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LLike most Australians, George * has spent most of the past two months trying to stay home. He watches Netflix, tries to cook new things, and takes his dog Baz for a walk in the park near his home in Coburg, north of Melbourne.
But life in a pandemic has its own particular challenges for George.
The 38-year-old man is a recovering drug addict. A polygraphic drug user who “specialized” in heroin and cannabis, his methadone treatment meant that during the peak of the virus he played with infection every day by taking the train to a clinic a few suburbs away. Sober for the past seven months, he is one of thousands of recovering addicts struggling with treatment amid the Covid-19 pandemic.
“In some ways it’s really good because, all those places you’re trying to avoid, like the places they reminded you to use, you can’t go there anyway,” he tells The Guardian.
“But trying to use the Internet for meetings and then having to travel to [treatment] When the government says you should stay home, it is not ideal. Also, I guess, like everyone else, he is alone. I’m probably a bit of a recluse, I don’t see a lot of people anyway, but I haven’t been to see my mother for over a month, which is kind of difficult when she’s been the person who has always supported me. “
For George, who has positive hepatitis C, not having to visit a pharmacy every day means less stress.
“I think it’s anxiety more than anything,” he says. “The last thing you want on top of everything is to worry that you’re going to get the virus by being on the train every day or being pulled over by the police who might say, ‘You’re a drug addict.’ The other day I told someone that it would be pretty tough. if after all I did I died while trying to stay clean. “
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Across Australia, the Covid-19 crisis has triggered a seismic calculation in addiction medicine. While people like George manage to find a way out of the crisis, experts worry that the growing substance abuse fueled by the virus, along with new restrictions on an already overburdened drug and alcohol rehabilitation system, may make Australia face a crisis. addiction.
“We are really concerned about what is to come in the next six months,” says Leone Crayden, executive director of The Buttery, a rehabilitation center near Byron Bay on the north coast of New South Wales.
“We know that alcohol sales have increased, we anecdotally know in our community that people are piling up prescription drugs. It is still early, but this is what is happening and I hope that the governments know it “.
Problems in drug and alcohol treatment in Australia did not start with Covid-19.
Earlier this year, an independent special commission, appointed to investigate the rise in addiction to crystalline methamphetamine in New South Wales, highlighted a “longstanding and significant unmet demand for treatment” in Australia. The commission estimated that between 200,000 and 500,000 people were unable to access drug and alcohol addiction treatment each year, and a survey of residential rehabilitation facilities in NSW found that 21% had waiting times of between three and six months.
There are also significant gaps in treatment. Before entering residential rehabilitation, most facilities require clients to undergo a period of detoxification. But the research found that those services were often not well linked, creating a significant risk of relapse between detoxification and rehabilitation. Other forms of treatment are simply not widely available. In 2016, the federal government manufactured the drug Naloxone, which works as an antidote to opioid overdoses, without a prescription at Australian pharmacies. But other problems like cost remain a major barrier. While the Commonwealth government has been testing free access to Naloxone in three states, a new study published this week found that over-the-counter sales of the drug had not increased substantially since it was rescheduled.
Rehabilitation centers and addiction specialists say these problems have been exacerbated by Covid-19, as services see an increase in demand while their capacity is severely restricted by the virus.
At the medically supervised injection center at Sydney’s Kings Cross, director Marianne Jauncey says social distancing measures mean her capacity has been reduced from 18 to nine clients at any given time. And Jauncey says that the reality of social distancing has radically changed the way they interact with customers.
The fifth of Australians has purchased more alcohol since the shutdown began. Photography: Andrew Fosker / REX / Shutterstock
“In our stage three area, which is the aftercare area, we’ve removed some of the chairs and removed the tea and coffee, so no one is hanging around anymore. That’s really difficult because the whole idea of Stage three is about connection. That’s when we want to connect with our customers and it’s very difficult for us, “he said.
“The rest of the world is learning how to connect with technology while at home, but it is much more difficult to connect with someone who is homeless on the street or who lives in a hotel or hostel if they are not physically present. We are like everyone in that we are trying new and different things, but it is not natural not to be physically there. The whole point in some way is to bear witness. “
While the customer base at the injection center has not changed, other services are seeing a sudden change in demand as the Covid-19 stress impacts a new user cohort.
A national YouGov Galaxy poll conducted in early April They found that a fifth of Australians had purchased more alcohol since the shutdown began, and were drinking more at home. For a week in April, spending on online gambling increased by 67%, while spending on alcohol and tobacco increased by 33%, according to a database of consumer spending compiled by analytics consultancy AlphaBeta and the Illion credit firm.
The link between stress and substance abuse or harmful behavior is well established. After the devastating Christchurch earthquake in 2011, spending on poker machines in the city tripled. Despite a significant drop in tourism and an exodus of about 10,000 city residents, gaming revenue increased by nearly $ 4 million against a downward national trend.
Amanda Curran, vice president of the Australian Association of Psychologists and a registered psychologist, says factors such as lack of stimulation, increased stress, particularly around finances, and possible illness, are driving the rise in substance use rates. .
“On top of that, disconnecting from social support systems like friends, neighbors, therapists, the church, and family can contribute significantly to mental strain,” she says.
“For those in recovery, lack of access to support services is a major concern. Those who traditionally participated in support groups like AA or NA may not have access to a computer to attend online meetings, and are particularly at risk here. ”
Treatment centers like The Buttery are already seeing the effects of the virus. Crayden tells The Guardian that since the closing rules were implemented, the center has seen a significant increase in calls from people concerned about drug and alcohol use.
“We get more calls to our intake line from people saying, ‘Look, my partner had a lot of control over their alcohol or drug use in the past because they worked and had their routines, but that doesn’t happen anymore, so at 6 p.m. beer is turning into 12 p.m. beer ‘”, she says.
“People have their own harm reduction minimization strategies: eat well, sleep well, stay busy, exercise, and just have a purpose. Well, many people have been retired, are not working, and therefore have no such purpose. We are all eager to get coronavirus, for our families. We are seeing many calls from young mothers who are overwhelmed with homeschooling. So there is a lot of anxiety and fear and we know that people self-medicate to deal with it. “
At the same time, Crayden says, The Buttery has been unable to accept new residential rehabilitation clients since the virus occurred. While he is finding innovative ways to continue customer reach, including buying phones and laptops for those who don’t have access to technology, he fears that the 90 people already on his waiting list will face additional challenges while working at a strategy that allows them to take on new clients.
Anecdotal reports of increased substance use, along with funky treatment options, have led Suzanne Nielsen, deputy director of the Monash Addiction Research Center, to warn of the possibility of a syndemic – two endemics operating at the same time. .
Australia was already grappling with a growing crisis of opioid-related diseases and death rates before Covid-19, and Nielsen fears that unless authorities begin to consider the risk of increased addiction rates, the problem could get worse. While he says that facilitating access to methadone was a good step, governments could do things like expand the number of medically supervised injection centers and increase free access to naloxone.
“Obviously, when people inject drugs, it’s often multiple times a day, so if you’re really going to reduce the risks associated with that, the injection room really needs to be in your local area to be able to attend without traveling long distances. ” she says.
“In cities as large and geographically diverse as Melbourne and Sydney, it really doesn’t make sense to have a place. Kings Cross is no longer the epicenter of injection in Sydney and we absolutely need more of these services in order to have more equitable access to them.” .
Jauncey agrees, noting a 2019 recommendation from NSW Deputy Coroner Harriet Grahame for a feasibility study at a new injection center in southwest Sydney after Amaru Bestrin, 25, died of a heroin overdose in a public toilet at Liverpool hospital. .
“People take drugs where they get them,” said Jauncey. “We know that injection centers are not a honeypot, so you must place these services where the market is.”
All of the experts The Guardian has spoken to are also concerned about a changing profile of the illicit drug market. In the same way that the closure of major sports codes has seen online sports betting websites simply switch to offer odds in dark leagues such as Russian table tennis and Nicaraguan soccer, experts warn that a possible shortage of Heroin caused by border closings could have unintended consequences.
When Australia experienced a major heroin drought in early 2001, the country experienced a 67% reduction in fatal and non-fatal opioid overdoses. But there is also evidence that many long-term users simply switched to other substances like prescription benzodiazepines.
Nielsen says evidence from abroad, and in particular from the US The US suggests that “supply shocks” in the heroin market could lead users to more dangerous drugs, such as the prescription opioid fentanyl.
“We have seen in other countries that when there have been supply shocks it may be a time when more potent drugs are introduced,” she says.
“Fentanyl is an obvious candidate because it is easier to ship and because of its potency. It is one of those things where we just don’t know which way it will go because we don’t have the data yet.”
Jauncey says the potential for users to switch to fentanyl analogues and crystalline methamphetamine is a major concern for those in the industry.
“It is an annoying problem. We all look forward to seeing a change in availability and when we see a change in access, supply and strength,” she says.
“We do not produce heroin in Australia, everything is imported from Southeast Asia and China, where we have well established trade routes that have now been discontinued.
“On some level, it is a crystal ball looking. But we know that when there is a commotion on the market, you see a greater search for treatment. What I hope will happen is that the treatments are available and ready for them. One of The not-so-good results are that people can potentially start using other substances, which can be more harmful.
“We are concerned about the risk of fentanyl and high potency analogues. The other thing that concerns the sector is an increase in local methamphetamine. We do not manufacture our own heroin, but we make our own methamphetamine.”
* It is not his real name.
