Recovering heroin addicts in Edinburgh who need self-isolation are now receiving home deliveries of methadone, as experts call for more creative thinking to save lives.
While Scotland’s drug death rate is expected to rise further when annual figures are released this summer, there have been warnings of another public health emergency in addition to the coronavirus pandemic, as drug addicts abandon their prescriptions for substitution treatment due to long queues at pharmacies, move away from support services and risk an overdose by turning to more dangerous alternatives when the supply of street heroin is interrupted.
The Guardian spent time on the Edinburgh delivery run with two officials from the Change Grow Live recovery charity. After picking up the prescriptions from the pharmacist, Rab Dylan and Lukas Waclawski then drop off the bags of opioid substitutes – usually methadone – clean needles or kits of naloxone, a drug that saves lives in the event of an overdose. Some visits are daily, especially when a person is considered to be at risk of overdose or in need of regular monitoring, while others take place every few days in an attempt to relieve pressure on services.
A homeless couple were accommodated six kilometers from their usual pharmacy, north of the city. Dylan and Waclawski meet them in the parking lot of their guesthouse for a contactless delivery, with gloves and masks.
As a salty breeze blows from the Firth of Forth, Waclawski demonstrates the use of the naloxone pre-filled syringe while maintaining strict physical distance. “You can inject it through your clothes,” he advises, “into the larger muscle, which is usually the thigh.”
Karen (not her real name), who has been on treatment since January, says deliveries have been “so helpful” since she and her partner were asked to self-isolate after developing symptoms of coronavirus. “Before, we had to go to the pharmacy every day and I was paranoid because people in the line cough and sneeze, without covering their mouths.”
“Guys are just happy to have someone to check in with,” adds Dylan. “Since a lot of services are moving away from face to face, if we can go out and have some interaction, it has to be positive.”
Lauren Gibson, head pharmacist for substance abuse and prisons at NHS Lothian, who coordinates the delivery program, said: “The relationship with this patient group is so important and we had to find ways to keep that going. . It’s not just about having access to methadone and drugs; it’s about the whole recovery program, like food packages, naloxone and overdose help, wellness checks, mental health – it’s about maintaining these vital relationships with people. patients, even if it’s virtually or on their doorstep. “
The Scottish Government’s Drug Deaths Task Force last week called for the deployment of home awareness networks across the country, and many local authorities have followed suit. The task force also urged ministers to treat drug addicts as a priority group for coronavirus testing, and initiated the use of depot injections, such as a monthly injection of slow-release heroin substitute, which the Welsh government has now systematically made available to recovering drug addicts.
There is a broad consensus on the need for immediate access to substitution treatment, especially in the hope that more addicts will seek help as street supplies decrease or become more dangerous or more dangerous. prohibitive cost. But street workers report that in some areas desperate people have still been waiting for a prescription for more than a week. They are of the pragmatic view that some of the take-out methadone will inevitably end up on the streets, but that this must be balanced with the urgent need to make treatment as easy as possible.
Tracey Clusker, Nurse Manager for Addiction at Midlothian Health and Social Care Partnership, is blunt: “We have to think creatively to save lives. If there’s a time when people need quick access to a prescription, it’s now.
Clusker has delivered methadone, along with food packages, condoms and sanitary napkins, to at-risk drug addicts who normally frequent his innovative coffee clinic, and holds weekly Zoom Groups where they can discuss how they are doing. in the face of isolation.
Gibson and Clusker hope the pandemic can spur a shift in priorities both for those battling drug addiction and for the general public.
Gibson says, “One of the good things about a negative time is that we get to engage people in treatment who would not have considered it before. We are working hard to keep treatment open and accessible for those who are vulnerable and in difficulty and we will work hard to ensure that this continues after Covid. “
Clusker is cautiously optimistic. “Once this is over, will people understand this group better, will it reduce the stigma of addiction if the public now sees the world from a different perspective?” “