OST prescriptions supporting reductions in illicit use
Several individuals interviewed were impacted positively by assertive outreach and rapid prescribing of OST, with each reporting associated reductions in their use of illicit drugs:
I would use like now and again, if I had a spare bit of money, I would have a wee treat, I would call it myself, but now it’s just didn’t do anything for me, I think it’s cause I’ve got the tolerance with the methadone, so it’s just a waste of money doing that. (M, 46)
The measures taken by service providers across Scotland to meet the treatment needs of patients during the pandemic were generally well received by individuals within this study, some of whom had remained ‘unreached’ by services for years.
Well I’m on a script now, so I’m actually on the heroin side of it, I’ve come, I’ve never had a script, it was heroin every day as you know, but now I’m on a script, it’s not heroin every day, it’s only heroin if I feel like treating myself. (M, 50)
Several interviewees spoke of disruptions in the drug market, including reduced availability, and lower quality in particular, as being responsible for increases in the frequency and severity of withdrawal symptoms:
It wasn’t as strong for like the heroin side of it, it was really weak, so it wouldn’t hold you as long, you know, if you missed your, your script or whatever, it wouldn’t hold you, you would need to go and source it again, and it would be just like a roundabout. (F, 33)
There is a sense from the interview data, however, that those who suffered most from increased withdrawal tended to be experiencing circumstances which were more chaotic, such as regularly being out of treatment, having inconsistent patterns of drug use, often being arrested, and/or admitted to hospital.
Increased drug use and relapse
Around a quarter of interviewees spoke of their lockdown experience as involving a greater use of drugs. Participants felt increased drug consumption enabled them to cope with isolation, and associated boredom:
I’m worse, I’m taking 10 times more than I would averagely ever normally do, you know, there’s that much of it. (M, 43)
Most interviewees reported being negatively impacted by the lockdown measures, particularly through the loss of, or reduced access to, social supports. Three participants who were each active within their respective recovery communities pre-lockdown, spoke of relapsing into illicit drug use, due to significant reductions in recovery-focused activities:
Well I was actually off it (heroin), at the time, but it was only when you had to be stuck in the house that I started it again. (F, 43)
Feelings of ‘guilt’ and ‘shame’, and of being excluded from the support of their peers in recovery, were reported by two participants from separate recovery communities, following relapses into drug use.
Using different drugs
In response to changes in drug quality and availability, some participants described using different substances, and often settling for those which were easiest to access which tended to be benzodiazepines, crack cocaine and alcohol:
I’ve never touched it, I’m 43 year old, started taking drugs at 12 year old, I’ve never took that crack really, only recently. (M, 43)
Participants across sites were largely able to cope with Covid-related disruptions impacting the availability of their preferred substances, however. This is evident both in the prevalence of poly-substance use within our sample, and from interview data capturing longer-term patterns of drug use, which suggest individuals’ preferences can and do change frequently.
Changes to route of administration
It was rare across sites for individuals to report changes to their preferred route of administering drugs, where they did however, these changes were related to desperation, perceived harm, drug potency and economic constraints.
Switched to injecting
Three participants reported sporadic IV drug use following extended periods avoiding the practice, related to perceived reductions in heroin quality (potency). The following response describes one individual’s post-lockdown attitude towards injecting:
If it’s shite, I’ll just inject it, aye, because it’s shite anyway. (M, 31)
Not uncommon within this dataset, is infrequent yet high risk IV drug use, a finding which is particularly true for individuals who reported being inexperienced in the practice:
[I] muscle popped (intramuscular injection, rather than intravenous), because I couldn’t get a, I couldn’t get a vein (…) it’s no that I couldn’t find a vein, I just don’t know how to do it, and I was ashamed, I mean, I was ashamed that I took heroin, that’s why I done it on my own. (M, 32)
The new trend of injecting ‘Prop’ (injectable cocaine solution) in one homeless hostel site, described in participant accounts, not only prompted several individuals to return to injecting, but one participant also reported observing several other residents starting to inject for the first time:
I already know four (…) I’m no a jagger, I’ve seen people turning from no being a jagger to, will I be alright? And I don’t know what to do here. (F, 44)
The extract below describes vividly the challenges faced by participants who were experienced injectors such as blurred vision and an inability to focus, which in this case, required another person to administer the drug:
I think it’s to do with the person that’s been trying to inject me, like I usually do myself, but when you’re wired, you see things under there, so you’re in and out and you just end up getting fucked up eh, so, no it’s no a good situation … You can’t focus properly, you’re seeing things that you, like there’s a guy that I was getting to hit me and it was like he was analysing my arm, looking at it for like 20 minutes, but he knew where every vein in my arm was, because he used to jag me with the brown (heroin) and it would be sound. (F, 33)
Switched to smoking
Over half of those interviewed have experience with IV drug use, but many of these no longer engaged in this method of using drugs, and this had been the case for some time prior to the pandemic. One individual decided their recent bout of pneumonia, and new access to OST, provided respectively, the motivation and the means to ‘cut out’ injecting altogether, and switch to smoking, on a significantly reduced scale:
Like I said, I’ve never been unwell, so (…) I got the script the next day, so that was me, the heroin was cut out, and the injecting and everything was gone, because that was weakening my immune system as well, so I couldn’t get better, that could have made me worse, you know what I mean, so all that went out the window, everything. (M, 50)
Similarly demonstrating a newfound level of autonomy around his drug use, one participant speaks of having pride in his ability to manage through the pandemic without injecting:
No, I’m actually off the pins just now to be honest, I’m quite proud of myself …that’s been five month now. (M, 46)