Episode 14: Emergency Measures
Image: A latex-gloved hand raises a microphone. (Photo: Garth Mullins)
Governments are taking drastic measures to try to slow down the spread of #COVID-19 – declaring emergencies, shutting down businesses and sealing borders. But what about drug users? We have been facing a deadly public health emergency for years, with no drastic measures taken. Will they forget us again this time?
Since the first coronavirus case was confirmed in British Columbia, around 150 people have died from a contaminated drug supply. Four people have died from COVID-19. Now we face both crises at once.
Many drug users in our community are middle aged. And the life can really put years on you. Many of us have COPD or are immunocompromised. The pandemic could cut through us like a scythe.
Transcript
A transcript of this episode is available here.
Demands
Ensure patients can access medication while socially distancing. Give people take home doses. Stand down rules about witnessed ingestion of opioids and opioid agonists (like methadone). Waive requirements for doctors visits and urine screenings.
Pass legislation to make pharmaceutical drugs universally free at the point of service.
There are already shortages of slow-release oral morphine (Kadian). Countries need a strategic opioid reserve. Domestic production of opioids and opioid agonists must be a priority. In WW2, governments ordered car plants to retool and make tanks.
House everybody immediately. Alternatives are needed to crowded shelters, SROs, vehicles, and couch surfing. Unoccupied housing in cities around the world should be expropriated and redistributed to vulnerable people and families. Immediately open hotel rooms for housing.
Declare an immediate moratorium on evictions, suspend rents and halt all mortgage default foreclosures. (Vancouver Tenants Union, ACORN, The BC Government Employees Union)
Legislate paid sick leave for all workers, including paid leave for all workers who are quarantined, or self-isolating. (Vancouver Labour & District Council)
Cancel student debt.
Give everyone an immediate basic income payment. Increase income assistance and disability to a living wage. Expand access to unemployment insurance to include contract workers, freelancers, and people who work in illicit markets. (The Vancouver Tenants Union, BC Federation of Labour (BCFED), ACORN)
Change labour legislation to require employers to provide paid sick leave. Penalize any employer that puts workers in danger of contracting COVID-19 or harms efforts to contain the spread of the pandemic.
Law enforcement should immediately stand down on all drug law enforcement for the duration of the COVID-19 pandemic and beyond. People currently held on drug charges and non-violent offenses should be released immediately. Social distancing is almost impossible inside and people often aren’t given access to basic sanitary items.
Provide a safe supply of drugs. Having to score every day makes self-isolation impossible. There are reports of shortages of fentanyl and meth in the U.S.
We’ve lived through one public health emergency for 5 years already. We’ve been through sharply increasing fatality stats, rationing, scarcity, discrimination, false media reports, panics, controls on our movements, sickness & deaths of loved ones. And we’ve used harm reduction to try to survive.
Now many of us feel anxious. And many also feel a sense of detachment and fatalism. If you inject something that could kill you several times each day for several years, a virus can seem less immediate. Government has been undermining faith in health programs and emergency responses for years. It is hard to expect everyone to suddenly take those same authorities seriously. It is also hard to ask people to take action on something when the material circumstances to do so have been denied them.
But the virus is holding a mirror up to capitalism. And we all see a system that has always left so many of us vulnerable. Things that seemed impossible last week are here now. And that means the solutions that we’re proposing could well be on the table too.
COVID-19 guidance for people who use substances
(https://yale.app.box.com/v/COVID19HarmReductionGuidance)
BE AWARE that some early symptoms of withdrawal and COVID-19 infection are similar. These include fever and muscle soreness. If symptoms include a persistent cough, it could be COVID-19.
YOU ARE AT AN INCREASED RISK OF BECOMING SERIOUSLY ILL OR DYING because
COVID-19 infection will worsen breathing impacts of opioids, benzos, and alcohol
Opioid withdrawal may worsen breathing difficulties
Smoking, including drugs like crack or meth, makes breathing problems worse
DIFFICULT TO INHALE: If you smoke drugs, like crack or meth, cigarettes or vapes, COVID-19 infection will make it more difficult to inhale smoke. Smoking drugs, cigarettes, or vapes will worsen breathing problems.
IF YOU THINK YOU’RE GETTING SICK: Avoid going to your local harm reduction and addictions programs – HAVE THEM DELIVER SUPPLIES TO YOU. Tell them you are sick so they can take steps to keep themselves safe.
BE PREPARED FOR INVOLUNTARY WITHDRAWAL: Be ready to go through involuntary withdrawal. Your dealer might get sick or the drug supply might be disrupted. Try to be prepared by stocking up. Talk to a medical provider about starting methadone or buprenorphine. Make sure you have all the necessary medications, food, and drinks needed to help detox. Try to have protein-based and electrolyte drinks like Pedialyte or Ensure on hand.
STOCK UP ON THINGS YOU MAY NEED TO MANAGE YOUR SUBSTANCE USE AND PRACTICE HARM REDUCTION.
DRUGS: If you have money and are able, stock up on your drug(s) of choice before things deteriorate. AVOID BINGEING on drugs that you are stockpiling so you have access to a supply. Try to buy from people you trust and have as many WAYS TO CONTACT DEALERS in your area as possible.
ALCOHOL: If you have an alcohol use disorder, the money, and are able, stock up on enough alcohol to last a few weeks. AVOID BINGEING on stockpiled alcohol so that you have access to enough to avoid alcohol withdrawal, and things like seizures. One way to do this is by MANAGING YOUR ALCOHOL USE by consuming an amount of alcohol equivalent to one can of beer, 1.5 ounces of rum, or 5 ounces of wine hourly as needed. Try to avoid bootleg alcohol.
HARM REDUCTION SUPPLIES: Be prepared for the POSSIBILITY OF SYRINGE EXCHANGES AND DRUG TREATMENT PROGRAMS CLOSING DOWN. If you are able, stockpile enough harm reduction supplies to last you a few weeks – longer if you are at higher risk of infection or complications. This includes things like: naloxone, syringes, cookers, pipes, and straws. Get a Sharps container to get rid of used syringes. If you can’t get one, use something like a plastic laundry detergent bottle or soda bottle. Label these bottles “SHARPS CONTAINER”. Do not recycle them.
NALOXONE: Stock up on naloxone in the event of an unintentional overdose. Emergency services are likely to take longer than usual during a pandemic.
METHADONE & BUPRENORPHINE: Check with your medical provider to see if services might be changing. Ask your program and provider if you can have take homes or more and longer refills on your medications. This means that you don’t have to go to your provider to get new doses after your first collection. IF YOU HAVE A PRE-EXISTING CONDITION that puts you at greater risk of infection, LET YOUR PROGRAM KNOW.
REMEMBER THAT PRACTICING HARM REDUCTION CAN HELP YOU TO AVOID COVID-19 INFECTION AND ADDITIONAL STEPS CAN HELP TO REDUCE YOUR RISK OF GETTING SICK
DON’T SHARE YOUR DRUG USE SUPPLIES: Injecting equipment; crack or meth pipes; rose or spoons (for smoking crack or freebasing), straws or other nasal tubes (for inhaling/snorting); bongs, vapes, joints; and drinks.
AVOID INJECTING ALONE: The illicit drug supply continues to be toxic. Be careful about the risk of overdose. Try not to use alone, especially if you inject drugs like heroin, fentanyl, or drugs that might have come into contact with them. There are a couple of things you can do to try to stay safe: (1) You can reduce your risk of COVID-19 infection by staying at least six feet away from other people, coughing or sneezing into your arm, avoiding touching your face, and washing your hands for at least 20 seconds with soap and water. (2) If you have a phone, call someone, preferably nearby, and ask them to stay on the line while you are injecting so they can act or call 9-11 (or the medical emergency phone number in your country) if you become unresponsive.
IF YOU RUN OUT OF SYRINGES: These can be disinfected and help prevent HIV and Hep C with 1:10 DILUTED BLEACH. If there’s a lot of blood, rinse once with water to remove it. If not, skip this step and rinse once with bleach. Load bleach fully into the syringe and keep it there for two minutes. Then expel it. Then rinse twice with clean water. If you don’t have bleach, at least three rinses with clean water can work almost as well. Dull syringes can be sharpened using the striker on a matchbook. Rinse after sharpening to remove any particles in the syringe.
IF YOUR SYRINGES ARE NO LONGER SAFE, you have a few options but be aware that these might be difficult with COVID-19 or make symptoms worse:
1. SNORT IT – Chop them into a powder finely and sniff slowly. It works but not as well as injecting does.
2. BOOTY BUMP IT – Dissolve with citric or ascorbic acid, put in a NEEDLELESS SYRINGE and squirt it up your bum/anus. Onset takes longer but you need less and the high lasts longer.
3. SWALLOW IT – Heroin/fentanyl will go via your liver BEFORE reaching your brain, resulting in a morphine effect – but stopping withdrawal.
4. SMOKE IT – Smoke drugs instead of injecting but keep in mind this can be hard to do with some drugs.
CLEAN YOUR SMOKING SUPPLIES: Use mouthpieces and pipe covers on your smoking supplies when possible. Frequently clean these mouthpieces and pipe covers using an alcohol-based cleaner (like Purell or some other brand) or wipe (minimum 60% alcohol concentration).
WIPE DOWN DRUG PACKAGES: Use an alcohol-based cleaner or wipe to immediately wipe down your packages. If your dealer carries drugs in their mouth, ask them if they can stop doing this. If they won’t, be careful handling the packages and do the cleaning as advised above. Remember that antibacterial washes don’t kill viruses but are better than nothing, especially if they contain alcohol.
DO NOT PUT DRUG BAGS OR WRAPS IN YOUR MOUTH, VAGINA OR ANUS: If you must carry drugs in your body, clean vigorously with an alcohol-based cleaner both before and after you take it out.
WASH YOUR HANDS with soap and hot water vigorously for at least 20 seconds (but longer if you can) every time you come into contact with others, after handling money and after you get your drug packages. Paper towels are preferred for drying hands, or at least use a clean towel. If you cannot wash your hands, clean your hands with an alcohol-based cleaner or wipes (minimum 60% alcohol concentration) – like the ones distributed by harm reduction programs.
PREPARE YOUR DRUGS YOURSELF: Don’t handle or touch other people’s drugs or equipment and don’t let them touch yours. Avoid buying and splitting packages of drugs with others during this pandemic, if possible, to limit the number of people handling drugs. If you must split the drugs, make sure the person who touches the drugs washes their hands.
REMEMBER that people who use drugs and the people in their lives commonly have weaker immune systems, respiratory (breathing) problems, and other conditions that place them at a higher risk of getting COVID-19 infection. Help keep everybody safe by following this advice.
Created in collaboration by the Yale Program in Addiction Medicine, Global Health Justice Partnership, and Crackdown. Adapted with thanks from a document produced by 3D Research.
Credits
Crackdown is produced on the territories of the Musqueam, Squamish and Tsleil-Waututh Nations.
You can support us at Patreon.com/crackdownpod.
Thanks to Louise Vincent, Urban Survivors Union, North Carolina, housing activist Wendy Pedersen, and OPS Vancouver manager Trey Helton.
Our Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fresz, Jeff Louden, Dean Wilson, Dave Murray, Al Fowler, and Laura Shaver.
Rest in Peace Chereece Keewatin.
Crackdown’s senior producer is Sam Fenn. Our producers are Alexander Kim, Lisa Hale and Alex De Boer.
Our science advisor is Ryan McNeil. Assistant Professor & Director of Harm Reduction Research in the Yale School of Medicine.
Garth Mullins is host, writer and executive producer. You can follow him on twitter @garthmullins.
Original score written and performed by Sam Fenn, James Ash, Kai Paulson and me. Our theme song was written by Garth and Sam with accompaniment from Dave Gens and Ben Appenheimer.
We make this podcast with funds from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. And from our Patreon supporters.
Follow us on twitter @crackdownpod. Our patreon is here.
