COVID-19 and addiction treatment delivery: Oliver Standing of Collective Voice talks to the SSA

SSA: How has the addiction treatment sector responded to COVID-19?

OS: “The response in the field has been absolutely fantastic. We’ve seen a truly unprecedented level of collaboration, with things happening in days that that would normally take months. We’ve seen voluntary sector and NHS providers working together really well but also in close partnership with public health directors and commissioners at a local level. It’s been a great effort all round really, amazing to see, but it’s also important to acknowledge that concerns do exist.

We’re taking the crisis very seriously, and that’s why I’m in regular contact with Public Health England (PHE), partners in local government and other central government departments like the Department of Health and Social Care.

Collective Voice has made an offer to smaller treatment providers that maybe don’t have that larger back-office capacity, HR or operational function. If there’s anyone out there that’s worried about the impact of COVID-19 on their organisation, Collective Voice will try its best to link you up to someone in a larger provider to get in contact with you and support you. So just get in contact, by twitter or email, and we will do our best to look at it.”

What do you see as the main challenges for treatment services operating during the COVID-19 pandemic?

“Ultimately drug and alcohol treatment and recovery, as part of wider health and social care, is a vital bit of the ‘protect the NHS’ efforts which will keep people out of acute health settings and allow our hospitals to focus on helping people with COVID-19. Services are actually dealing with an increase in need at the moment, anecdotally people are saying self-referrals for both opiates and alcohol are up. It’s understandable people want help in a time of crisis.

A lot of treatment and recovery work is done face-to-face through one-to-one keywork, group work, or through community pharmacies. We’re seeing more and more staff isolating at home – and it’s absolutely right that they follow the government guidelines – but it means that services are experiencing staff shortages. You’ve then got the instruction that people should avoid non-essential face-to-face contact, leaving community providers with no option but to pull some groups. People will still be getting support, but it may be over the phone. We know that having that therapeutic bond with a worker is incredibly valuable, and however brilliant and dedicated staff are, getting support over the phone may not be quite the same for some people in recovery. Likewise, all the mutual aid groups like AA, NA and SMART recovery have gone online.

The other issue is about community pharmacy provision. There’s a lot of intel coming from the field that community pharmacists are working very hard to keep that system going as much as possible but are definitely experiencing a lot of pressure at the moment and struggling to provide daily OST (opioid substitution treatment) supervised consumption. That’s why some treatment providers are moving people away from daily consumption. So, you might have seen that Change Grow Live (CGL) has published its standpoint on that, saying people will generally be given a fortnight’s supply of OST meds. These are sensible and pragmatic decisions taken during an emergency and we hope there will be guidance from PHE on this issue very soon to reassure people they are doing the right thing in really trying circumstances.

And of course, there’s the ongoing issue of PPE (personal protective equipment) – more is coming into the system but there are still front-line services working with really vulnerable people that don’t have it, and that includes residential settings giving round the clock support.”

We talked to Owen Bowden Jones a couple of weeks ago about what happens when COVID-19 restrictions end. Are there any plans for what happens when the restrictions are lifted?

“Treatment providers are essentially operating at different levels, so the current level is a fire-fighting mission – keeping people safe, keeping people alive, with a strong emphasis on harm reduction and keeping that link open to services. But there are clearly those medium- and long-term levels as well. The crucial question is how do we keep those links open with people so that when the challenges of COVID-19 diminish we can draw people back into services and try to avoid the deeply concerning risks around overdose? We know that being in treatment is a huge protective factor around drug related deaths, and for sticking to OST treatment plans, so we’ve got to keep that contact going. I’m sure that some of the innovate practice like the digital stuff that has emerged recently through necessity will stick once the most intense challenges of COVID pass.

There’s also the issue of prison releases. There’s been a lot in the media about whether low risk prisoners should be released to safeguard public health and relieve pressure on the NHS. We know that a lot of low risk prisoners serving short sentences for non-violent drug offences are people with multiple and complex needs. So, if early releases do happen – and I believe they should from a public health perspective – there’s then a prospect of quite vulnerable people coming out into a community support landscape with diminished capacity. We know that only about a third of people get support within three weeks of leaving prison for their drug use; and that’s in normal times, let alone at the moment. But there has been some useful guidance published recently by NHS England making it clear that prisons should work with partners in the community to make that transition as smooth as possible – and some good coordination efforts from providers to make sure they are ready to meet the needs of people coming out.”

So is there anything that people can do to help the situation if they are able?

“I think if the general public wanted to help, the best thing they could do is to contact their local treatment provider. You could just Tweet them saying “I’m happy to volunteer”. There are COVID-19 mutual aid groups that have sprung up across the country almost on a ward level. I’ve got one here where I live, and I got a flyer through the door offering help so it’s very local. And I think it’s interesting for people in our world with a big focus on mutual aid, where we’re so used to talking about it in the context of recovery and addiction and NA and AA, to recognise this is an approach that works much more widely. It has much broader applicability in times of challenge, and it’s great to see the model being used to support people during COVID-19.”

Volunteers

The recovery movement has always had a higher proportion of volunteers than many other parts of the voluntary sector, so we’re really clear that volunteers are covered by the keyworker guidance about who can go out to work. I think there was a slight worry that if someone’s going to work and gets questioned and says “I’m a volunteer” it might sound less critical to some people’s ears than it would to us, because we understand how those volunteers work in our system. So, we’ve put an item on our news page, which makes it clear that those volunteers are part of that critical workforce.

Collective Voice is an advocate for voluntary sector addiction treatment and recovery organisations campaigning in national and local government policy settings. It also works to facilitate information sharing among addiction treatment sector to develop cohesion and sharing of best practice.

Oliver Standing is the Director of Collective Voice, follow him @OliverStanding