Addiction News: global opioid policies and treatments during COVID-19
Global responses to the challenges of COVID-19 have varied from the innovative to the absurd. Many support groups have gone online, resulting in world-wide support networks replacing those that were once very local. Wearable technology for monitoring overdose has been appropriated to help monitor COVID-19 patients. Here is a summary of opioid-related stories that we have covered in the last few weeks in the Addiction Newsroom.
Disrupted opioid supplies
Opioids have been in short supply. The opioid trade is used to constant change, and when land borders closed due to COVID-19, opioid trafficking simply moved to the sea, rather than use traditional road routes. For cultivators, some challenges were more difficult to overcome, and much like the UK’s lettuce producers, farmers in Afghanistan have struggled to find labour to harvest opium poppies during lock-down. Mexico has also reported a decline of 9% in poppy cultivation. Amidst reports of reduced drug supply have also been reports of increased access to treatment; in Punjab 86,000 new registrations for Outpatient Opioid Assisted Treatment were recorded since lock-down began. Raising questions about what support those 86,000 accessed before this recent interruption.
Stay at home
For many service users in the UK, the daily medication pick-up is more than just a practical necessity, and the regular contact with a clinician or pharmacist is an important part of treatment. This is, however, exactly the kind of routine contact that vulnerable people are now advised to avoid. In Scotland, people who use drugs can now have methadone delivered to them to reduce the risk of being exposed to COVID-19. Scottish prisoners are now being offered Buvidal, a long-lasting Opiate Substitution Treatment (OST) involving a prolonged-release injection of buprenorphine. Buvidal has also been offered to addiction treatment service users in Wales. Drug treatment charity We Are With You has started a ‘click and collect’ service for people to order needle exchange and harm minimisation equipment.
Don’t stay at home
Canada initially relaxed rules on OST prescribing, and has now cancelled its ban on peer-assisted injecting to encourage people to use safer injecting facilities rather than to stay at home alone. This policy change illustrates the difficult balance of risks that has always been present in addiction treatment. How do you balance the contradictory needs to stay at home and to continue attending treatment services? A partial way through this difficulty has been trialled in Vancouver through online supervised injecting. Here, people using drugs are observed by ‘digital spotters’; both closely online, and at a safe distance, when injecting opioids.
Don’t carry Naloxone (carry Naloxone)
In contrast to efforts to support vulnerable people during COVID-19, are reports that some police forces in Texas and Indiana stopped carrying Naloxone. They were instead instructed stay 2 meters away from people suspected of overdosing whilst waiting for medical backup. The directions prevent those police from giving any medical aid during those crucial minutes. This is an approach that seems unlikely to save lives, and that manages to mark people who use drugs as, quite literally, untouchable.
Elsewhere, technologies used in addiction treatment have been adopted by those treating people with COVID-19. In New York, researchers trialled a wristwatch usually used to monitor the heartrate (and other vital signs) of those vulnerable to opioid overdose. The watch is now being re-purposed to monitor people recovering from COVID-19 who are still deemed to be ‘at risk’ so that they can be discharged from hospital whilst monitored for any signs of deterioration. Another form of digital spotting.
Abrupt changes imposed by the global pandemic have bought about many innovations in treatment and policy. Some of these will, given time, inevitably revert to how they were ‘before’. Others might signal the start of new forms of treatment that will persist. We will keep a close eye on these innovations and changes in the Addiction Newsroom and continue to keep you posted as they happen.
By Rob Calder, Addiction News editor
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