There are particular challenges in relation to Scotland’s population of people who have a drug problem over half of the 60,000 people with drug problems are aged over 35 and have multiple morbidities, often including COPD – a group of lung conditions that cause breathing difficulties – so are a very vulnerable high risk group in relation to COVID-19. People can temporarily have a lowered immune system due to use of different drugs even where they do not have significant underlying conditions.
General harm reduction advice
For people who use drugs the general advice is:
- Wash your hands for at least 20 seconds regularly including after going to the toilet, before eating/drinking and when you blow your nose, cough or sneeze
- Avoid touching your face, eyes, nose and mouth with unwashed hands
- Cover coughs or sneezes with a tissue or your inner elbow, then throw the tissue in a bin and wash your hands
- Wash your hands for at least 20 seconds before and after preparing or taking drugs
- Effective handwashing is the most effective way to prevent infection, but where handwashing has not been possible use alcohol hand gel sanitiser
- Wipe down any drug packaging, wraps or baggies with alcohol wipes as soon as possible after buying
- For preparing drugs, always prepare a clean surface, cleaned down with anti-bac spray or alcohol wipes, if it’s not possible use something like clean kitchen roll and dispose of it afterwards
- Do not share any paraphernalia, including needles, water, spoons of equipment for injecting straws or equipment for snorting, pipes for smoking or dabbing in shared bags.
- New equipment greatly reduces the risk of ALL infections
- If fresh equipment is not available guidance for cleaning works is below and pipes or snorting equipment can be wiped down with alcohol wipes
Containment or isolation advisories
The COVID-19 outbreak is a rapidly evolving situation. The Scottish Government, together with Health Protection Scotland, have already announced [and may announce further] a variety of containment or isolation advisories with implications for staff and people using services.
Social distancing is a measure you can take to reduce the social interaction between people which helps reduce the transmission of COVID-19. Social distancing can protect vulnerable groups such as people who use drugs and has been recommended by the government for all who can and strongly advised for people aged 70 or over, people with underlying medical conditions and pregnant women.
Measures you can take are:
- Avoiding any contact with people who have symptoms
- Avoid non-essential use of public transport
- Avoid social contact including by not going to public places such as pubs, cinemas or restaurants
- Avoid social contact with family and friends instead use phone, social media etc to keep in touch
- If you need to contact services such as GP, contact by phone first
If you, or someone you live with, develops symptoms of COVID-19, the Government and Health Protection advice to self-isolate is:
- Stay at home for 7 days if you have a new continuous cough or high temperature
- Stay at home for 14 days if someone in the household has a new continuous cough or high temperature even if they don’t have symptoms
As a result of these measures, people who use drugs should be advised that when collecting new equipment from Injecting Equipment Provision (IEP) services, try and take enough equipment to last two weeks and ask for naloxone.
As a last resort, if people can’t get new equipment, ensure existing works are cleaned using the three container method but remember not to share these cups – watch this helpful video to see an example.
An information flyer, created by SDF in consultation with colleagues in NHS Scotland and public health, has been designed to inform people who inject drugs how they can reduce their risk of infection and contains advice regarding the acquiral and use of injecting equipment provision during the outbreak.
We also have a booklet which highlights good hygiene practices for people who inject drugs in order to prevent the spread of bacteria and viruses.
People living with HIV
For people living with HIV, current advice from Terrence Higgins Trust is that people on HIV treatment with a good CD4 count (anything over 350) and an undetectable viral load are not considered to have weakened immune systems. HIV Scotland suggest that if your CD4 count is less than 350, if you’re not on treatment or if you have a detectable viral load, then it is particularly important that you follow social distancing guidance.