Accessing methadone — used for opioid substitution therapy — has become an odyssey for users, a group the European Centre for Disease Prevention and Control (ECDC) considers “particularly vulnerable [to the coronavirus] because of their high level of pre-existing health problems and lifestyle factors.”
“People who are HIV positive or have hepatitis are being forced to crisscross the city daily in order to obtain their dose,” Testa said.
“Everyone is under an immense amount of stress, trapped with flatmates and family members with whom they don’t get on,” she added. “Without a support network, the risk for relapse becomes enormous, and the dealers are still out there, waiting when the users come looking for them.”
Alfonso Arana Marquina, president of Proyecto Hombre — Spain’s largest drug rehabilitation NGO — said that users overtaken by anxiety will go to any length to get their fix.
His organization’s 27 centers have attempted to remain operational by limiting the number of people admitted to in-patient treatment to facilitate social distancing and also expanding phone therapy services to talk users through moments of desperation.
Spain does not have a national strategy for drug users, and regional administrations have taken different approaches. While the northern region of Navarre — where Arana Marquina is based — opened new shelters to allow homeless users to self-isolate safely, in Andalucía many outreach centers are closed.
“The collective we help has been especially hard hit by the elimination of that support,” Arana Marquina said.
In Lisbon, NGOs like GAT Portugal — which works with people with HIV and viral hepatitis — have stepped in as public social services have shuttered.
GAT has kept its harm reduction centers open and taken to checking in on patients by phone, although this solution is “problematic for poorer people who don’t own phones,” said Adriana Curado, coordinator of the group’s mobile drug consumption project.
To prevent new coronavirus infections, Curado has also limited the number of people allowed to access the van GAT operates with medical charity Médicos do Mundo, in which users can consume drugs in a supervised, sterilized environment.
Similar steps have been taken by Ares do Pinhal, an NGO that distributes methadone from vans that move throughout the city.
The lockdown in Portugal has closed restaurants and reduced opportunities to obtain money by begging or doing menial tasks, leaving many users without the cash to pay for drugs. This, said Curado, has led to a surge in demand for treatment.
In response to the crisis, the Portuguese government has taken steps to make it easier to access opioid substitution therapy and is considering loosening protocols regarding naloxone — a medication for opioid overdoses which had only been available in ambulances and hospitals.
“Our harm reduction teams can now carry it, and we’re hoping to convince authorities to let us distribute it among users,” said Curado. “In a crisis in which ambulances sometimes take hours to show up, alternative infrastructure has to be created.”
Similar bureaucratic advances are happening in France, where the pandemic has led health authorities to simplify the process of renewing drug prescriptions — including for opioid substitution treatments.
Laurène Collard, coordinator at Fédération Addiction — which includes over 1,000 professionals working with addiction — said demand for opioid substitution therapy has spiked since France’s confinement rules went into effect. She said her organization is liaising with the health ministry to liberalize access to treatment.
“We need to give users options, because if we don’t, the results could be catastrophic,” she said. “Either they’ll go out looking for drugs — putting themselves and others at greater risk of infection — or they’ll go into withdrawal, which is unbelievably painful.”
Despite interruptions to the supply of sterilized needles — which some users had apparently stockpiled when the lockdown went into effect — Collard said that most of France’s treatment centers had managed to operate with a certain degree of normality during the crisis, and had even received some support from national authorities.
“Users are the most neglected people in the best of times,” she said. “They’re completely forgotten in times of crisis. Fortunately, the government has recognized that if nothing is done to address their needs, one just has a new crisis waiting to happen.”
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