Side event: Drugs, COVID and the most marginalised

Organized by the International Doctors for Healthier Drug Policies with the support of Release

Dr Emily Crick, Chair International Doctors for Healthier Drug Policies (“IDHDP”): The meeting will be recorded and uploaded. I work with IDHDP. We call for better drug policies that center a health and human rights approach. If you’re a doctor and not involved, please do join us!

Wilson Box, Civil Liberties and Drug Network, Zimbabwe: Changing Patterns of drug use in Zimbabwe. National lockdown March-September 2020, was very strict and most people did not have access to basic services. If you wanted to go to central district you needed special pass. PWUD did not have access to services. Marginalized, stigmatized and criminalized to some extent, it was very difficult for our community to have access, especially treatment. With the lockdown, a lot of NPS, especially rise of crystal meth appeared, especially affected youth who now have mental challenges, we also see rise in gender-based violence and crime. All this happened during this period of lockdown. Community members somehow had to find a way to make a living, increase n drug use was a cause for concern, increase in marginalization. We are second-class citizens because of stigma. As an organization, we had to fight, we managed to assist food handlers and treatment services. Increase in drug use was too high, a cause for concern. We worked with different stakeholders to ensure PWUD are respected and served, including their rights and health, and services are afforded to our community.

Dr Atul Ambekar, National Drug Dependence Treatment Centre, India: Namaste and Good Morning! Our COVID situation has gone from bad to worse. As far as addictive substances goes, that has been progressing in India. First large-scale survey on alcohol and drug use pre-covid, and already a very large treatment gap. There is OST/MAT, largely buprenorphine. Major challenge was pandemic and the lockdown, serious restriction on availability of alcohol and drugs as well as challenge in accessing treatment and services. The number one challenge was the non-availability of alcohol leading to withdrawal symptoms. We sprung to action immediately, produced video educational videos for policymakers and service providers. Pre-covid MAT, methadone was daily observed, but India has a long experience with buprenorphine fortunately, so it was available on a wide scale but mainly as daily observed. Regulating OST has been a concern for a long time in addiction community in India. Immediately worked with colleagues and policymakers to bring about wuick sweeping reforms on continue services, ensure safety of patients staff, and be more liberal in dispensing of take home – first case when methadone was offered for take-home across all methadone facilities, buprenorphine increased. Challenge 3 – capacity building for professionals – a pandemic of zoom webinars, exploited all possible ways. Developed online training moduls, interactive power points. Were also documenting, online monitoring. Early impression that alcohol and drugs continued to be available but increased prices, hardly any reports of diversions to OST contrary to fears and preconvienced notions. That’s very encouraging and a lesson learned for everyone. Telemedicine guidelines don’t allow prescription of OST, why shouldn’t that be allowed? This advocacy is a work in progress. UNODC, WHO could develop advocacy and technical tools, we need to do more advocacy in this regard. Haven’t seen the tail of it, worst is not behind us. Also don’t know what it’ll look like post-pandemic Opportunity for good research

Kassandra Fredrique, Drug Policy Alliance, U.S.: What we’ve seen in drug user health and how our systems reacted. We have documented and predicted that the overdose crisis would worsen, forcing ppl inside, isolation and shutting down of services would create circumstances where for some people their use might become more chaotic, and that’s what we’ve seen. Overdose increased dramatically and the kind of overdose diversified. It’s been a drug poisoning crisis, an issue of adulterated supply. The U.S. is in dire need of safe supply, adulterants cutting our supply. Mainly fentanyl. Folks not given the info on how to navigate this through. An epidemic within a pandemic. Covid exacerbates all structural inequities, housing and healthcare. Harm reduction left out of health care continuation planning, no PPE, no additional funding. The shadow healthcare system for PWUD – in NY when the vaccine was rolled out, HR agencies were considered healthcare workers when they weren’t at the beginning of the pandemic. If we didn’t have the HR infrastructure, we would have had more people die. HR workers are the unsung heroes. Healthcare infrastructure couldn’t have met the demand. Buprenorphie, telemedicine, all these red tapes were reduced. District Attorneys decided not to prosecute drug charges and sex crimes  – there are ones who will continue not to prosecute these charges. Advocacy community has been fighting for these for a long time, now they’ve seen it did not decrease crime. Pushing a conversation on how treatment needs to be improved, the shortcomings have been exposed in a different way than expected. We’ve seen legal changes and changes in practice, as well as pushback against law e forcement engaging with drugs in any way. Biden’s stance and first-year priorities have also move towards a liberalized way. But things are far from being right. Data coming out to push back against the current infrastructure. As more people are dying, we need to diversify conversations around this. Every overdose death is preventable. How do we keep these in place as we move forward.

Q&A:

Dr Emily Crick: Any innovations in Zimbabwe that are positive?

Wilson Box: There has been some in treatment. Production of Zimbabwe Drug Master Plan, written together with ministry. Includes strategies of implementation. We are hopeful it will be adopted holistically so people who use drugs can access treatment.

Dr Emily Crick: Atul mentioned a lot about alcohol, is it similar in Zimbabwe?

Wilson Box: Yes, we have challenges. Alcohol is a tradition in Zimbabwe. It’s been a varied issue, especially with the younger generation.

Dr Emily Crick: Increased adulteration?

Kassandra Frederique: One of the things we watched was the U.S. supply. We’ve seen fentanyl spread across the country as a way to extend the heroin supply. Calls for safe supply is increasing, the urgency and time is here. Folks felt the supply becoming more volatile.

Dr Emily Crick: In India?

Dr Atul Ambekar: No systematic studies, anecdotal info from patients. There’s been some difference in quality, it’s slightly more diluted. We expected complete obstruction of market which hasn’t happened at all – shows the flexibility of drug market.

Dr Emily Crick: how can communities and the global community think about improving marginalization of pwud?

Wilson Box: Support PWUD. They are uman beings, they have rights, they need to be respected. This could go a long way.

Dr Atul Ambekar: continue to advocate for drug user population as a vulnerable group in the pandemic (infaction and care). We’ve seen the necessity of organizing health services as a hierarchy – people don’t realize addiction services are how important, but PWUD should be priority in all health interventions, including in vaccinations

Kassandra Frederique: there are things that make pwud vulnerable that has nothing to do with their drug use – housing, food, clean water. People who don’t have access to these are the most vulnerable to covid, and not because of their drug use, that’s just one part of them. Drug use does not make the fullness of them. Housing for all, food for all, access to running water. As a movement, we need to push colleagues in other movements to center people who use drugs. It was their connection to drug use that got them PPE or a higher priority, that’s the only way the got connected, through harm reduction services and organizers to get into hotel rooms etc. Others in other movements need to take into consideration that our vulnerable population is their vulnerable population as well.

Dr Emily Crick: some moves to house homeless populations.

Kassandra Frederique: HR orgs really serve as connector to broader efforts around covid. Bc our movement is fighting and strong and respected in some ways, we were able to advocate. We need to see people as more than PWUD, people who navigate other structural issues.

Wilson Box: challenges are discussed on the national level now, we are motivated and hopeful.

Dr Atul Ambekar: pandemic exposed a lot of faultlines in society. One of the factors that make us vulnerable is drug use. Exposed need to be looking at particular vulnerabilities of our communities. Reflect on priorities for our societies going forward. First few weeks when alcohol was not available and people were suffering, there was a discussion if alcohol is a necessity or a luxury item – it’s an opportunity to reassess. Drug user advocacy should become a mainstream in all facets of social advocacy. There is hierarchy in advocacy. They don’t like you if you advocate for drug users. We need to cross that bridge.

Dr Emily Crick: Thank you so much to panelists!

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