Why COVID-19 Is Hitting Drug Addicts So Hard

People with serious drug problems are particularly at risk of coronavirus because of underlying health problems, but also because normal treatment options are being cut off.

"Isolation can be catastrophic for drug users."
Frederik Schindler

FRANKFURT — For people struggling with addiction, the COVID-19 pandemic is truly an existential threat.

Most drug addiction services are open for emergencies only, and many meeting places are closed to visitors. Many addicts are already classed as vulnerable when it comes to the coronavirus, as they have underlying health conditions. And as there is hardly anyone out on the streets, all opportunities for earning money — through begging or collecting bottles — have vanished.

"For our clients, the area around the main station is their living room, their workplace, their bedroom," says Gabi Becker, who runs the addiction support organization Integrative Drogenhilfe in Frankfurt. She is in contact with the most vulnerable drug addicts in the city on a daily basis. "The current situation has taken away everything that makes up their life."

Safe injection rooms are among the support services that are being affected by coronavirus restrictions in Germany. They provide sterile needles for those who are highly addicted and in poor health, helping them access drugs in the way that poses the least risk. This allows addicts to inject themselves in a hygienic environment where they can access first aid if anything goes wrong.

Experts fear that restricting the injection rooms will lead to higher rates of drug use on the streets. The coronavirus crisis could pose a different kind of danger for addicts. "It increases the danger of people getting themselves into much higher risk situations, where they can't easily access help," says Dirk Schäffer, senior officer for drugs and prison at German AIDS Support. "We may well see a rise in drug-related emergencies and deaths as a result."

The German government's commissioner on narcotic drugs, Daniela Ludwig (CSU), is also concerned. "For many thousands of people, injection rooms are a vital service," she says. "At this time, with the coronavirus, injection rooms are more important than ever as they help to reduce infection. Drug addicts are particularly at risk."

Experts fear that restricting the injection rooms will lead to higher rates of drug use on the streets.

If these services were to close, the consequences could be catastrophic.

Interestingly, Ludwig's predecessor, Marlene Mortler (CSU), was not a supporter of injection rooms. She argued that the aim of drugs policy should be to reduce drug use. Eventually, however, she came to see injection rooms as "a preventative measure that aims to minimize harm."

The general feeling among addiction organizations and support services is that Ludwig's policies are less idealistic. German AIDS Support is campaigning for a completely new direction for drug policy that doesn't criminalize addicts.

AIDS Support — together with the organization Akzept (which campaigns for humane drug policies) and the network Junkies — is calling for the government to put in place new measures to help addicts during the coronavirus crisis.

"COVID-19 is interrupting the supply of illegal psychoactive substances, and the problem is growing every day," the organization says in its report. This means that many addicts will experience dangerous withdrawal symptoms.

When asked about this concern, Daniela Ludwig says, "We must avoid a situation where people are going through withdrawal without supervision. There is also a danger that without support, addicts may turn to substances that pose a greater risk to life."

It is therefore important to make sure that there are adequate supplies of medically approved substitutes available.

In Germany, an estimated 160,000 people are addicted to opioids such as heroin. Half of them are receiving treatment using substitutes such as methadone. Many of these patients have to visit their doctor every day, which means they are constantly putting themselves at risk of being infected with the coronavirus. There is often no help available in their local area, especially if they live in the countryside.

"Prescriptions for substitutes should be sent to local pharmacies, so that people have access to safe, local supplies," says Dirk Schäffer from AIDS Support.

Ludwig disagrees. She says that substitutes have to be adapted to each individual patient and should only be prescribed under medical supervision. "Switching addicts to a substitute so fast, that doesn't work," she says.

In Germany, an estimated 160,000 people are addicted to opioids such as heroin.

But Ludwig does want to make access to methadone easier for those already using it. She says it could be possible for stable patients to be issued prescriptions covering a longer time period than the usual few days. When asked, the Ministry of Health responded by saying: "Avoiding all unnecessary social contact is one of the main aims of our coronavirus strategy. Therefore we are considering how to go forward with substitution treatments."

In a letter to the health ministers of each German state, Ludwig called for substitution services to be provided with personal protective equipment as a priority, as they are among the most relevant and most at-risk services.

Gabi Becker says that addiction services do not have enough protective equipment, and disinfectant is also running out. Some employees are concerned about the lack of supplies. "But there is also a strong sense of solidarity," she says. "Our workers want to be there for the people we support."

She says that addicts must not be forgotten during the coronavirus crisis, as addiction doesn't simply disappear. "Our clients need to be looked after without bureaucratic obstacles getting in the way of their access to substitutes," says Becker. "Otherwise they will go into forced withdrawal when they can no longer buy drugs. That could be life-threatening."

She says that the main priority must be to help people, not to comply with regulations. "For the most severely addicted, who have no other option, we could supply drugs in a controlled environment, to minimize the risk," she suggests.

Addiction doesn't simply disappear.

It is not only underlying conditions that make addicts particularly vulnerable during this pandemic. "Isolation can be catastrophic for drug users who have conditions such as depression or anxiety," Dirk Schäffer says.

For many drug users, their only social contact is with other users, and that is a big part of the reason we still seeing gatherings of people at drug spots. "That doesn't mean drug users aren't taking the spread of coronavirus seriously," says Schäffer. "It just means they are trying to avoid further social isolation."

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Reading Rumi In Kabul: A Persian Poet's Lesson For Radical Islam

Born some eight centuries ago, the famed poet and philosopher Rumi offered ideas on religion that bear little resemblance to the brand of Islam being imposed right now in Afghanistan by the Taliban regime.

The work of 13th-century poet Rumi still resonsates today

Mihir Chitre

Among the various Afghan cities that the Taliban has invaded and apparently "reclaimed" in recent weeks is Balkh, a town near the country's north-western border. Interestingly, it was there, about 800 years ago, that a man called Jalal ad-Din Mohammad Balkhi, better known as Rumi, was born.

Some see the grotesque exhibitionism of the Taliban advance as a celebration of Islam or a "going back to the roots" campaign. As if followers of Islam were always like this, as if every willing Muslim always propagated austerity and oppressiveness. As if it was always meant to be this way and any shred of liberalism was a digression from the quest of the religion.

In fact, a look at the history of the religion — and of the region — tells a different story, which is why there's no better time than now to rediscover the wisdom of the poet Rumi, but without doing away with its religious context.

In a world where Islam is a popular villain and lots of terrible acts across the world in the name of the religion have fueled this notion among the West and among people from other religions, it's paramount that we understand the difference between religion as a personal or spiritual concept and religion as an institution, a cage, a set of laws created to control us.

Why do you stop praying?

To begin with, and largely due to the film Rockstar, the most famous Rumi quote known to Indians goes like this: "Out beyond the ideas of wrongdoing and rightdoing, there's a field. I'll meet you there."

Rumi's original Persian verse, however, uses the words kufr (meaning infidelity) and Imaan (meaning religion), which was translated as "wrongdoing" and "rightdoing." To me, the original verse surpasses the translation with a vital, often missed, often deliberately forgotten, interpretation, which is to highlight the fact that there is humanity, love and compassion or a certain kind of mystical quality to life beyond the concept of religion and that is the ultimate place, the place where Rumi invites us to meet him.

It would be incorrect now to read this and think of Rumi as irreligious. In fact, he was quite the opposite. But his interpretation of religion was personal, spiritual and not institutional or communal or exhibitionist.

In one of his poems, translated by Coleman Banks as "Love Dogs" in English, a man who has stopped praying to God because he never got a response meets "Khidr," an angel messenger, in his dream:

Why did you stop praising (or praying)?

Because I've never heard anything back.

This longing you express is the return message.

To me, through this poem, it's clear that Rumi advocates for a personal relationship with God. In fact, he goes on to say that being true to God is to long for his validation or nod, that life is longing.

A copy of Rumi's spiritual couplets at the Mevl\u00e2na Museum in Konya, Turkey

A copy of Rumi's spiritual couplets at the Mevlâna Museum in Konya, Turkey — Photo: Georges Jansoone/Wikimedia

Don't sweep the history of Islam with the broom of radicalism

For those familiar with the European literature of the 20th century, I could say that this echoes the ideas of Samuel Beckett. But remember: Rumi lived 800 years ago, at the heart of what we call the "Muslim world." To equate Islam on the whole with repressiveness and hostility, as many of us do today, might just be a criminal contradiction then.

It's also interesting to note that after the Quran, Rumi's is probably the most widely read work in the Islamic world, which suggests that Rumi's ideas, which may sound too progressive for anyone remotely associated with Islam in today's world, have, in fact, been accepted and cherished by the Islamic world for centuries. Sweeping the whole history of the Islamic world with the broom of radicalism wouldn't then be the fairest assessment of either the religion or of radicalism.

This physical world has no two things alike.
Every comparison is awkwardly rough.
You can put a lion next to a man,
but the placing is hazardous to both.

(From the poem: "An Awkward Comparison")

It's tragic that the Taliban has ravaged the same place with their own power-hungry, totalitarian interpretation of the religion which once produced a mind that embraces it with wide arms of warmth and peace and refuses to be compared with other followers of the same.

How to cure bad habits?

It is vital for us to separate groupism or communalism, which often escalates to barbarism, from the thought it is based on. It is vital then to read and reread that what Rumi sees as religion is the private association with God. It is also vital to mark the emphasis on individuality in Rumi's thought.

All the Western ideas of liberalism are based on the idea of individuality, which in turn is based on post-renaissance European thought. Asian philosophy is contrasted with its Western counterpart in the fact that it is rooted in mysticism as opposed to individuality.

Islam itself has long had a tradition of mysticism that is known as Sufism. Sufism is a sort of an inward dimension of Islam, a practice that encourages a direct, personal connection with the divine, a spiritual proximity to the omniscient that transcends the physical world and temporarily subverts immediate reality.

Sufism is the quest for the truth of love and knowledge, without necessarily always distinguishing between the two. Rumi was known as the Mevlana (Maulana) and his poetic collection Masnavi meaning "the spiritual couplets" is known as the Persian Quran. He was no doubt a mystic, a Sufi, and one who strongly endorsed the personal, for the most intimately individual is the truly spiritual.

Rumi might remain unparalleled in not just the Islamic world but also in the world of philosophy and poetry across the globe. Another thing that he will remain is dead. The Taliban, on the other hand, at least for now, looks rampant and alive.

It is now up to us, the other people who are alive, and the ones who are going to be born — not just Muslims but everyone else as well — to choose which interpretation of Islam we uphold or react to, how we read history, and what we borrow from it.

How to cure bad water? Send it back to the river.
How to cure bad habits? Send me back to you.

(From the poem: "My Worst Habit")

I think what we, as a world, need now more than ever is to be sent back to Rumi.
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