Overcoming challenges of managing specialist substance misuse in housing during lockdown

Phoenix Futures, 26 May 2020

As a specialist housing and treatment provider, we have unique insight into the challenges faced by individuals with a history of substance misuse and how the current crisis might affect them.

One of the challenges is disruption to treatment and prescribing services, including suspension of supervised dispensing, so we have had to adapt to control risks.

Our newest addition to our supported housing schemes is Progress House in Lewisham, where we support drug and alcohol dependant clients to reduce, stabilise or stop using. It’s early days, but we’re proud of our clients’ achievements so far: two have gone to rehab this year and many more have moved on into lower supported or independent accommodation, including our own abstinent houses.

Storing controlled drugs on site

Our drug and alcohol service partners in Lewisham approached us when they became aware that pharmacy-supervised consumption of methadone and other controlled drugs would be suspended. So together we drew up plans to ensure that we could safely store their medication on the premises.

This has involved buying locked boxes, which are stored in a locked cabinet in the staff office. We have had to be inventive: possession of controlled drugs prescribed for somebody else without the express purpose of conveying them to the person they were prescribed for is illegal. To protect our staff, the only keys for the locked box are held by the service user, who opens and self-administers the medication. We developed a local procedure to support the process, agreed risk management plans with clients, and are in regular contact with the prescriber.

Guidance issued to staff ensures they know what the signs of withdrawal and overdose are and when to seek medical treatment. Additionally, and importantly, we are working with our partners to ensure that our staff and clients have ongoing access to Naloxone.

Our culture of collaboration and trust

This has been relatively straightforward because we have a strong culture of collaborative working in the service. We work collaboratively with partner agencies and commissioners, but also with our clients. We included clients in conversations with our partners, asked them to help us formulate risk management plans, and have trusted them to administer their medication sensibly.  

Other risks we anticipated were that our clients could have potentially life-threatening withdrawal symptoms if they were unable to access their usual supply. There’s an increased risk of overdoses – because of an increase in adulterated substances, or because lack of access to support networks can lead to increased use.

Additionally, we recognised that people who use our services are more likely to have pre-existing health conditions that may place them at greater risk if they contract the virus - the average age of mortality for both homeless people and drug and alcohol users is early-to-mid-forties.

Staying connected

We have encouraged and supported our clients to attend remote mutual aid meetings and access substance use and mental health support online to bolster the work of our teams.

Keeping clients connected with loved ones has occasionally be difficult. Some of the people we work with have been estranged from friends and family and are only just rebuilding the connections that many of us take for granted. They don’t all have access to smart devices, and we are seeing more and more evidence of how digital exclusion is proving to be a barrier to accessing support.

Despite the challenges, our communities remain places of contemplation and change. Daily, socially-distanced groups continue in our large group room facility in Lewisham, and clients across Phoenix services are using additional time spent at home to work on their recovery and explore their creativity.

There’s been some impressive vegetable and herb growing, some brilliant poetry and art, and some great video-making. Further, two clients in our Progress House have stopped using illicit substances in the past few weeks. One has moved into one of our abstinent houses and the other is undertaking a community detox, with medication stored onsite.

Adapting to the current crisis has been incredibly challenging but results like this keep us going. We’re hopeful for the future.