Manchester had the most comprehensive local intelligence system in the UK when it came to drug use , and also carried out annual trend studies , professor of criminology and social policy at Manchester Metropolitan University , Robert Ralphs , told the Current substance use trends among homeless and street-based populations session at the RCGP and Addiction Professionals conference . People had been reporting significant changes to the heroin market in Manchester , with the pandemic leading to poorer quality drugs and smaller-sized deals , which had in turn been driving increased poly-drug use . There was far more reported use of ‘ Spice ’, pregabalin and benzos – usually diazepam , he said . ‘ This really buoyant street market for prescription drugs was leading to binge use of these substances , and increasing concerns and reports of overdoses and drug-related deaths .’ EVERYBODY ’ S USING BENZOS Lockdowns had meant people experiencing homelessness had fewer chances to obtain money from begging . Not only were most people working from home or furloughed , but advice to move to card-based transactions meant that even those people who were around were far less likely to be carrying cash . There were also fewer opportunities to shoplift or steal from houses , pushing people towards more affordable alternatives to the heroin or crack they might normally use . ‘ People were talking about £ 10 for 0.1
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gram of really poor-quality heroin – for the same money they could get a quarter of an ounce of Spice ,’ he said . Researchers had found heroin with purity as low as 2 per cent , often adulterated with more than 50 per cent caffeine and up to 30 per cent paracetamol , with interviewees saying that ‘ everybody ’ was using benzos and pregabalin as the ‘ gear is shit ’.
The government ’ s Everyone In scheme meant services were coming into contact with people who ’ d never engaged with services – or not for a long time – and many were using pregabalin on top of methadone or poor-quality heroin as it helped sleep . The variable quality of street benzos didn ’ t deter use , he stressed . ‘ People would talk about taking whole strips at a time , with 15 in a strip , and they talked about taking 30 or 40 benzos at a time .’ One user also reported taking 70 pregabalin in a single session .
RECIPE FOR DISASTER Testing had found the content of drugs varied wildly , with some street-based counterfeit drugs containing no active ingredient whatsoever . ‘ So the concern is if someone ’ s using 20 diazepam sold as 10mg but it ’ s only 2mg , or they ’ re taking 20 pregabs which are supposed to be 300mg but are actually only 100mg , what happens the next time they buy someone ’ s diverted script and it ’ s actually the proper amount ?’ he said . People taking benzos , pregabalin and Spice on top of a methadone script , crack and heroin had been ‘ a recipe for disaster ’, reported one service manager at a homelessness charity where several clients had already died .
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‘ So there ’ s been a marked shift from heroin use to much wider poly-substance use , which brings many more unknowns in terms of contents , effects and interactions , especially as much of it is counterfeit ,’ said Ralphs . ‘ All of that combined increases the risk of fatal overdose ,’ with serious concerns about how effective naloxone could be under those circumstances .
NATIONAL PICTURE The national picture was similar , he said , with PHE in 2020 reporting significant increases in availability , use and harm associated with ‘ street ’ benzodiazepines , particularly among ‘ entrenched ’ drug users in hostels and people sleeping rough . Street benzos in Scotland – particularly etizolam – were involved in almost 900 deaths in 2020 , up from less than 60 in 2015 .
‘ As someone who works with homeless people , it just makes your heart break that it ’ s still so difficult for people to get into treatment ,’ said session chair Dr Stephen Willott , a Nottinghambased GP . ‘ We just need to make it easier for those who are changing their phones so frequently and have no address to get same-day access if possible .’
Manchester had developed a street engagement hub , said Ralphs , with all the services together in one place , including rapid prescribing . ‘ That ’ s proved really popular , and with the repeal of the Vagrancy Act lots of other local authorities and police forces will be looking at that type of model .’ Many people were
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Street benzos in Scotland – particularly etizolam – were involved in almost 900 deaths in 2020 .
understandably self-medicating because of the situation they found themselves in , so it was less a question of what could motivate them into treatment than simply getting them accommodation , he said . ‘ The additional support with Everyone In really helped a lot of people .’
Ultimately , people were mostly fully aware of the risks of such extreme poly-drug use , but were fatalistic , he stated . ‘ They ’ ll say “ my friend died from this ” or “ these are killing people ”, but they ’ re still taking them in huge quantities . ‘ Poly-substance use ’ doesn ’ t even begin to do these amounts justice .’ DDN
George Tsartsianidis | Dreamstime . com
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JUNE 2022 • DRINK AND DRUGS NEWS • 15 |