06/10/20 Tony Duffin

Outreach work and COVID-19. Correlation – European Harm Reduction Network recently brought together a panel of experts to share insights on recent developments in their harm reduction practices, the challenges experienced by their communities, and the impact of COVID19 on operations. We’ll hear from Jane Mounteney, Head of the Public Health Unit at the European Union’s drugs agency, the European Monitoring Center on Drugs and Drug Addiction; Sara Woods, Policy Officer at the Mainline Foundation; and Tony Duffin, CEO of the Ana Liffey Drug Project in Dublin.

Program: 
Century of Lies
Date: 
Wednesday, June 10, 2020
Guest: 
Tony Duffin
Organization: 
Drug War Facts
Tony Duffin
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COL

061020

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DEAN BECKER: The failure of drug war is glaringly obvious to judges cops wardens prosecutors and millions more now calling for decriminalization and legalization the end of prohibition. Let us investigate the century of Lies.

DOUG MCVAY: Hello and welcome to Century of lies. I'm your host Doug McVay June 26th is a support don't punish Global day of action events and activities related to support don't punish willl go on all around the globe will hear about this year's Global day of action later in the show. But first on June 3rd correlation European harm reduction Network held a webinar entitled Outreach work during the covid-19 epidemic exchange of experiences and paths forward; a panel of experts shared insights on recent developments in their harm reduction practices on the challenges experienced by their communities and on the impact of covid-19 on operations. We're going to hear from some of the participants.

Jane Mountainy PhD is head of the public health unit at the European monitoring Centre for drugs and drug addiction.

JANE MOUNTAINY: I would like to just do two things one is just very briefly highlight the few of the resources and activities that people may be interested in and and II just to share of top-level results from a very recent study and and hopefully the bits that will be interesting for people here from Outreach background. So first of all, all the EMCDDA has set up some information is also is we've got a hub which is covid and drugs-related where we've put examples mainly of guidelines procedures health-related information that have come in from a range of countries so that everybody can access download, not have to reinvent everything from from scratch. So if you're looking to develop some, you know service level procedures or what have you.

The website resource, you may find some things in your language. Hopefully that's interesting. The second thing we've done a bit like this initiative is we've set up a series of webinars on key topics that we've had two so far one on services and one more General how people people's first responses and they're open to everybody. The next one is tomorrow and it's on prevention and impact of covid and then there will be one on the 17th, which Will be covid use and harms and will be won on the first of July which is on darknet markets. So again, you can check on our website. Everybody's welcome. It will be great. I have got an ice cream van that's just come down the street. So I might have some background music just to I'm not sure there's anything I can do about that. So just that just enjoy my voice floating over the, okay the second the second topic is just to share some results of a very recent study.

We have done what we call a trend spotter study, which is a quick rapid assessment methodology where we bring together all the data we can including expert opinion and we try and get the voices of front-line Professionals in there to try and understand a topic rapidly. We looked at Services. What's the impact of covid on Health Services both harm reduction and drug treatment. That's what I'd just like to share one or two of our findings before you go ahead. And what I realize is this is really fresh data, and it's from April, but it's out of date already and I think that's what's really interesting is if I was doing a focus group with people here today.

JANE MOUNTAINY: Would be asking questions. How is it now coming out of lockdown where I think what we picked up is people going into lockdown and containment measures. So I think we need to bear that in mind things are moving so quickly that it a questions need to change. Not not not just the answers and we are needing to look for the new methods to pick things up. So this is from this report came out last month. We based it on three online surveys a web survey with people who use drugs and we're got a good response yet about 11,000 people responding and we did some online facilitated groups with experts top-level. What did we find? I mean, there's no no big groundbreaking findings to say that as with all couples trip services. We saw a big drop in the provision availability of treatment and on this harm reduction provision across Europe in general. So we saw closures and reduced availability.

In all countries or in all areas of harm reduction drop-ins needle and syringe provision drug consumption rooms shelters and Outreach say so drops closures reduction in availability reported across the board some Services as you well know stayed open sometimes against the odds. And for those that were still running essentially everyone was reporting we have to very quickly put in into place new hygiene measures.

JANE MOUNTAINY: And new social distance measures. Those were the two big immediate changes that that Services were reporting. The other one was and I think again like us all there's an increase in the use of new technologies so drug services on reduction Services. We're getting the same kind of challenges we did are specifically and I'll just highlight one or two of the challenges that came up from respondents. So particularly at the start of the crisis and containment was accessing materials particularly protective equipment the issue of educating clients about the risks was repeatedly mentioned and particularly for some groups. There were there were issues around it was hard to to get the social distancing messages across that was a report and working with more or the particularly marginalized client groups and services were moving into prep slightly different areas to those.

They've been folks on or more basic hygiene food housing issues came to the fore and so they were working in those areas more than before managing infected clients covid. This was rare. Not many services were reporting a high level of infected clients with covid but but somewhere and they're the issues were more around quarantine and how to implement those sorts of measures Staffing shortages across the board was a problem for different reasons.

Sometimes it was around rotors and changes in the actual shifts some sometimes it was about quarantine and people having to be quarantined for two weeks, Child Care issues that many when kids out of school, but also in some services staff were moved and taken out and put into two other provision.

JANE MOUNTAINY: Enrolling new clients was an issue particularly with some of the drug treatment services and particularly where they needed a face-to-face contact at the start that was became more challenging and broadly managing demand for substitution treatment. Sometimes it was that there was increased demand services are closed. The ones remaining had struggle supplied medicines was also an issue for a few countries.

Just briefly then service demand, but I just looking here at the harm reduction issues that came up where unlike treatment harm reduction Services were more likely to have no change in the demand or actually increase whereas treatment it tended to be a drop, new requests was one of the issues and these were often around things like types of requests so that whereas before it more client where he was about Food hygiene.

Maybe income so pulled where people no longer had their tourists and sources of income. For example, sometimes it was two new types of services. So the service was demand was around low threshold OST. For example, there were some examples of new clients. So in some areas more drug-using sex workers were coming to Services people coming out of prisons and using services. So the worst time new clients completely new and some new needs one of the things

that's come up a few times is around client struggling with alcohol and benzos, but benzodiazepine issues and people working around support for anxiety Etc. So some slight differences reported their services adapting. I mean and I think this was a big finding how quickly the services that stayed alive adapted and their flexibility and there was more generally and moved from face-to-face to more online services from center-based often to try to avoid Gatherings to arrange a flexible options home deliveries of equipment and medications postal deliveries. Some self-service spots were set up in some countries where people could help themselves and more takeaways generally say just to summarize for those Services they'd open that our what else that you showed.

There was a fairly impressive response to be honest, and there were quite a lot of positives recorded. We were perhaps surprised initially a how many how many people are fairly positive in terms of what had happened how they've been able to innovate and adapt and particularly about the new low threshold services that were we're coming up as a response also policies around solidarity with clients into responding to the pandemic situation the stars and clients working together negatives clearly the closures and concerns about reopening and plans for reopening there were Concerns around the delays in HIV and hepatitis hepatitis C being flagged and also disruption in treatment of infectious diseases issues around drug-related deaths and certainly delays in confirmation their autopsies taking place. So a loss of the flow and our understanding in terms of Overdose deaths what's actually happening and I think the other thing was about does there were some concerns around unintended consequences and that the fact that

Are unknown so some people were a little bit concerned about the unsupervised access to OST concerns about overdoses, but we didn't have the information one way or another yet to know into the future last Point here into the future. We ask people, you know, what were their thoughts at this stage and many sort of window of opportunity and said while it been hard and within many problems there were this was perhaps for services window of opportunity.

Particularly in terms of new service models and hold on to the things that were positive and that we seem to be an improvement and also particularly in terms of new technologies and how can they continue to use the new technologies in their work and the telemedicine an ehealth that was a sort of Rapid tour of our first round round of findings. There's a report anybody that would like to know a little bit more you can find on our website and we're deep in the second wave now which is on harms and use just to say they'll be a report that we're writing at the moment that will hopefully come out in a couple of weeks on specifically looking at covid an impact on drug use and drug related harms. That's where we are now. Thank you for the opportunity.

DOUG MCVAY: That was dr. Jane Mountainy head of the public health unit at the European Union's drug agency the European monitoring Centre on drugs and drug addiction. She was speaking on a webinar organized recently by correlation European harm reduction Network on the Active Outreach work during covid-19. You're listening to Century of lies. I'm your host Doug McVay. Now. Let's hear from Sara Woods. She's a policy officer at the mainline foundation in Amsterdam.

SARA WOODS: Oh, I'll try to summarize non Outreach work as briefly as possible in the Netherlands. We haven't we have looked at the changes in the drug market and we haven't heard any consistent big changes in the drug Market as in availability or quality or price changes, so

Some say gets harder to some say it doesn't some say it's more expensive some say more cheaply. So there's no consistent changes in that and as for treatment and accessibility a lot has listening to all your other stories. We've had a very consequent a consistent availability of everything of course things have changed and I'll elaborate on that a little bit, Our heroin maintenance treatment, which we have in the country has continued OSD has continued and many have as others have mentioned as well have now received it as a take home. So they get it for the week whereas they wouldn't beforehand which which some appreciate but others. I think it was Portugal that mentioned that some were really Keen to get their supplies for a week. But now yeah, what you do see is that the contact is ready missed and that is I think a major thing that we seeing for ourselves for our own Outreach work.

But also what we've heard from Outreach workers all throughout the country that that has been a big challenge Morrow said it as well, you know, we need that physical contact that face-to-face With people you can call people but some people you can't reach over the phone and some conversations, You can't have over the phone. It's very, you know, you get these very short emergency conversations you can have but it's hard to really connect with people and it's hard to really see how people are doing that.

We've heard that from several Outreach workers throughout the country and I think it's a good practice worth mentioning that for this reason there are quite a lot of Outreach workers that started or even never stopped seeing several of their clients face-to-face all throughout the situation and it was something that we heard more and more especially in may we heard more and more Outreach workers picking that up again that they really made an effort, you know, just see people in front of, you know, go to their house and just meet them outside their house go for a walk with them. I heard a Beautiful story of a person a client who had found a plexiglass screen in the trash and had it installed it himself in his house so that he can have could have face-to-face contact with people. So so that was I think a very important change and also a major change in our work at Mainline. We the past few months together, With the trimble's Institute, which is a major drug Research Institute in the Netherlands and the MDX a which is the drug user Union. We combine our forces these past months and we did a lot of over the phone it it's signaling among perform reduction professionals, but also among the community we have several. We call them our drug Scouts. We have several Scouts throughout the country and over the phone. We asked professionals working with the with the community but also the community themselves.

SARA WOODS: What is it that you see? What do you see on the drug Market? What problems do you encounter? What what? How is your work what challenges are there? But also what are your best practice successes or what's working? Well, so that forced us to shift, but we're also not an you know, we're not a primary care provider we said but we shifted a lot to more signaling and

And reporting to to other professionals but also to the Ministry of Health, so we turn more towards that role the past two months rather than drug education and referral and some good practices while the one that I mentioned is that people really made an effort to do face-to-face contact. I think there's a good practice and not necessarily Outreach for good practice. I think is those who have Made an effort to continue the work the work programs. It has been a major impact on people's lives that the work programs were discontinued for income reasons, but also for daily structures and and life. So we've heard some very good situations all throughout the country where people continued to pay or organizations continue to pay even when work was

No, not possible. But also where they started cleaning the streets and and making it possible to get income through that then let's see now. My neighbor starts fixing his house. I hope you don't hear this then we as for drug education and support. Like I said we did most of it, over the phone in the costumes, but now since this month were doing more Outreach work again. So we're going to other other cities and seeing people face-to-face, of course, all Corona proved keeping distance and those those things and we've also for the we also do Outreach for men who have sex with men and who do chem sex. And for this group we have we now offer an online support group rather than in our office and it's well, it's quite well attended and we also see a bit more men coming to our chat and so coming to the chat and asking for advice there.

SARA WOODS: We're so there we see that the digitalization is having effect and making online services more interesting for people use drugs as well.

DOUG MCVAY: That was Sara Woods policy officer at the mainline Foundation. She was speaking on a webinar organized recently by correlation European harm reduction Network on the subject of Outreach work during covid-19. You're listening to Century of Lies. I'm your host Doug McVay. Now, here's Tony Delfin CEO of the Ana Liffey drug project in Dublin.

TONY DELFIN: It's important to me to view to go to understand that that this is kind of a micro activities like a microcosm of what happened. We aren't the only service that bonded just want to acknowledge some of their services in the moment, but I guess drawing covid-19 crisis as it was in from March onwards the leadership from the state actually was very very good from the HCE at Health Centers executive in Dublin in the north city and county three Health office and in the midwest in Limerick, and it's really healthy State. I can say that the state agency really responded well and gave us leadership in terms of partnership.

We worked with Excuse me. We work with Community, Kumite Therapeutic Community things to diction support team. Sankalpa DePaul Islands, Chrysalis, Midwest Simon Novus and it's important to me for you to understand that we worked in partnership with higher threshold Services as well as harm reduction services, and of course it took a lot for the team at Ana Liffey to respond and Take the team of fantastic and we stayed out on Outreach from throughout from the beginning.

We stayed and we worked in the streets and I'll talk a bit more about that in a moment. But the first question I was asked was which covid-19 regulations are currently in place place in our city. I'll talk about something at the moment. But but this was a Cross Island and from mid-march, we regulations were brought in and we work, gradually slowly brought into lockdown and they've stayed in place until around the 18th of May when they became to be reopened the economy and will have more easing of restrictions next week. In terms of our client group. We were asked to suppose we already worked with that 80% of the people we worked with the homeless and our Focus turns to the homeless population in Dublin and and in the Midwest Liberty and we couldn't keep our services fixed Site Services open because we simply couldn't guarantee people's safety.

TONY DELFIN: So we moved out into Outreach. We already did Outreach Services Outreach has always been very important to us. But we slowly went on to our beach and one of the things that we noticed early on was that I had the people we were serving really didn't understand. What was what was happening whilst there was quite significant information going around for the wider population iconic group really didn't understand why were people wearing masks? Why would a shot shot? Why would a services that they normally go to closed?

So we spend a lot of time explaining to them what was going on and and what access then help them to Access housing and to access treatment, but I think I think the state's response of quite significant response of providing housing. people in terms of cooling units, under Services isolation units for people who are homeless was phenomenal in the early days of we were a job was to reach out to people do needle exchange get people that the equipment they needed but then also to help the meadow the conditions the doctors and nurses to assess people who were over the fun while we were in the street and assess the people who had Two symptoms of covid-19 and if they doctor said earlier said listen, we need to get them to an isolation unit.

TONY DELFIN: We've arranged for them to get their older bring their ourselves. So we recognized very early on that actually the public health response to covid one priority and that descriptors to stop the spread of it and actually harm reduction was now secondary to the public health response, but obviously those two things work well together. So how we did that we we obviously maintain social distancing in Ireland. We are asked to keep two meters apart. We've maintained hand-washing, cough etiquette and the appropriate use of PPE. So we didn't wear masks Etc. If someone had symptoms, we asked them to wear PPE and that was effective in terms of our outreach work we were able to- well nobody within the team contracted covid-19. I'm pleased to say so so that that was that was what we were at now. I suppose I go back to what Jane was saying at the very beginning. Now, we've had to adapt further. We as the economy opens up and services begin to to come back online. We are now providing Addiction Services on Outreach and in reach into the accommodation service because very few people are actually on at the Moment in Dublin and limited so we are really supporting people in the environment. They are so we're gonna be doing addiction Works harm reduction work things like Community detox as Asian relapse prevention those kind of pieces with people who are housed. So that's what we're working with the HSE Health Service executive now and I guess how did the next question was. How about the services adapt to these regulations were as I said response to lockdown means that people we work with are housed.

There was a really good outcome in terms of methadone on the streets for people who are homeless and people who need who are overextended and we went from a 12-week wait for methadone treatment to a two to three-day wait to get people on to methadone and as I've already mentioned that the work we did around assessments of symptoms.

TONY DELFIN: Then yet there was just it was just a great as I say great piece of work in terms of the joint work. We did with the existing Services who also had to adapt and redeploy their their teams. And then how does the impact of the situation of people who use drugs and other marginalized groups like homeless people or so delivery harm reduction services on that these places were an essential part of the public health response during the early days of the crisis and continue to be so and while has would adapt the delivery of services on that which basis will continue to be important. So I think what I'm saying is is that it was essential that Outreach Services State functional that harm reduction was available and low threshold Services were adaptable to get people into housing into treatment into drug treatment and into treatment for covid-19. So I will leave it at that. Is that okay?

HOST OF WEBINAR: That's okay, and it was very very good overview. I think was used did you say that methadone was easier accessible for people in the waiting lists shorter waiting times 2 to get in your room.

TONY DELFIN: Yes. So we had a 12-week waiting list prior to covid-19 and after covid-19 at the very beginning the or Internet so general practitioners and Clinics have caps as to how many patients they could have without those caps were with lifted and more people get on to methadone, which is great and we hope we hope that we will maintain that we on there and we certainly at the beginning. I think we worked obviously within within the perspective of what was possible, but I think during covid-19 at the beginning there was a real sense that you know do something don't be like the best video enemy of the good, you know, you're going to make mistakes but do something and yeah, we were allowed to take risks and we were allowed to to to get it to work differently.

DOUG MCVAY: That was Tony Delfin CEO of the Ana Levi drug project in Dublin. He was speaking on a webinar organized recently by correlation European harm reduction Network on the subject of Outreach work during covid-19.

And that's it for this week. Thank you for joining us. You have been listening to Century of Lies where production of the drug truth Network for the Pacifica Foundation radio network on the web at drugtruth.net. I'm your host Doug McVay editor of drugwarfacts.org.

We'll be back in a week with 30 more minutes of news and information about drug policy reform in the failed War on Drugs for the drug truth Network. This is Doug McVay saying so long so long for the drug truth Network. This is Doug McVay asking You to examine our policy of drug prohibition the century of Lies Drug Truth Network programs archived at the James A Baker III Institute for public policy.