New figures reveal impact of Covid-19 on drug treatments

Image credit: Rehab Center Parus
Image credit: Rehab Center Parus

Report by Ed Sheridan, Local Democracy Reporter

Local people seeking support for opiate use more than doubled in a year as a result of the reduced availability of street purchased drugs, new Islington Council figures have revealed.

In a trend noted in drug services throughout the capital, 212 new Islington residents sought treatment in the first two quarters of 2020/21, as compared to 95 in the first two quarters of 2019/20.

Better Lives is an integrated adult substance misuse service delivered by Camden and Islington NHS Foundation Trust and, while the town hall’s Better Lives senior commissioning manager Emma Stubbs has said that Covid-19 gave a “unique opportunity to draw people into treatment, particularly opiate users, who may have chosen to decline previous offers of support”, the figures also reveal the continued scale of the challenge for the borough’s drug and alcohol users.

According to statistics presented to the council by Better Lives, the level of unmet need, or the estimated proportion of people in the borough who are dependent on opiates and/or crack, or alcohol, and not in the treatment system, remains high.

There are an estimated 2,168 crack or opiate users in the borough with an unmet need of 60.2%, slightly higher than the national average of 53.9%. An estimated 3,674 people are dependent on alcohol, with an unmet need of 84.7%, again slightly higher than the average for the country of 82.6%.

In an introduction to the report, Islington’s director of public health, Jonathan O’Sullivan, said: “During Covid lockdown, the initial focus of support was on ensuring that residents could access, or continue to access, the critical elements of their care. Assessments were carried out by phone and in person, with the necessary PPE [personal protective equipment] safety measures in place.

“Post lockdown, it was possible to offer other types of remote support including online groups and online key-working. There was a delay in offering online groups during lockdown while the appropriate platforms were developed and staff were trained to facilitate virtual groups.

“By the end of September, a number of online groups were available to service users including mindfulness, support for sobriety and relapse prevention. The service has been working hard to re-instate as much face-to-face provision as possible, although these activities have to be carefully managed so that social distancing can be maintained in buildings, and consideration will be given to the newest lockdown measures before further face-to-face support is offered.”

According to Better Lives, in contrast to the numbers seeking support with opiate use, lockdown saw a “marked reduction” in the number of people presenting for support around alcohol, though the figures for Islington for the first two quarters in this area are broadly equivalent to last year, as the service works to encourage greater numbers into treatment.

The town hall is now planning to make its services resilient for further waves of Covid-19, while delivering flu vaccinations throughout the department and ensuring all face to face interventions, including drug screening, are reinstated safely and quickly.

According to the report, the pandemic period saw a reduction in the frequency of opiate substitute medication dispensing in order to ease pressures on community pharmacies, while increasing the provision of injectable medication naloxone, which reverses opiates’ effects.

It is understood the council has identified a number of opportunities following the effort to keep working through Covid-19, including more use of digital platforms to connect staff and service users, and a “more flexible approach” to dispensing regimes having significant benefits for some peoples’ recovery.

Emma goes on in the report to list a number of challenges found throughout the Covid-19 period in supporting service users, with inpatient detox and residential rehab sites closing or with severely restricted access limiting treatment for people who would usually benefit from 24-hour support.

The pressure on local pharmacies also saw long waits for collecting medication, with safeguarding issues also “challenging” to identify when people were not being met face to face, according to Emma a particular concern for those experiencing domestic violence and abuse.

The report adds: “There has been an increase in reported incidents related to domestic violence and abuse and safeguarding. Whilst this is concerning, it is positive to note that these issues are being identified and those involved appropriately supported.

“[There were] more complex presentations which may be a consequence of the reducing availability of other support services or a delay in presenting/ deteriorating in mental and physical health due to Covid restrictions.

“[Another issue was] access to essentials such as medication; food which was particularly challenging at the start of the pandemic whilst services such as ‘We Are Islington’ were being set up.

“In order to ensure that service users are safe over the Covid period, a decision was taken to delay any planned discharges from service. Alongside the increase in numbers of people presenting for opiate treatment in particular this has meant an increase in individual caseloads.”