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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