Overdose risk looms for addicts freed from lockdown
Drug experts have warned that when the Covid-19 storm is over and the lockdown is lifted, SA may have to deal with a spike in potentially fatal overdoses by users of hard drugs such as heroin.
MJ Stowe, national advocacy coordinator for the South African Network of People Who Use Drugs, said the disruption in access to these drugs means many addicts will be at risk of overdosing when they are released from controlled facilities such as shelters.
“After a period of abstinence, a person’s tolerance to heroin decreases within several days and the opioid system resensitises to pre-use levels,” Stowe said.
“If a person uses the same amount they were using prior to the period of abstinence, the chances of an overdose are substantially increased.”
In a letter published in the South African Medical Journal, Stowe and other experts have called on the government to scale up access to opioid-substitution therapy to mitigate the risk of overdose.
They say opioid therapy programmes have enrolled hundreds of people across the country over the past six weeks of lockdown.
The treatment such programmes offer has been shown to reduce criminal behaviour, improve the general health of addicts, reduce HIV and hepatitis infections and improve life expectancy for drug users, the letter says.
“Without opioid substitution therapy as maintenance, most heroin-dependent people are likely to reinitiate heroin use once they return to their communities,” it says.
“After the lockdown, the overdose risk will be elevated due to reduced tolerance and the concurrent use of other central nervous system depressants such as alcohol. The trauma of leaving a formal safe shelter and ongoing drug criminalisation further increase overdose vulnerability.”
Maria Stacey, a Cape Town clinical psychologist and public health expert, said despite evidence that opioid-substitution therapy works, many municipalities resist it due to moral objections and a lack of policy expertise.
“Often there is no empathy for drug users and they are often blamed for having brought the drug problem upon themselves,” she said.
Forcing drug users to go cold turkey in distressing times like the lockdown is dangerous. “We hear stories that drug users at the Strandfontein camp for the homeless [in Cape Town] are escaping daily to procure drugs to numb themselves from the withdrawal symptoms. This proves that going cold turkey doesn’t work for heroin users. Heroin use needs to be medically managed,” she said.
Professor Harry Hausler, head of the nonprofit group TB HIV Care, said restriction of movement and forced quarantine of homeless people have “resulted in human rights violations” for people who face painful heroin withdrawal.