The relaxation of rules on dispensing methadone to drug addicts during the pandemic has led to an increase in street-dealing of the substance, gardaí say.
Doctors have been advised to prescribe emergency doses of methadone, an opiate given to drug addicts to ease their cravings, or sedatives to prevent addicts experiencing withdrawal symptoms while they self-isolate.
The emergency HSE guidance also includes the option of conducting assessments of addicts via video-calls, and the delivery of methadone to their homes.
Some clinics have also relaxed rules around the amount of methadone a user can take home, and some pharmacists and doctors have dispensed with a requirement that users take methadone on their premises.
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There is evidence that the relaxed protocols have led to an increased amount of methadone being on sale on the street. Gardaí in Dublin have in the last week reported a significant increase in the amount of methadone being sold illegally between drug users.
“There’s been a big increase,” said one Dublin garda. “There would always be a bit of it being sold, but it has shot up since the start of this crisis.”
He said there was concern that vulnerable addicts were being forced to hand over methadone to others under threat of violence.
The trend “does not come as a surprise” as methadone users are being given longer prescriptions since the crisis started, a spokeswoman for the addiction charity Merchants Quay Ireland said.
The latest HSE guidance also states that those who are addicted to heroin but not yet on a methadone programme should immediately start on one if they have a suspected or confirmed case of Covid-19. This is to prevent them spreading the virus while going out to seek or buy heroin.
Similarly it says those addicted to illegally-obtained benzodiazepines, such as Valium or Xanax, should be temporarily prescribed the drugs by their doctor to “facilitate the patient remaining in self-isolation”.
Benzodiazepines can also be prescribed to chronic alcoholics who may not be able to obtain alcohol while in isolation.
Assessment process
The guidance is contained in a contingency planning document seen by The Irish Times. Doctors are advised they may not be required to go through the usual lengthy assessment process before putting someone on a opioid substitution treatment (OST) programme, which typically involves replacing heroin with legally-prescribed methadone.
During the crisis doctors can fast track addicts if they meet one of several criteria, including if they have visible “track marks”, wounds from injecting drugs, on their arms.
Drug workers are also asked to urgently identify homeless people in need of drug treatment, and to get them into an OST programme without delay.
The HSE states that every person put on such a programme should also be offered Naloxone, an emergency drug used to reverse the effects of overdoses.
To prevent the need for recovering addicts to leave their home during isolation the HSE advises drug workers to consider having methadone delivered to their homes by a driver or healthcare worker. It states that the driver should take a picture of who takes possession of the drugs to ensure they go to the intended person.
Treatment
When dealing with benzodiazepine addicts who must self-isolate, GPs are advised to prescribe them a max of 30mg of benzodiazepine per day.
“It should, however, be made clear to the client and should be documented that such treatment is for the duration of the isolation only,” the HSE states.
The fast-track method for starting someone on methadone was a “common sense approach”, said Dublin GP Dr Garrett McGovern. However, he is concerned there are not enough OST programmes outside Dublin to facilitate this.
“As you move out to the surrounding counties there are plenty of places that don’t have adequate OST services,” he said, adding that Dublin-based doctors should be treating users from surrounding areas.
