This letter was written by Arild Knutsen, a Norwegian drug user activist, to raise awareness of how the Covid-19 epidemic can affect people who use drugs – and how to protect them.
Dear all who use drugs or who are in substitution treatment,
A life of poor diet, little sleep, and a lot of drug use can cause the coronavirus to leave you worse off than people who live healthier lives. If the coronavirus does not hit you directly, the epidemic has nevertheless become so widespread and severe that it will affect many of you indirectly. There are notifications of restrictions and closures in many types of health and harm reduction systems, including in the low-threshold services.
Therefore, you may want to make plans and come to new conclusions for what to do in the current crisis. What might it mean for you?
People who use heroin or other opiates should be aware that a virus outbreak will make heroin more likely to hit your breathing centre, making it easier to overdose.
Therefore, it is advised that more equipment, needles, etc than usual should be picked up every time.
Those who smoke heroin should not share the smoking equipment. If a heroin smoker becomes ill, other ways of avoiding injection should be considered if it becomes too uncomfortable or difficult to smoke.
In such a situation, the heroin can be sniffed, taken rectally, or swallowed. If heroin is swallowed, it is important to know that it then passes through the liver before it reaches the brain, and therefore it will only act as morphine and not as heroin, but you will be “well-reported”.
The health care system is in danger of being overloaded, health services can be curtailed or shut down, and if your dealer becomes ill then the access to the drug you depend on may be impaired. Prepare yourself for the changes that might come.
Avoid sharing cord tubes, beeps, balloons, e-cigs, and joints with each other. Such sharing is particularly contagious. Avoid other people touching your drugs and preferably prepare the doses yourself. Take the drugs yourself, instead of letting others help you.
If you can afford it, then this is the time to buy a small stock.
If you are receiving substitution medication then you should check with the pickup location whether there is a change in opening hours, or other changes that may make the retrieval system different. Make sure you have your pickup phone number available on your phone. Feel free to ask if you can get more medicine at once to avoid issues in the future.
If you can, obtain naloxone (Narcan) and get trained in its administration. With an increased risk of overdose, and massive pressure on emergency services, timing will be of the essence. Having naloxone awareness and a network could be crucial in saving lives.
Dear all who work in the system for assisting and helping drug users,
This may be the time for reassessment of retrieval arrangements for medications, to contribute to the general prevention of infection. This is especially important for those patients who have a health condition that indicates that they are particularly vulnerable.
This may be the time to actually listen to the substitution patients’ own input on medication choices, in order to prevent participation in the street market, with the added health benefit that it now entails.
It is important to organise housing measures, social measures, detention, and treatment stays in a smart way so that those who need the services are not unnecessarily rejected. It is a challenge to balance the density of users and the risk of infection that it entails on one hand and the danger to life and health of non-treatment on the other. Anyway, changing the facility should be considered more important than just starting to decline.
Dear all who work as police,
You should take into account that users may now decide that it is necessary to a higher quantity of drugs at once than they usually do. Here, humane and sensible considerations should be taken instead of exploiting the situation for further control and punishment.
From a user’s perspective, buying more at a time now is a sensible choice that makes sense beyond the drug user environment. If drug environments are stressed now, this can further aggravate the situation. Then people hide their doses in body cavities and do many other things, which increase the risk of infection.
There are many tips on preventing coronavirus on social media, but please be critical with the source. The most important advice is to wash your hands frequently and for a long time. Avoid touching your eyes, nose, and mouth after exposing yourself to risk. Cover your cough and sneeze with elbow or tissue. Avoid large crowds. Stay at home or by yourself if you feel unwell, and contact a doctor if your symptoms worsen.
Arild Knutsen
