The new, more dangerous strain of COVID 19 has raised pressures facing substance misuse services to an all-time high. As more community workers contract the virus, and their close contacts and colleagues are forced to self-isolate, concern is growing for the welfare of service users and the challenges ahead. Martin Blakebrough, CEO at Kaleidoscope, examines the critical role drug and alcohol services could play in the vaccine’s roll-out. With a clinical workforce ready to go, governance in place and bases fit for purpose, he asks, what’s holding the government back?

Measuring the impact on those hardest to reach

Looking back to the first wave, is it possible to know how many of our service users were infected? We were unable to test them. We saw very few hospitalisations it is true, but again, who would call the ambulance for those completely isolated? And if they were to die with drugs in their system, would it be recorded as a Covid death? You see it was difficult to measure the extent our service user community was directly impacted by coronavirus.

Many people with addictions self-medicate, and as a consequence they are used to feeling below par. The difficulties of booking a test, engaging with a new service and arriving at a test centre on time present mental and physical barriers for our service users that many people cannot understand. Another reality is, why bother? Testing positive would become another problem among a hundred other issues. If you are addicted to drugs, the motivation to get those drugs will surely be greater than the symptoms of Covid.

However during the first wave, from our observations, there was no significant increase in the number of deaths recorded and confirmed coronavirus cases were few within our community. Worryingly, this new wave of infection has rippled through our workforce already. A number of our frontline workers have tested positive, particularly within our residential services, evidence of just how widespread this new outbreak must be. Where our employees have contracted the virus it is difficult to know as they live and work in multiple settings, but an increased infection rate amongst my staff puts our service users at greater risk. If service users are less likely to be tested within the current testing structure, or even notice coronavirus symptoms, this will certainly challenge our service delivery. If the virus takes hold of our community, we would be firefighting a very serious public health risk. This is where Vaccine Woman comes into play, a superhero ensuring our community know how and where to get vaccinated.

Enter Vaccine Woman. We are awaiting a costume design…

In the first wave, I like many others was both surprised and relieved at the limited Covid cases among our service users and workforce. But as we see numbers increasing how can we protect our community, those who are currently treatment naïve, and anyone not accessing support from our services.

Testing could prove a useful addition to many community services, so that service users do not suffer unnecessarily or misdiagnose their drug use as the cause of their symptoms. However I believe the key issue is that when the time is right, how will vulnerable people access the vaccine and ensure they complete both doses? Enter Vaccine Woman, a champion for the vulnerable aided by clinically trained peers, she ensures the vaccine is accessible where service users already attend, be that their treatment setting or hostel, a disused carpark or a squat where people who use drugs have to exist. Vaccine Woman, like Naloxone Man, meets people who use drugs where they are. Like all good superhero’s, they fight to preserve the rights of the underdog.

By involving keyworkers in the vaccine’s rollout, workers already engaged with society’s most hard to reach people, we can more easily guarantee they receive the all-important second dose. With an online system that records data in real time, we can contact those hardest to reach and follow up on appointments. We simply cannot have a vaccination rollout that ignores those more vulnerable as a result of negative mental health or substance misuse.

Many people we help come to us after having fallen out of mainstream services, further validating the pivotal role of the third sector in the vaccine rollout. In a positive step forward, DACW members have agreed to support a nationwide approach to meet these particular needs. It is our hope that Public Health Wales and the Welsh Government will support our medical teams through vaccine training to ensure that everyone gets the help they are deserving of.

Every community needs its heroes

What if Naloxone Man was to join forces with Vaccine Woman in a heroic mission to protect those at risk of being left behind? We know that under lockdown conditions some people choose to drink more as a coping mechanism during bleak times. In the spring lockdown an Alcohol Change study revealed that one in five drinkers (21%) had been drinking more frequently since the lockdown, and 15% had been drinking more per session. The same is sadly the case for a number of our service users. With less opportunity for social interaction we know many more will take their chosen drugs in privacy, raising the risks involved. The swift provision of Naloxone could prove increasingly vital as the ambulance service is stretched to a point never before experienced. Drug related deaths across England and Wales continue to rise and 4393 lives were tragically lost last year and Naloxone is a powerful overdose prevention tool, but to ensure its success a social peer to peer support infrastructure must exist.

We need imagination to ensure we support those we serve, and must think creatively about support bubbles, online technology and other interventions. It would be sensible to pair service users who live alone in a buddy system where they can support each other, via social media and face-to-face wherever government guidelines permit it is safe to do so. We know that peer support works, and it is available outside of the traditional hours many mainstream services can manage.

We are optimistic that the collaborative working of third sector services, DACW members and healthcare heroes, supported by Welsh Government and Public Health Wales, could turn the tide on the worrying wave of infection and protect our service users. A testing and vaccination system that meets our communities’ individual needs, operating alongside a peer led support network that protects those most at risk, will give us all a fighting chance. Naloxone Man and Vaccine Woman are standing ready.

Martin Blakebrough, CEO at Kaleidoscope, Tweets @mblakebrough62

 

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