An online click-and-collect service for needles and drug equipment has been set up by a national treatment charity as the sector seeks to adapt to the consequences of the Covid-19 pandemic.
We Are With You, which provides drug and alcohol treatment services in 80 locations in England and Scotland, has started the initiative in Truro in Cornwall, the Scottish Borders, Dumfries and Galloway, Argyll and Bute and Glasgow.
The scheme is one of a number of changes that drug treatment services have introduced to adapt to the restrictive lockdown environment, with others including restructuring of supervised consumption of heroin substitute treatment, and door-to-door delivery of the anti-overdose medication naloxone.
But senior directors at the charity have criticised the government for failing to enact measures earlier in the pandemic that could have simplified the provision of opioid substitute therapy (OST) with methadone or buprenorphine.
People who use drugs are vulnerable during the pandemic due to itinerant lifestyles, underlying health conditions and limited access to public health information. Drug-related deaths in England and Wales had already hit a record high before coronavirus struck.
Lorraine Maden, lead clinical pharmacist at We Are With You, said the click-and-collect service was under consideration prior to the pandemic as a means to reach out to people who had not previously engaged with services but added “Covid-19 has accelerated it”.
“When we provide the equipment it’s about the interventions we can have, the conversation to get people into treatment and recovery longer term,” she said.
People who inject drugs including heroin and steroids are able to access a web portal and request a wide range of needles and equipment including foil packs, needles for different types of veins and specially designed spoons that do not burn when users heat them up.
They will then be able to collect them from an arranged address where they will be met by staff, who have personal protective equipment (PPE) who will provide the delivery using social distancing measures.
Many users of drugs have underlying health conditions, Maden said, and require delivery to the door.
“A lot of our clients our heroin users and have COPD [chronic obstructive pulmonary disease, a lung condition],” she said. “The age of users, particularly if they have smoked crack and heroin over the years, some of them are having to shield.”
Needle sharing facilitates the passing of blood-borne viruses and so, by providing clean equipment, levels of a wide range of diseases, including Hepatitis-B, Hepatitis-C and HIV, can be reduced and consequently relieve the burden on healthcare.
“The more that we can do to reduce those costs is a benefit to society as a whole,” Maden says, adding there is also a risk factor with Covid-19 and sharing drug equipment.
Dr Rachel Britton, director of pharmacy at the charity, said across the country they have had to individually assess clients who require daily supervised consumption to see if they can switch to collecting the medication weekly or even fortnightly. In Scunthorpe, for example, the number of users of drugs who require daily supervision at the pharmacy has reduced from between 50% and 60% to just 3%.
She said: “We moved away from people having to attend the pharmacy every day to collecting their medication either weekly or in some cases every two weeks, so moving quite quickly away from the need to go to the pharmacy every day. That obviously helped the pharmacy as well.
“It’s always safer for clients to have OST available to them rather than be off it and use street drugs. That was the overarching principle. People are on supervised consumption, if we remove that how do we keep them safe?”
But there are risks in taking people off daily supervised consumption, Britton said, with risks of clients taking a week’s worth of methadone in one day or selling methadone to other individuals, known as diversion.
“We were particularly concerned about people who had a recent history of overdose, particularly if that was intentional,” she said. “Giving that group of individuals a large quantity of opiates is not a safe thing to do.”
Shortly after lockdown measures were introduced, the government announced plans to allow pharmacists to provide OST medication without a prescription but many weeks past before the legislation was laid – and even then a “push the button” clause was written in, meaning a secretary of state has to formally enact the measure.
Britton said the legislation “would have made a difference done at the beginning”.
“We would still like that legislation enacted,” she said. “Although there’s no massive crash of the system, and that includes us, at the beginning it would have been valuable.”