Emergency relief for opioid withdrawal

The IDPC assists with emergency relief to street-based people in opioid  withdrawal in South Africa.

MJ Stowe | South African Network of People Who Use Drugs
Julie Mac Donnell | South African Drug Policy

Insight into how financial assistance from the IDPC is assisting SANPUD to support street-based people currently withdrawing from opioids.

The International Drug Policy Consortium (IDPC), through their Support. Don’t Punish Initiative Program grant, is providing financial assistance to the South African Network of People Who Use Drugs (SANPUD). The funds are being used to support street-based people currently experiencing opioid withdrawal under coronavirus disease 2019 (COVID-19) restrictions. The grant allows for activities which focus on advocating for rights and agency of people who use drugs (PWUD) to be implemented. It also provides funds which enable us to visibly showcase the current repressive manner in which PWUD, especially street-based people, are being treated. 

Currently, in South Africa, there is a lockdown period which was initiated on 16 March and was initially scheduled to be in place until 21 April. However, a recent extension was announced, which will keep the country under restrictions for an additional two-weeks. Under these lockdown restrictions, the South African Government has said that people may only leave their place of residence to i) seek medical care; ii) purchase groceries; iii) visit the pharmacy; iv) access banking services; v) obtain fuel for a vehicle; or to vi) collect a social grant. All other movement and travel are curtailed, and the lockdown is enforced by the South African Police Service (SAPS) and law enforcement. Unlike most other countries, under this lockdown full stop. South Africans are not even allowed to leave their homes to walk, run, walk their dogs or cycle on their bikes. People seen by law enforcement on the streets are stopped, questioned and fined/arrested if they are deemed to be outside their residence without the applicable documentation.

Figure 1. A photograph of some of the symptomatic medication being provided to treat some the symptoms experienced by street-based people in opioid withdrawal. Photograph by Julie MacDonald.

As street-based people dependent on opioids– mostly heroin, which is also referred to as unga, nyaope and whoonga – are relocated to the City’s designated sites and their movement is restricted, they are unable to access opioids. Subsequently, many people are going into opioid withdrawal. In Cape Town, there have been some street-based people who are enrolled on the Step-Up Project’s opioid substitution therapy (OST) program who have been given a supply of methadone which will cover the lockdown period. However, outside of this program, access to OST is extremely poor. This limited access translates into street-based people who have been relocated to a foreign environment, with no access to opioids or symptomatic medication to stop the onset of opioid withdrawal. This situation is exacerbated by a lack of medical support services tailored to meet the needs of PWUD. 

Figure 2. A photograph showing the marquee tent in which many of our service beneficiaries are residing during the lockdown period Photograph by Julie Mac Donnell.

​City’s site in Strandfontein [Fig. 2]. At present, our efforts to secure this are on-going with many working relentlessly.
In the interim, we decided that the provision of symptomatic medication, which would address the symptoms of opioid withdrawal, would be the second best option. With the support of the IDPC, we have managed to reprogram some of the activities and have used the money originally allocated elsewhere to provide immediate relief and support to the people in withdrawal at the City’s main site [Fig. 2] for street based people.
Over the last week, we have managed to purchase symptomatic medication [Fig. 1] and collaborate with a doctor to assess the people in opioid withdrawal and prescribe medication [Fig. 3] to alleviate some of the withdrawal symptoms. However, there were unfortunately some residents at the site, who were experiencing such bad withdrawal symptoms, that they had to transported by ambulance to the hospital for further care. One such person, a 34 year old woman who had been vomiting and suffering from such chronic diarrhoea that she was severely dehydrated and unable to even stand for the doctor to carry out a full medical assessment. When we arrived to assist her – she had vomit all over her blankets, her hair and the floor upon which she was sleeping. 

Figure 3. One of the clinicians sits with a patient on the floor who is too ill to get up. Photograph by Julie Mac Donnell

​While we acknowledge that symptomatic medication may only provide mild relief from the agonising withdrawal pains, we have seen that our efforts have made a difference. Arriving on site to happy ‘Hi sister’ calls from residents who know that help has arrived, is an uplifting experience. Although we cannot provide medication for all the residents on the site – we have also offered some care to some critically ill, and aged people who may not be withdrawing from substances. For example, a 67 year old man had only just come out of hospital before being moved to the City’s site. He had arrived with a urinary catheter and was also faecal incontinent. Sadly, this crucial medical information had not been given to the social worker on arrival, and he had been lying on the ground, soiling himself and experiencing pain from what the doctor concluded was an infection from the catheter not being properly looked after. He too was given some pain medication and an ambulance was called to take him back to hospital, for which he was tearfully grateful.
We also have had the joy of seeing several people come through their withdrawals who are now able to eat again and move around, pain-free and without nausea and vomiting. They have also been very supportive of the other residents who are still in the early days of withdrawal.
As we continue to implement these activities, we suspect we will be faced with considerable challenges. These challenges are likely to arise from the politics amongst operators and government entities responsible for the well-being of those people residing at these supposed ‘safe’ sites. However, as SANPUD, we remain committed to meeting people where they are at and will continue to try our best to reach as many of the PWUD community as we can, so as to provide them with much needed support during this complex and difficult time.