Overdose prevention during coronavirus lockdown in Edinburgh
Blog post in support of International Overdose Awareness Day
Author: Wez Steele, Support Worker in rapid access accommodation with lived experience of chronic homelessness and substance use
Welcome to the scary and surreal of working in what many would call a “frontline” (I prefer “forward facing”) service at the beginning of lockdown. It has shown me the very best and the very worst of us, as professionals, partners, friends, strangers and neighbours. Providing rapid access accommodation for some of Edinburgh’s most disenfranchised and underrepresented vulnerable adults is no mean feat at the best of times…
People who are homeless are highly vulnerable to coronavirus, and they also present an infection risk to others. This has created much urgency to house them, to fulfil a basic human need of safety and shelter. Interesting that we, as a society, were arguably not particularly bothered about providing for them until there were consequences for our own safety. Providing this shelter and safety sounds straightforward, right? Well please let me assure you it is far from straightforward.
Please mind the gap … it is a very long drop, and it’s a slow, painful climb back out.
Most of our residents have a history of complex trauma and they self-medicate to cope. Some would say that they abuse drugs. I beg to differ. To cope with their life situation, they take drugs and are criminalised as a result. They will often have conflict with other members of the homeless community which can result in people being asked to leave temporary accommodation, and some simply abandon their rooms preferring the familiar freedom of the streets. The population is also extremely fluid. When I return to work following a few days off, this means getting to know several new residents, and missing several others that have moved on. Lockdown has increased pressures on staff and residents alike, not to mention other services, many of which had to close their doors and operate remotely as best they could. These pressures can include frustration at attempting to relationship-build while also socially distancing. Trying to get close to someone emotionally while advising them to keep away physically really is a contradiction in terms. Feeling our own anxiety around the pandemic and attempting to have a calming influence on residents can create and inner conflict regarding congruence and being real with those we walk alongside. Our residents feel isolated and discarded by society as a matter of course. Trying to break through these barriers while keeping everyone safe from Covid has led to using unfamiliar technology to run groups, facilitating video calls and providing art materials in attempts to keep people engaged and occupied. All of these have had teething problems and bumps in the road but have produced some excellent outcomes and well worth the effort for all involved.
A person at high risk of overdose could be provided with a naloxone kit, have an assessment for opioid substitution treatment and start this within hours or days of arriving at a service.
The gap between the ‘haves’ and the ‘have nots’, the ‘homed’ and the ‘homeless’, the ‘hurting’ and the ‘healed’ has never been starker as it was during the lockdown period. I have seen exceptional practice and partnership among the unlikeliest of allies who have worked to continue providing essential services to those in the most need. The lockdown experience has given many of us the opportunity to really push the envelope and provide services which otherwise we could only have signposted to. A case in point was Take-Home Naloxone being dispensed in-house from temporary accommodations. Another prime example is GPs and Community Psychiatric Nurses coming to patients to assess and often start OST and other vital medications the very same day. I would like to repeat that and give it more emphasis. A person at high risk of overdose could, potentially, be provided with a naloxone kit and have an assessment for opioid substitution treatment involving starting their prescription within hours or days of arriving at a service or being seen by a practitioner. This really is amazing and will go a long way to reducing drug related deaths, our other major public health crisis, which has slipped from centre stage during the Covid-19 outbreak.
I would like to pose a rhetorical question: Why is this not the norm, and how can we make it so?
The economic forecast is bleak at best, catastrophic at worst, and I am expecting a sharp increase in people seeking support to avoiding homelessness and substance use harms in the coming months and years. I will be amongst those working tirelessly to reduce these harms, to prevent these harms and avoidable deaths.
To those of you wondering if you could do more, I would encourage you to do so. At the very least, please mind the gap because I would not want to see you or a loved one falling down it. It is a very long drop, and it’s a slow, painful climb back out. I know as I was fortunate enough to make it, maybe that is why I do what I can to ensure people can climb back out too.
Image by: Greg Plominski