DDN June2022 June 2022 | Page 15



The pandemic had meant people experiencing homelessness in Manchester were turning from poor quality heroin to bingeing on a cocktail of substances , often counterfeit and potentially deadly . DDN reports

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
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 .
‘ 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
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