27 Mar 20

At Counselling Online, we know that many people in our community are feeling anxious about COVID-19, and that people who use drugs will have specific needs and concerns during this time. Your health and safety is important to us, so we asked an expert to share some tips for harm minimisation during the coronavirus.

We’re so grateful to researcher Penny Hill for helping us out with some advice.

Trigger Warning - Please note that some of this content may be triggering for people who are choosing to abstain from substances.

photo of a girl in her room listening to a record player | by aerosphotos @ unsplash.com

COVID19 & harm minimisation advice for people who use drugs

This is a difficult time for many people globally, but not a time to panic. It’s important to reassure yourself that harm reduction and treatment services and researchers are working together to get the best outcomes during the coronavirus pandemic for people who use drugs. This will include many services moving to telephone and online options so you will have access to support during this time.

As you’ve all likely noticed, advice during this time is changing daily. This information is accurate as of 26 March 2020.

People who use drugs, especially those who are older or have co-occurring medical conditions, are at increased risk of becoming unwell at this time.

  • It is very important that you limit sharing of drugs and equipment — including drinks, cigarettes, vapes, joints, bongs, straws, foil, pipes and injecting equipment.
  • If you do need to share, sanitise all equipment, and clearly mark any equipment that has already been used by others.
  • Try to minimise contact with others.
  • If having sex or doing sex work, remember that COVID-19 can be transmitted by coughing, kissing and direct contact with bodily fluids — so try to limit this type of contact and use condoms.
  • And the number one tip is the same for everybody right now: WASH YOUR HANDS!

Using with less risk

Prepare and learn to administer drugs yourself if you don’t already.

  • Wash your hands thoroughly for 20 seconds with soap and water.
  • Keep your preparation and work surfaces clean with microbial wipes, alcohol (at least 60%) or bleach.
  • Plan for what you would do if the person who usually prepares or injects you with drugs became sick or hospitalised.
  • Avoid carrying drugs in your body, but if you must, then clean drug bags/wraps with an alcohol-based cleanser both before and after you carry it.

Look after your general health

  • Keep hydrated.
  • Eat well.
  • Get enough sleep.

Plan and prepare for overdose

You should know:

  1. COVID19 infection will worsen breathing impacts of opioids, benzos and alcohol.
  2. Opioid withdrawal may worsen breathing difficulties.
  3. Smoking any drugs makes breathing problems worse.

Naloxone

If you or your mates use opioids, speak to harm reduction workers and pharmacists about accessing naloxone now.

  • Naloxone is a medication that reverses overdoses of opioids and is now available over-the-counter.
  • Opioids include heroin, methadone, bupe, oxys, fentanyl, morphine and codeine.
  • Harm reduction service to work out the easiest way for you to access naloxone supply locally.
  • Avoid injecting alone, but stay 1.5m apart whenever you can.

At this time, drug availability may be limited, and you may need to prepare to go through involuntary withdrawal

  • Avoid bingeing on drugs that you have stockpiled.
  • Talk to an opioid replacement therapy (methadone) prescriber about starting methadone or buprenorphine, or talk to your current prescriber about take home doses and refills. If you’re not sure where to start, have a chat to Counselling Online, check out HRVic's helpful tips,  or contact your local Alcohol and Drug Information Service.

NOTE FOR VICTORIANS: Keep in mind that as of April 1st, SafeScript, Victoria’s real time prescription monitoring program with be mandatory for all pharmacists. Medications monitored by SafeScript include strong opioid painkillers, benzodiazepines, other strong sleeping tablets, stimulants for ADHD or narcolepsy, and other high-risk medicines. For more info, check this link.

Am I experiencing COVID19 or withdrawal?

Early symptoms of withdrawal and COVID-19 infection are similar – including fever and muscle soreness. If symptoms include persistent coughing it could be COVID-19.

  • Speak to harm reduction workers and prescribers about organising back up plans in the case of getting sick or mandatory self-isolation.
  • If possible, make sure you have all necessary medications that you might need for withdrawal, and food and drinks (protein-based and electrolyte) that you might need to detox off the drugs you use.

Advice for families & loved ones

Self-isolation or quarantine are likely to be a difficult time.

  • Unusually stressful situations (such as a global pandemic) can strain even the happiest family dynamics, even before the addition of concerns about drug use and withdrawal symptoms.
  • Support is available:
  • If you’re experiencing or concerned about sexual assault, family or intimate partner violence, reach out to 1800RESPECT on 1800 737 732.

For more information on how to support a family member who uses drugs, see The First Stop website.

Services & Supplies

Supplies of equipment may vary across the country throughout this time.

  • Stock supplies of needles and syringes might change in the coming months, speak to your local NSP provider about how much equipment they think you should take
  • Disinfectant products are in more limited supply:
    • Alcohol swabs are currently in limited supply, so only use them for injecting purposes. Do not use them for cleaning of other surfaces.
    • Use soap to wash your hands.
    • Clean surfaces with products that are at least 60% alcohol-based wherever possible.
  • If you do foresee running out of injecting equipment, consider sterilising equipment through these guidelines.

If you have concerns about availability, your local NSPs and harm minimisation services are best placed to answer questions about your specific area. Get in touch with the service in your state to find help near you:

What we are doing

As your harm reduction workers, we are doing our best to communicate with the policymakers about how to get the best outcomes for people who use drugs at this time.

Where I work, in Victoria, a range of working groups have been set up between the sector and DHHS coordinated by VAADA and the Penington Institute specifically on the topics of: needle and syringe programs (primary, secondary, outreach and vending machines) and the supervised injecting room, naloxone access, pharmacotherapy, residential rehabilitation, non-residential, group and community services. We are prioritising your interests in these groups — please let workers know if you have any feedback or questions, updated information will be provided as soon as possible.

If you are interested in how harm reduction services are adapting internationally, have a look at this Drug Reporter blog and open letter from Europe.

Most of all: stay safe, and look after yourself.

Penny Hill

If you would like to discuss your concerns around harm minimisation, or if you just want someone to let you freak out for a while, our counsellors are here for you 24/7.

Penny is a PhD Candidate and Research Assistant at the Burnet Institute, working with the Centre for Research Excellence into Injecting Drug Use (CREIDU) and the National Naloxone Reference Group (NNRG).

This advice has been collated from various resources from the following websites: