Thanks. I agree that we can’t replace drug services with tech, and more generally, folks can get wooed by tech as a solution to all our problems, erroneously. And I don’t think there’s any country in the world that has funded drug treatment fully. I know that here in Australia researchers have estimated that we need at least double the number of services to meet demand (ie double the funding).
What would make a massive difference in Australia is full decriminalisation for all drugs. That is, use and possess offences attracting no penalty. We have drug diversion for these offences which involves compulsory session with drug counsellor. I’ve got drug counsellor colleagues who spend most of their funded time on these sessions for which only one on ten actually have a drug problem that needs treatment. Yet there are long wait lists for all kinds of treatment including drug counselling
And yup opioid replacement therapy needs to be easier to access. Here very few pharmacies will dispense making it harder to get. Only some doctors are registered to prescribe which is another barrier. Drug stigma is a massive cause with many clinics just not keen to serve this population. They wouldn’t do that about cancer or diabetes would they?
Another thing to promote more of is “safer consumption sites” - called various names globally. In Australia these are “medically supervised injecting centres”, in the US, more euphemistically “overdose prevention sites”. I understand these don’t exist in the UK and part of the idea of BuddyUp is to fill some of that gap. Australia has made it about medical supervision of injecting but that’s a really expensive model, and there are only 2 sites in Australia so it serves a very select group who live close to those sites. The app version uses trained health staff and or volunteers who are drug users themselves or have experience with drugs, and all remotely located. So it’s a lot cheaper. But still helps that someone is monitoring the person especially if they are taking opioids. We know that using alone is a top reason for fatal OD. Having said that just getting naloxone out to people and their friends and family makes a difference too.
I heard from a UK colleague recently that in the last year there were 2 deaths per week there where nitazenes were detected, likely ppl using heroin substituted or adulterated with nitazenes. My hope is that this doesn’t turn into a US style fentanyl analogue overdose crisis. But also maybe such a public health disaster might shock people into funding more innovative things and fully funding what we have - we can see in Canada that their tragic number of opioid deaths has led to much greater government funding of services, and willingly to fund drug checking services too.
As you mention, a public health crisis did indeed allow for some unusually compassionate treatment in British Columbia-especially the Lower East Side of Vancouver. Have you heard of DULF ? They set up a compassion club for drug users which was providing tested quantities of Cocaine, Heroin, Methamphetamine and Fentanyl (until the right wing press got hold of it...) https://www.bbc.co.uk/news/articles/c3wp03d97jvo
