06/10/20 Tony Duffin

Century of Lies
Tony Duffin
Drug War Facts

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.

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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 I'm your host Doug McVay editor of

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.

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.

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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, 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 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 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.