05/27/20 Tony Duffin

Century of Lies
Tony Duffin
Drug War Facts

This week on Century of Lies: the impact of COVID-19 on the provision of services to people who use drugs. This week on Century: How COVID-19 is shaping the future of drug services in Europe, featuring: Tony Duffin, CEO of the Ana Liffey Drug Project in Dublin, Ireland; Mat Southwell, a Partner at CoAct Expertise in Drug Use and HIV, located in Bath, England, and a Project Manager with the European Network of People Who Use Drugs; and Phaedon Kaloterakis, President of the European Federation of Therapeutic Communities.

Audio file





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

DOUG MCVAY: Hello and welcome to Century of lies. I'm your host Doug McVay editor of drugwarfacts.org the European monitoring Centre on drugs and drug addiction is holding a series of webinars on drug policy.

Drug use harm reduction and treatment in the context of the covid-19 pandemic. We're going to hear some audio from one of those today the most recent webinar in the series entitled. How is covid-19 shaping the future of drug services in Europe.First, Let's hear from Matt South. Well, he's a partner at coact expertise in drug use and HIV, which is located in bath England. He also provides technical support to bridge Hope Health Organization and he's a project manager with the European network of people who use drugs.

MATT SOUTH: Thank you very much for to me to contribute to this webinar and Alexis. Thank you. Thank you for your public commitment to the meaningful involvement of people who use drugs. So this box represents for me the secondary needle and syringe program that we're running in my hometown of the bath. My normal engagement is to the other half of my work is to be a technical advisor supporting International Development on drugs and HIV and clearly that has closed down in the in the covid lockdown so and as drug Services withdrew to protect staff from delivering face-to-face Services. We scaled up our local peer-to-peer delivery of needle and syringe programs peer-to-peer naloxone distribution, and also then spreading messages around the new challenges around covid around trying to set up in our own.

We laid user base Supply or supplier based needle and syringe programs introducing hand-washing and trying to encourage people to adopt safer practices particularly looking at sustaining harm reduction around HIV and hepatitis and managing continued threats of opioid overdose. We had a spike of cannabis cocaine injecting during this period and that was the one of the underlying causes of the

Glasgow HIV epidemic and know we're clear that the numbers of needles and syringes been given out during that period we weathered that storm because we had three or four peer-based secondary needle and syringe programs giving out needles and syringes often alongside the sale of drugs to actually make sure that we didn't lose contact with the most vulnerable drug users during the during the lockdown.

We've also been playing a key role in terms of mediating as drug use groups to get our peers into OST services in my own town. We have 10 new people into Services partly because people feel that they are one they were very fearful and therefore entering OST was a protective engagement. But also the fact that treatment is not more liberal that we are getting weekly take homes at the was fast access to services and services weren't overly dominating and paternalistic and requiring people to engage in Daily supervise the distribution new people came forward because of that liberal liberalized approach and I think as we look to the future, I think we really need to ask questions about why it took a pandemic to introduce what we know is good practice around treatment. Notably. The version is almost non-existent all of our reports from all the drug user groups around Europe is that it's much much harder to secure Street methadone at this point in time.

So really, I think we were all looking to see what would happen when the majority of people were getting weekly take homes. And I think it's really positive evidence that know when people saw the value in their methadone and saw the protective function that that could promote could play if they were caught in a lockdown. Oh people responded by looking after that medication and using it in a really constructive and important way. So I think with the what one thing that's really missing in this picture is the issue of crack pipes. We've had a lot of frustration in the UK. We lobbied Public Health England to promote access to crack pipe distribution arguing that with the respiratory disease. It was critical that we promote crack pipe distribution.

MATT SOUTH:Unfortunately our home home office and said no on the grounds that it would be akin to drug liberalization make doctor Magdalena Harris is publishing a paper in the International Journal of drug policy setting out the case for crack pipe distribution and reminding us the early harm reduction in the Basin was offered achieved through Civil Disobedience and no watch this space So, yeah, so it's been an interesting time with really used Community mobilization across Europe and many of our different groups. I'm reflecting on my experience in bath, but it mirrors the work of drug user groups across Europe playing pivotal roles in helping to keep harm reduction from others.

At ease and to keep drug users engaged notes during these very difficult times.

DOUG MCVAY: That was Matt South. Well, he's a project manager with the European network of people who use drugs. He was speaking at a webinar entitled. How is covid-19 shaping the future of drug services in Europe that was hosted recently by the European monitoring Centre on drugs and drug addiction. You're listening to Century of lies. I'm your host Doug McVay.

Let's hear more from that emcde a webinar participants were asked if they had known back at the Of 2020 what we know now about the covid-19 pandemic what if anything would they have done starting on January 1st with that for knowledge in order to be prepared? Here's Phaedon Kaloterakis president of the European Federation of therapeutic communities,

PHAEDON KALOTERAKIS: the preparedness of any any intervention any treatment approach also has to do I think with the government's preparedness in some ways for Example we increase in our circuit communities with it not so far. We don't have any case of coronavirus infection and in any case but talking with colleagues in Spain or Italy they do have in their programs people who are affected. So because here the government was very quick to react to the coronavirus. I think that really helped us.

But at the same time I would like to make three points which sound more and they probably are more General, but to me, they're also very very important. The first point is that we do need a stronger voice for the most vulnerable groups of people who use drugs for example, the refugees people who are incarcerated mothers who have children just to mention a few examples and I'm talking now about the treatment programs and talking. I'm not talking about advocacy organizations and talking about treatment programs and we should be more political and I, I use this use of the term political in the Aristotelian sense.

Not not about partisan politics. I'm talking about a citizens who take a stand. I mean we do and we work against stigma, etc, etc. But we need that more because when a crisis like the coronavirus comes along then the ones who are more vulnerable than others really suffer. So we have to be prepared.

PHAEDON KALOTERAKIS: We have to do this beforehand, for example with the refugees that we have in Greece and we have many refugees as you as you might know because we were not prepared as treatment programs. Now, there is a problem and we're coming were running after it. Okay, so I think we need we need politically to take a stand as even as treatment programs.

Even if we are not advocacy as I said organizations, so that's one thing that I would have done differently if I had to go back to January. Now. The other thing is that we need he has he has a two-fold aspect. There is a two-fold purpose in this. I mean the one we have to put more specialized emphasis on personal health and personal hygiene. I mean, okay, but the second aspect is also political.

We have to push for for the treatment programs to become an integral part of any National Health System.

Because when as I mentioned before a crisis like a coronavirus and then it comes then we can see the big holes in the system and the holes in the health system have oh also to do again with the most vulnerable even a health matters because we focus on drug use, but we should also focus on personal health and personal Legend and we have that we have to

PHAEDON KALOTERAKIS: Leaves the policymakers that what we do should be an integral part of our national health system.

And the third one? Okay, it's quite obvious and everybody or you know, most people really realize that we can do we could have a more effective use of the internet. Okay. It is too generic. I realize that but for us, I mean you cannot substitute physical presence when it comes to treatment and therapy.

EFTC PRESIDENT: And especially when we're talking about the psychosocial approach you cannot you cannot do that that effectively online you cannot substitute if you can but up to a point, but again, we can do things on our own more or managerial level meetings and different managerial tasks. They can be done now more effectively online and we realized this and this will bring many changes in also.

PHAEDON KALOTERAKIS: It would be good for our budgets. For example, we don't have to travel too much to meetings anymore. So these are the three things that I would have done differently in general before

DOUG MCVAY: that was phaedon kaloterakis president of the European Federation of therapeutic communities. He was participating in a webinar entitled how is covid-19 shaping the future of drug services in Europe that was hosted recently by the European monitoring Centre and drugs and drug addiction. Here's Tony Deffin of Ana Liffey drug project with his response.

TONY DUFFIN: So thank you. So in classic response, if any of you ever get to be asked questions by journalists, you should thank them for the question and then answer the question you want to answer but but I will get back to the question. I'm going to stick to what's on the what's on the slide because it will keep me keep me on track but in March, March 2020 there was a heightened level of fear and anxiety as I've alluded to before.

Policymakers and practitioners were finding their way to respond to a crisis that no one had experience of and we were in Uncharted Territory and I did talk to Donald Cassidy yesterday on Monday and we talked at length about this this finding out at finding our feet and I think it's really important that I say now that with regards to working with people in Dublin who are homeless who are at risk of homelessness and who have complex and multiple needs like problematic drug use mental health issues physical health issues.

Hatred issues ETC the state's response of providing extra accommodation. So we provided cocooning units and isolation units for people who were homeless and improved accessibility of prescription drugs, like methadone and benzodiazepines and I'll come back to that in a moment, but suffice to say the moment in terms of methadone. We went from a 12-week wait to 2 to 3 days and we can talk about that in a moment and in terms of previously. It wasn't permitted to provide stabilization prescriptions and in certain circumstances now idiots. And again, that's something I'll come back to you. But this has helped to stabilize people and help them to remain in isolation for with their own choosing because obviously we've provided them with the options which helps to reduce the spread of covid-19. And that is very important.

I think at the beginning we were very clear very quickly many of us that that our primary job, even though we're a drug service was to reduce the spread of covid-19 and that was critical in you know, coming together and working together for example, as of the 24th of April 20 20 in Dublin City there had been 33 people within this cohort diagnosed with covid-19 three clusters of covid-19. IE two or more cases had been identified within homeless accommodation all clusters, were of two cases only and there have been no known covid-19 related deaths and I checked with Austin this morning and I'm pleased to say that that's still is the case. There has been no known covid related deaths amongst people who are homeless to cohort were working with and in terms of people use drugs as well. So that's very that's very positive, even though obviously there are other difficulties huge difficulties around covid-19 Island participate about discussions.

TONY DUFFIN: In the very early days for coming back to the question in the very early days of the covid-19 crisis many of the people we met on Outreach simply did not know about covid-19. So they had no knowledge of her latest advice what the restrictions were or how the service provision landscape had changed our team spent a lot of time explaining the situation supporting people around their fears and frustrations and getting them linked into treatment and housing options. So upon reflection.

And getting ready and I do think you know, we have to come to terms with the fact that we haven't already that we're going to be living with covid-19. And for the foreseeable future that we need to when you plan drug service providers care should be who are on the front line should talk to people as early as possible to use their services about the impact of restrictions and Link people into Services earlier on to ensure preparedness for future pandemics of color or covid-19 ways.

So I suppose I'm saying that we're really pleased with what we did and if we're looking back and looking back to January if we'd known what we know now, perhaps what we say. Well what we're saying you what I'm saying is we could we could have done it a little bit earlier, but without but you know, that's just looking to to find some sort of critical sort of observation we so that's my slight. Thank you.

DOUG MCVAY: That was Tony Duffin CEO of anonymity drug project. He was participating in a webinar. Entitled how is covid-19 shaping the future of drug services in Europe that was hosted recently by the European monitoring Centre on drugs and drug addiction. He was responding to the question of what his agency would have done in order to prepare for the covid-19 pandemic if we had known at the beginning of January 2020 what we now know about the disease, here's Matt Southwell project manager for the European network of people who use drugs with his response to that question.

MATT SOUTHWELL: Yes. I want you to pick one thing that I'm really People we all doing which is the we have to go to new project in Europe and put called the OST treatment literacy and rights project and this is funded through a unrestricted educational grant from cameras. And it's a key opportunity for us to Champion treatment rights and to Champion and more empowered engaged to relationship for people who are dependent on opiates within opiate substitution Therapy.

I think this key opportunity because we have suddenly gained many of the things we've been fighting for for many years. No rapid assessment and treatment entry weekly take-home Doses and into an overly restrictive and intrusive treatment relationship and suddenly we've gained these things but many countries have set it as a sort of temporary measure with the idea that that would then spring back at the end of this period so I think one of theM Ww're really Keen to do is to highlight how drug users are really responding progressively one by coming into treatment in greater numbers and to managing take homes, very positively and we hope this will lead to a new dialogue around the quality of users and the management of OST treatment in the future which could benefit of benefits as all by increasing the capacity of treatment and the accessibility of treatments as well.

And also allowing us tend to focus more Resources on those who have the most complex and challenging needs the this I wish we could go back to the January and changes the fact that we've been developing a project on peer-led harm reduction. We had funding in place which then fell to pieces at the end of the year at the beginning of the year and we've been subsequently tried to bid again and be an unsuccessful. That's really meant that in the mid to intervene with our country groups and support them to use community-led harm reduction to helped expand the not to sustain but also expand the reach of harm reduction in this period when drug services are necessarily pulling back to protect staff and to and and other manage their health and safety responsibilities. So yeah, I wish we had the resources. I mean we responded very rapidly by getting a leaflet called covid-19 advice for people who use drugs that was that went out in 20 languages Within About 10 days of the epidemic breaking really helping peers to prepare prepare for what was coming. I wish we'd had the resources to do more and go in and support Community LED harm reduction on the ground. I'm frustrated. We were left and just responding with a leaflet.

DOUG MCVAY: That was Matt Southwell, project manager for the European network of people who use drugs. He was participating in a webinar entitled. How is covid-19 shaping the future of drug services in Europe. That was hosted online by the European monitoring Centre on drugs and drug addiction the title of this recent EMC DDA webinar was how is covid-19 shaping the future of drug services in Europe with answers to that question. Here's Tony Duffin CEO of Ana Liffey drug project

TONY DUFFIN: Yes looks getting back to work safely too many people some Services had to close down at the beginning because they couldn't guarantee social distancing and such.

For our part we had to close our drop-in service with March and not do sorry not do group work and things like that. So so we're we're looking at how to reorganize ourselves but suffice to say that we did stay out and Outreach we did carry on with needle exchange. We did obviously do other things that we could do. So the team have been on the ground throughout and I just a few bullet points out.

TONY DUFFIN: The mobilization of drug services to reduce the spread of covid-19 has led to increased collaboration collaboration. Of course, there was collaboration before but this has lead to even further meaningful partnership, which has asserted was led by the HSC from the outset and focus on the primary goal of stopping the spread of covid-19. And I think I said it already but I think that that Focus really brought people together and then we had the removal of barriers to say Service provision.

So things like methadone waiting times will reduce significantly so prior to covid-19. It was 12 weeks to wait for Methadone. So three months and now it's two to three days and we want to retain that collectively talking to people we obviously want to collect the time that data going forwards. Also there has been an innovation with regards to things like benzodiazepine stabilization prescriptions in certain circumstances wasn't allowed before now with now in certain circumstances it is of course, it's no surprise that where as I mentioned providing the accommodation so many people are cocooning.

They're living in a hotel room a very nice hotel room perhaps with with an en suite they're having their prescription drugs delivered to them by Ana Liffey or indeed our colleagues a chrysalis and they have food they are warm. It's no surprise I can say

Say to you at least anecdotally that people are happier that they're in that situation that they are healthy. They are healthier and we need to evaluate that we need to be able to prove that but I'm just telling you from a harm reduction Services perspective know people in that situation for many people things were are improved their health has improved so that that's an outcome. There is a greater need for range of addiction specific interventions and supports to people in their accommodation people can't come to services.

TONY DUFFIN: We've got to go to them and deed we are doing that and we will continue to do that many many of the the extraordinary services that have been probably put in place for covid-19 ago to continue certainly to the end of the year and Beyond a little bit beyond so and we find our way forward what I mean by that is harm reduction Community stabilization and detox relapse prevention. So providing psychosocial support as well.

You know, it's important to me is my last bullet point harm reduction will remain an important part of the public health response to drug use in future pandemics or covid-19 ways to help reduce the spread of the virus and to minimize drug-related hard and listening to map talk about, you know, not being able to provide crack pipes. It's hugely disappointing to hear that we do provide crack pipes to people in Ireland and it is a home adoption intervention. It is apublic health intervention with regards to People's Health in terms of their chest and such so, you know, really we just want to hear that and any support we can give to them that we will so yeah, that's that's my slide. Thank you.

DOUG MCVAY: That was Tony Delfin CEO of an Olivia drug project. Now, here's Matt Southwell project manager for the European network of people who use drugs.

MATT SOUTHWELL: So I think the first key issue is I think there's a there's I think a shared commitment from drug users and also from drug services to sustain the gains that we've made around OST. I think people who are on OST of really demonstrated their ability to manage take him Doses and I hope we can move forward to a much stronger and sustained meaningful partnership that allows treatment to be something that is much more of a partnership where we respect multiple different treatment outcomes. We recognize the role of high-dose Perscribing.

If we recognize the role of choice around different types of OST treatment know from diamorphine through to Deco group an orphan and all the various options in between I think choices is key to people being able to pick the right option for them at the right moment in their life, which may also change over the course of their engagement with drugs. I think we need to really recognize the role that Community Based organizations drug user groups can play in brokering the relationship between people who use drugs.

MATT SOUTHWELL: I mean we have No choice in Social distancing or physical distancing. We are working and living in those drug scene. So therefore continuing to provide education support and to think how we manage that and I would endorse the UN AIDS but press release that no argued for governments to recognize the community services need to be supported with PPE and other issues as well and not to see us as somehow outside the Healthcare System. I think we need to recognize

the drug user groups play a pivotal role in harm reduction Innovation. It's not surprising that we came out with guidelines within no days of this issue breaking because now we have lived experience. We have privileged access into drug scenes and we have a really detailed understanding of how drug use takes place which allows us to very quickly get in and understand risk that may be changing because of the environmental context like covid-19 or new drugs.

New issues and the reality was all of those things have been happening while the covid-19 pandemic has been going on. We've had surges of high quality Harry and we've had surges of cocaine injecting and we've had to respond to those issues as well as covid-19. It's not just we can just we don't just stop doing that other harm reduction work. We have to maintain that as well. I think it's important to have this comprehensive understanding of harm reduction so that we don't get isolated into some Silo's around HIV allows us to do work with people who inject drugs. Oh, but if you're smoking crack, I can't intervene or if you're chasing Harry and I can't intervene. I think we need to be much more nimble-footed and I think the UK in its stepping back from harm reduction in the last period has fallen behind some of our European Partners in no seeing the Innovation when I go to Dublin when I go to Berlin and I know we as drug users in the UK are now really offering to our government to help them catch up.

In after the Prairie Court, no caution the lessons that we learn by having a Glasgow the HIV outbreak in Glasgow. And finally, I think the other key lesson is that housing and employment are harm reduction know the moving of in the UK. They were expecting to have 5,000 homeless people coming off the street 14,000 people came forward for housing off the streets. So I think we really need to understand the huge opportunities of finally getting the Street Homeless.

MATT SOUTHWELL: Population off the streets and we really need to take up the opportunities and think about how we engage that population lastly the people who've really really struggled a bit in the people who aren't able to beg on table to shoplift aren't able to get involved in low-level acquisitive crime that group of really struggled and I think we need to think about offering that group other ways of raising an income like recharging electric scooters and bikes no thinking of creative ways.

People at the bottom end of them of the society can make money without resorting to Crime when they're really struggling.

DOUG MCVAY: That was Matt Southwell, project manager for the European network of people who use drugs. He was participating in a webinar entitled. How is covid-19 shaping the future of drug services in Europe that was hosted recently by the European monitoring Centre on drugs and drug addiction and that's it for this week. Thank you for joining us.

DOUG MCVAY: You have been listening to Century of Lies where production of the drug truth Network for the Pacifica Foundation Network on the web a drugtruth.net will be back in a week with 30 more minutes of news and information about drug policy reform in the failed War on Drugs for now 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.