asked to play a key role in ensuring people can access a safe supply. “I think if someone senior stood up and told them that prescribing was what GPs could do to support people throughout Covid-19 then they would do that,” he said.
“What is needed is an emergency response and that is what countries like Canada have provided.”
Catriona Matheson, chair of the Scottish Government’s drug task force, agreed that people must be kept in – or provided with – treatment wherever possible. “However services are really struggling to cope with the current level of service due to staff shortages,” she said.
“More outreach and rapid access in the model of John Budd’s service would be the ideal. Other options like telephone consultations and prescribing are under consideration as well.
“The benzodiazepine prescribing, from a harm reduction perspective, is sensible.”
But Monica Lennon MSP, Scottish Labour health spokeswoman, called for a more urgent response. “The needs of people who use and depend on drugs and alcohol are at risk of being forgotten,” she said.
“The leadership shown in Edinburgh by Dr John Budd and his colleagues is heartening and shows that workable solutions can be found. This leadership must be replicated nationally.”
On 6 April the Scottish Government announced an additional £166,000 would be made available for drug services, but Lennon said this was not enough.
“The Covid-19 crisis hasn’t replaced Scotland’s drug death emergency,” she argued. “It’s added to it and there is an urgent need for co-ordinated action.”
In 2018 1,187 people died of drug overdoses across Scotland. Last year’s figures are expected to be delayed by many months due to a dispute between Glasgow University’s toxicology service and the Crown Office.
A Scottish Government spokeswoman admitted the crisis had seen addiction services disrupted. She added: “Covid-19 presents a serious threat to the lives of people with underlying health conditions, including those whose health has been badly affected by drug use.
“This means in these unprecedented circumstances that we expect alcohol and drug partnerships are doing what they can to keep the people who rely on their services as safe as is possible.”
Photo thanks to Moussa81.