Learn from others
The Ana Liffey Drug Project from Ireland quickly adapted its frontline services for people who use drugs to prioritise and support the public health response to COVID-19. They focused their efforts on working on outreach in the streets of Dublin and Limerick to explain COVID-19 and provide sterile injection equipment.
On 12th March 2020 schools in Ireland closed to help reduce the spread of COVID-19. Five days later, on 17th March, Taoiseach Leo Varadkar addressed the nation stating that, ‘Never will so many ask so much of so few,’ referring to the people on the front line of the response to COVID-19 in Ireland. Ten days later, on 27th March at midnight further restrictions designed to reduce the spread of COVID-19 came into place. These restrictions remained in place until 5th May 2020 when some restrictions were eased. Further measures to ease the COVID-19 restrictions are set to be rolled out on 18th May 2020, but they will only come into effect if the medical advice from the National Public Health Emergency Team says that it is right to do so.
Ana Liffey is a ‘Low Threshold - Harm Reduction’ service, working on the streets of Dublin and Limerick, with people with complex and multiple needs i.e. problematic drug use, mental health issues, physical health issues, behavioural issues, etc. The majority of the people we work with are homeless or at risk of homelessness. Our ‘Low Threshold - Harm Reduction’ ethos and the competencies of our team are well suited to supporting this cohort of people during the COVID-19 crisis. Led by the Health Service Executive (Dublin CHO9 & Limerick CHO3); and working alongside our colleagues in Homeless and Addiction services, we have had to quickly adapt how we deliver our services to help to reduce the spread of COVID-19; and to respond to the increased drug related risks our clients have faced – particularly the increased risk of an overdose.
The group of people who use drugs that we work with are a particularly vulnerable group and are at a higher risk of contracting COVID-19. The sharing of syringes, crack pipes, tooters, etc. is risky and increases the chance of infection as COVID-19 is transmitted through droplets. So, providing Harm Reduction interventions is going to continue to be an essential response in stopping the spread of COVID-19 amongst this cohort. Should they contract COVID-19 there is a likelihood that they will require hospitalisation as many have underlying health issues which put them at greater risk of complications. For example, smoking crack or heroin can cause and/or exacerbate respiratory conditions; or someone with HIV or Hep C may have a weakened immune system.
We quickly recognised that the need to prevent the spread of COVID-19, amongst the people we serve, was now the priority. We recognised that we would have to adapt our frontline services very quickly to prioritise and support the public health response to COVID-19; and our team responded extremely well. We closed our drop-in services and stopped all group work as we could not maintain a safe physical distance for clients and staff. We focussed our efforts on working on outreach in the streets explaining COVID-19, providing our Needle & Syringe Program and explaining how to stay safe on both counts.
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 i.e. no knowledge of the 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 & frustrations and getting them linked into treatment and housing options. Soon we were supporting the medics to assess people we met in the street who had symptoms. We did this over the phone and if they needed to be provided a space in a COVID-19 Isolation Unit, we would arrange the transportation. Working during this period was challenging work for our team as the narrative in the media was of the potential for a steep curve – meaning potentially many infections. However, our team followed the Public Health advice of social distancing, hand washing, cough etiquette and other precautions involving the correct use of Personal Protective Equipment in line with Public Health guidelines. We adapted our two vehicles in Dublin by adding Perspex screens between the front and back seats; so, that we could bring people to the new residential Cocooning Units and Isolation Units provided by the State; and to complete other trips as safely as possible. We also began providing supports to people who are isolating in Dublin and Limerick as needed i.e. bringing what they may need to them so that they can remain in isolation – significantly, this includes prescription medication like methadone and benzodiazepines to help people, who need such drugs, remain stable. Members of our team also covered shifts at one of the Cocooning units in Dublin City.
The State’s response of providing accommodation and improved accessibility of prescription drugs (e.g. methadone and benzodiazepines) has helped to stabilise people and helped them to remain in isolation – which helps to reduce the spread of COVID-19. For example, as of 24th April 2020 in Dublin City there had been 33 people within this cohort diagnosed with COVID-19; three clusters of COVID-19 (i.e. two or more cases) had been identified within homeless accommodation, all clusters were of two cases only; and there had been no known COVID-19 related deaths.
The number of COVID-19 cases amongst this cohort were lower than had been anticipated; for example, in the week of 24th April, nearly 200 COVID-19 cases had been expected although only four cases were reported. Similarly, more clusters of cases within homeless accommodation and some associated deaths had been anticipated.
Looking to the future, it is not clear exactly what will happen, but concerns we have include…have we done enough to reduce the curve of infection amongst this cohort; what will happen to the drugs market; what impact will the changes to the drugs market have on people who use drugs (whether it be problematic use or non-problematic use); what harms will these risks cause and how can we respond to reduce these harms? It is clear, however, that Harm Reduction has been, and will continue to be, an important part of the Public Health response to drug use during the COVID-19 crisis to help stop the spread of the virus; and to reduce drug related harm.
This article was submitted by Tony Duffin, CEO of the Ana Liffey Drug Project, and was first uploaded to the HARM REDUCTION COVID-19 RESPONSE website of Correlation – European Harm Reduction Network. We thank Correlation for contacting Ana Liffey Drug Project and making it possible to present their actions also on the Save Lives- Protect People platform.
48 Middle Abbey Street
01 878 6899
Freephone 1800 78 68 28