WITHDRAWAL MANAGEMENT INTERVENTION FOR HOMELESS PEOPLE WITH OPIOID USE DISORDERS

SUMMARY

A week before the level 5 COVID-19 lockdown was instituted, a group of State and non-State organisations undertook to provide shelter, food, medical services and ablution facilities to Durban’s homeless population.The primary aim was to ensure that homeless people who use drugs remained in the safe spaces created by the City to avoid vectors of transmission of COVID-19 in a bi-directional manner. The secondary aim was to provide evidence-based services to reduce the trauma associated with forced withdrawal from opioids. At the height of lockdown, there were 260 people on the programme in two lockdown facilities. DUT's Urban Futures Centre (UFC) led a private medical team who provided opioid substitutes to 250 homeless people in a state of moderate-to-severe withdrawal.

AIMS AND OBJECTIVES

Provide homeless and low-income people addicted to heroin with evidence-based interventions to prevent mass withdrawal and overdose; link them to health and welfare services; prevent the burden on the public health system during the COVID-19 lockdown; ensure testing for COVID-19,TB, HIV and hepatitis; provide hope during this fear-provoking period; provide a model for running an urban-based out-patient facility. At present, the UFC is working with a range of NGOs, Urban Lime and Mass Design Architects to deliver a state-of- the-art harm-reduction facility in Durban.Together with the Bellhaven Harm Reduction Centre (capacity: 200 and up and running since lockdown level 2), they will provide a model for comprehensive harm- reduction intervention in low to middle-income countries. There are already spaces of peer learning; professional development; policy development; and data collation for publication.

IMPACT

During level 5 lockdown, this programme prevented homeless people from leaving safe spaces in search of drugs, and allowing them (mostly young men) to go through ‘withdrawal’ without experiencing severe and traumatic withdrawal symptoms (both physical and psychological). It significantly eased the load on the public health system during lockdown. Every day, around 15 new homeless people with a heroin addiction joined the programme since the institutionalisation of Bellhaven Harm Reduction Centre and received daily observed medical assistance. Recipients showed remarkable changes in quality of life; many are reunited with their families and are now taking care of their personal hygiene and general well- being.

WHY SHOULD DONOR ASSIST?

During lockdown level 5, funding for the programme was raised from the public, which covered the operational costs and the short- term opioid substitution until September 2020. Funding will be required for operational costs and capital expenses to retrofit the buildings that the programme will be run from. This will be raised from the private sector with the assistance of Urban Lime and the office of the eThekwini Deputy Mayor. This fully-fledged harm-reduction centre will be the first of its kind not only in South Africa, but on the continent. For this reason, and because of the critical role this centre will play in the alleviation of the social and economic burden of COVID-19, it will receive substantive international recognition. Harm-reduction centres such as Bellhaven and the one currently being co-created with Urban Lime not only provide much-needed healthcare intervention, they also play a crucial role in reducing crime, and ultimately in urban regeneration. With urban regeneration comes greater investment in the City. This is hugely advantageous to local business and is also important for universities given the prospects of opening up the market economy for recently graduated students.

PROJECT LEADERS AND CONTACT DETAILS

Prof Monique Marks Co-project manager – Michael Wilson from Advanced Access and Delivery; a part-time medical practitioner; three full-time registered nurses; two social workers and a researcher moniquem@dut.ac.za | Cell: 084 403 3934

TIMELINE

The longer-term goal is to establish a harm-reduction centre that will offer a range of other WHO- recommended services/interventions – the first of its kind not only in South Africa, but on the continent – indefinitely.

BUDGET

4 878 600.84