WHAT YOU CAN DO TO REDUCE THE RISKS OF SUBSTANCE USE DISORDER   DURING COVID-19 PERIODS.

I was inspired to write this piece by one of my clients when about five weeks ago the young man called me (I am a Substance Addiction Counselor). This wonderful and motivated young man has been seeing me in the past two years for a substance use problems (precisely Injecting Drug Use), he is at the maintenance “Stage of Change” since the past six months. What did my client want? His counseling sessions has been cut short due to the lock-down, he cannot get a means of transportation to visit the psychiatric hospital for his monthly appointments, his medication would soon finish; he was worried of how to replenish this, he is a casual worker who does not have a stable job; he was worried about feeding and how to get his medication? The questions were endless, and as we talked on the phone I visualized the present state of this young man in my mind, feeling what he was feeling, hearing those unsaid words, unsaid fear! Today I am going to let you all know what I told my client and how I counseled him and provided skills that has helped him in the past one month but before I delve into these, let me take us through some preamble of how vulnerable people who use drugs are at risks of COVID-19 infection.

Since February 28 when the first index case of COVID-19 was confirmed in Nigeria, the numbers of infection, deaths and of course successfully discharged cases have increased. As at 31^st May 2020, update on COVID-19 was as follows: Total Case Confirmed 10162, Total case discharged Cases 3007 and Total deaths 287. I will not go into the detail of explaining what is meant by COVID-19 and how to prevent it; this has been done by experts, media houses, social media and the government but for the purpose of this write-up which has to do with drug and substance abuse and COVID-19, it is important to briefly explain the relationship of the symptoms of COVID-19 and the negative effects of abusing drugs and other substances. According to the National Institute on Drug Abuse (N.I.D.A) U.S.A “ The Corona virus attacks the lungs, the Corona virus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who Vape, people with Opioid Use Disorder (OUD) and Methamphetamine Use Disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health. The Foundation for a Drug-Free World also explained that people who smoke crack cocaine are at risk to experience a heart attack, stroke, seizure or respiratory (breathing) failure which can result to sudden death. It attacks the respiratory tract and appears to have a higher fatality rate than seasonal influenza. The exact fatality rate is still unknown, since it depends on the number of undiagnosed and asymptomatic cases, and further analyses are needed to determine those figures. So far, deaths and serious illness from COVID-19 seem concentrated among those who are older and who have underlying health issues, such as diabetes, cancer, and respiratory conditions. It is therefore reasonable to be concerned that compromised lung function or lung disease related to smoking history, such as chronic obstructive pulmonary disease (COPD), could put people at risk for serious complications of COVID-19. (N.I.D.A.). So, let us see the similarities of the effects of abusing some of these drugs and the symptoms of COVID-19:

TOBACCO: The American Cancer Society: Smoking tobacco damages the heart and blood vessels (cardiovascular system), it increases the risk of heart disease and stroke, causes high blood pressure, lowers ability to exercise and makes the blood more likely to clot. There is no gainsaying that tobacco smoking affects the lungs and cause respiratory problems.

COCAINE/CRACK: The Foundation for a Drug-Free World explained that people who smoke crack cocaine are at risk to experience a heart attack, stroke, seizure or respiratory (breathing) failure which can result to sudden death.

INJECTING DRUG USE: The Semel Institute for Neuro-science and Human Behaviour explained that Intravenous Drug administration can lead to serious health problems; most drug addictions begins through less direct methods administration like smoking or ingesting the substance but dependence increases as the user seek stronger faster ‘Highs’ that they often consider or begin to abuse drugs such as heroin or cocaine through intravenous injections. Problems associated with intravenous administration of drugs includes skin infections (abscess sites), scarring and needle tracks, HIV/AIDS, overdose risks etc. There is no doubt that substance use could be associated with other co-occuring mental disorders like schizophrenia, depression, anxiety, suicide ideation and other medical conditions like hypertension, tuberculosis, cancer etc.

CANNABIS: Evidence that chronic cannabis users have an increased incidence of respiratory symptoms such as chronic cough, sputum production, dyspnoea, hoarse voice and chest tightness has been reviewed recently; marijuana smoke contains many of the same compounds as, and shares similar properties with, cigarette smoke as respiratory symptoms would be expected

TREATMENT AND MANAGEMENT OF PEOPLE WHO USE DRUGS IN NIGERIA

Government policy to treat people who use drugs (PWUD) in Nigeria has not really given a clear direction as to how these treatments should be provided, the bulk of psychiatric services are being provided by the eight regional psychiatric hospitals, departments of psychiatry in general and teaching hospitals in the country, with the associated problems of mentally induced substance use disorder it is evident that the services provided by these hospitals are grossly inadequate. According to Drug Use Survey- Nigeria 2019:

• One out of seven persons aged 15-64 years had used a drug (other than tobacco and alcohol) in the past year. The past year prevalence of any drug use is estimated at 14.4% corresponding to 14.3 million people aged 15-64 years who had used a psychoactive substance in the past year for non-medical purposes. Among every Four drug users in Nigeria One is a woman and the highest levels of any past-year drug use was among those aged 25-39 years. One out of Five persons who had used drugs in the past year is suffering from drug use disorders.

• 376,000 are high risk drug users, about 75,000(1/5 of 376,000) of this are injecting drug users and about 150,000 (40% of 376,000) wanted treatment but could not get it. Among the top four barriers to access treatments and supports are (a). People who cannot afford treatment, (b).People who fear of being stigmatized (c). Treatment services not available, (d). No information about treatment availability.

The above analogy shows the challenges of substance use and its associated problems in Nigeria even when there is no COVID-19 Pandemic. With this corona virus issue series of medical conditions and of course mental and substance problems are lacking attention from health workers because of work pressure arising from the pandemic.

WHAT TO DO AS A DRUG USER TO REDUCE RISKS OF SUBSTANCE USE DURING THIS COVID-19 PERIOD.

• Social distancing has hindered physical interactions, if you need to see a doctor in a very distant location, avoid that for now, you can go to a nearby hospital for immediate treatments.
• Seek other sources of help, do virtual counseling sessions, call your doctor or counselor on phone so that he can do an online prescription which can be sent through whatsApp so that you can take this to the pharmacy.
• Do not stockpile prescribed medications to prevent overdose or misuse but a sufficient amount of medicine that will last you for the appropriate time will do.
• Seek for family and other social support within your immediate environment.
• Avoid unnecessary interactions with strangers; they might be a source of relapse.
• Get yourself busy, involve in virtual help programs and education ( a lot of them are available during this period)
• Talk to someone if you are going through a tough time, have a role model whom you look up to at all times and who impact positively on your life.
• Love your family and accept their love too. Play games both indoor and even outdoor where the environment permits.
• Do not try to go cold turkey on your own. Opioid withdrawal can be dangerous, and symptoms can be severe.
• You can do some steam therapy or steam inhalation intermittently, it involves inhaling water vapor to open the airways and help the lungs drain mucus. it controls coughing, drain mucus from the lungs.
• Exercise and drink Green tea regularly, eat anti-inflammatory foods like tomatoes, olive oil, green leafy vegetables; spinach, ugwu vegtables , fatty fish like salmon, mackerel and sardines, fruits like oranges, mangoes, strawberries, cherries. Control sugar intakes.
• Manage stress. Avoid situation and discussion that will bring about anger, be happy at all times. This list is endless!

These are part of the advice I gave to my client during our telephone conversation. I hope this is useful to someone out there.

Fatima Abiola Popoola

Abiolaodus9@gmail.com

Drug Addiction Counselor

Zaria, Kaduna State.

Reference:

National Institute for Drug Abuse: Covid-19: Potential Implications for Individuals with Substance Use Disorders. April 2020.

“Collision of the COVID-19 and Addiction Epidemics”, Annals of Internal Medicine, By Nora D. Volkow, April 2, 2020

Luis IG Ribeiro  and Philip W Ind. NPJ Prim Care Respir Med. , Effect of cannabis smoking on lung function and respiratory symptoms: a structured literature review. Published online 2016 Oct 20. doi: 10.1038/npjpcrm.2016.71. NPJ Prim Care Respir Med.

Drug use Survey Nigeria_2019_BOOK.indb, Drug Use in Nigeria 2018, UNODC RESEARCH

Effects of crack/ cocaine, Truths about drugs. www.drugfreeworld.org> Drug facts>