Addiction and withdrawal don’t just go away during a lockdown, writes Bonnie Sumner, which is why health services and support agencies are doing all they can to make sure no one suffers.
It’s happening outside alcohol shops, in supermarket carparks and, sometimes, on quiet back streets between people riding bicycles.
Despite the lockdown, drug suppliers are still finding ways to get illicit substances to their customers, even if it means stretching the essential travel definition and mingling bubbles.
Almost two weeks in and it’s pretty much business as usual. But those with insider knowledge of the trade say it won’t stay this way for long.
“There will be a strangulation point when there’s not enough drugs, but we haven’t reached that point yet,” says a source with intimate knowledge of the drug economy. “There is tons of it here already being held by the distributors. But of course the borders are closed, so it’s sixth form economics, supply and demand – what we’re going to see is them choke the supply and then put the price way up.”
Early days, but harm reduction services like the NZ Drug Foundation are concerned that restricted access could result in unpredictable and worrying outcomes.
“We’re anticipating that with less travel across the country, a lot of the supply distribution chains that are there will mean that there’s less trafficking that can occur across the country, which in some ways could be a good thing,” says Ben Birks Ang, deputy executive director of programmes.
“But also if someone is dependant and they’re still doing what they can to access drugs, we’re a little bit concerned that that will result in more homemade drugs, or substituting for other drugs that are more available but could be potentially riskier for them.”
The Drug Foundation has teamed up with a number of other services in the sector to present a set of harm-reduction messages to people living with drug and alcohol addiction to encourage them to do everything they can to avoid overdosing at a time of increased risk.
“Some of the advice that we’ve been giving is if you can, reduce your use, or take a break from it, but recognising that for some people that could actually create much more negative impact for their households than maintaining a lower level of use or maintaining their use,” says Birks Ang.
“Also, if they are going to access things, [we’re saying] do it as safely as possible, and making sure they’re using less of it so that if it is a substitute substance, or a lower quality, or it’s got something else in it, there’s less chance that that can result in an overdose or health issues.”
Similarly, anyone who does reduce or even eliminate their drug use should be careful about starting to use again, he says. Avoiding overdose cases taking up precious hospital space during the pandemic is one of the key concerns.
“If people have had a break from substances and they have been using it before, their tolerance level would have been higher while using it because their body would have got used to that drug. Taking a break, their tolerance decreases because their body readjusts itself to a new normal. As they then access the same amount of alcohol or drugs they used to while they were using regularly, they are at higher risk of having an unpredictable or unpleasant experience and increase their chance of overdose as well.”
Other moves include the fast-tracking of intranasal naloxone, a drug that reverses the impact of an opioid overdose, for frontline services in March. Naloxone is carried by Ministry of Health-funded emergency ambulance services, and opioid substitution treatment services are exploring further ways to help opioid users access it.
The Ministry of Health has ensured that alcohol and other drug treatment services – as with other mental health and addiction services – are identified as essential services during lockdown. However, while there is an expectation that services are available for those who need them, the Ministry says it is aware that dedicated medical management withdrawal services have either closed or are considering closing, to ensure staff and the facility can be used more flexibly to respond to Covid-19.
The Ministry recommends a reconfiguration of the delivery of a service (that is, providing it through a different pathway), rather than removing a treatment option altogether.
“DHBs must ensure that there is a clearly defined and communicated care pathway for people who are experiencing withdrawal to access help,” says Robyn Shearer, Deputy Director-General, Mental Health and Addiction. “If the local expectation is that people are managed in primary or community care, DHBs should ensure that those services have information on withdrawal management.
Back at the coalface, encouraging drug users to have another person around who isn’t using but who knows what they’ve taken, is part of the message the Drug Foundation is trying to get across, and it has also been trying to educate the drug using community about common withdrawal symptoms and which ones to take more seriously.
“We also ask whānau and friends to keep an eye out for withdrawal symptoms, which can range from difficulty in sleeping, confusion and disorientation,” says Birks Ang. “This may be the perfect time to sit down with your loved ones and talk to them about how they might be able to cope without drug use.”
When it comes to harder drugs, there is also the matter of availability at the supply end – generally countries with their own lockdowns and restrictions on movement. As our source explains: “There’s stuff coming down through the Pacific … It all comes from China and Mexico and it comes in through the Pacific.”
Police say they haven’t detected any drop-off in supply yet, but are closely monitoring drug supply lines during the lockdown, according to Detective Inspector Blair Macdonald, manager for the National Drug Intelligence Bureau.
“At this time we have not seen any significant impact on the availability or price of illicit substances. However, it is too soon to draw any definitive conclusions into what impact the level 4 restriction period will have on drug use and supply trends.”
Police are working with the Drug Foundation to understand how Covid-19 might be affecting drug users and addicts. “We echo their advice to regular consumers of drugs to consider taking a break, as the effects of drug use on users and those around them are different whilst the nation remains at home during the level 4 restriction period.”
Of course, anyone desperate for a fix will be tempted to travel – with an increased risk of being arrested – and the Foundation is keen to get that message across too.
“If they leave their bubble or their house to get something, even if it’s left outside somebody else’s property so they’re technically not merging bubbles, there are more police around who will be asking people what’s happening so there’s a greater chance they will come into contact with a police officer while in possession of substances. So think carefully about whether the increased risk is worth it.”
The police are clearly concerned about the potential spread of Covid-19 through drug dealing. “People also need to consider that face-to-face contact with people supplying drugs, handling cash and close contact with those outside of your bubble all have the potential to transmit Covid-19,” says Macdonald. “There are no safety controls in place within the supply and retail chain of illicit drug distribution.”
As Women’s Refuge chief executive Ang Jury made clear recently, the situation is having a noticeable effect on domestic violence, with refuges seeing up to a 60 percent increase in requests for help since the lockdown.
“The lockdown can be stressful anyway,” says Birks Ang. “And I think if someone is trying to withdraw, whether it’s by choice or not, that’s a very uncomfortable situation. Their emotions can be all over the place and their ability to suppress or control their actions can be more challenging, so they might be more impulsive, they might have stronger feelings that are more difficult for them to contain.”
Drug harm reduction frontline workers are having to figure out new ways to communicate with their clients. An Auckland Alcohol and Other Drugs clinician/counsellor whose clients live in residential facilities for those in recovery, and who spoke to Newsroom anonymously, says they are busier than ever.
“It’s so new for everybody, we’re taking each day as it comes. It takes a while to create a safe routine for everybody, because everybody processes grief, fear and anxiety differently. So we’ve created a normal routine, we have a staff meeting via Zoom in the morning, then it’s groups online via Zoom, and also one-on-one work. Then all their meetings they’d normally go to are all via Zoom. But we keep things the same as much as possible.”
Gill Hood, chief executive of Care NZ Manaaki Aotearoa, an addiction treatment and recovery service, says they have been successful at reaching out to people. “We quickly mobilised to ensure frontline had laptop and headset. Telephone counselling, and potentially online counselling through Zoom, happened fairly quickly.”
AA and NA (Narcotics Anonymous) meetings nationwide have also moved to Zoom, but Hood says some clients don’t have internet access, so phone counselling is the way to go. “We make sure people aren’t disadvantaged if they don’t have data, find ways around that.”
In the meantime, everyone is watching for new and emerging trends in drug use over the lockdown period.
“We’re not sure what substitutions might happen,” says Birks Ang, “but we have a regular network of organisations who are monitoring the trends in their local communities so that we can nationally gather info about what it is that we’re likely to experience and can respond quicker around it.
“One thing we’re thinking about is as people get a bit more blasé around the lockdown they’ll start taking more risks in coming weeks compared to what they did in the first week of lockdown, and we’re keeping an eye on what that looks like.”
Hood says now is a good time to connect or reconnect with supportive harm reduction services. “Alcohol and drug services are open and taking referrals for whatever level of support you require. People wanting to access NA or AA, they can do so online. Stay in contact with people who can support you and access the services – they’re open and running.”
Birks Ang agrees: “Drug and alcohol services are considered an essential service, so they’re still operating and providing support. A lot of the community-based counselling that’s available is going online so calling people through phones, through internet. Services like needle exchange are still operating as well, just on some reduced hours. So there’s still good harm reduction services that are available, and are actually more important right now because that’s about hygiene, not just of blood-borne infections.”
Alcohol and Drug helplines are available 24 hours a day, 7 days a week free from landline or mobile. Call: 0800 787 797 or Text: 8681