Dual diagnosis: Why people are at risk during COVID-19

What is Dual Diagnosis?

‘Dual Diagnosis’ or ‘Comorbity’ are terms used when a person is diagnosed with one or more conditions. When referring to these terms in relation to people who use drugs, it means that the person is using a substance (s) and also experiences a mental health issue.

Drug use may cause problems for some people but exactly how it affects someone will depend on the person, the drugs which are used and how they are taken. There is direct link between drug use and mental health and it is estimated that around 50% of people who use drugs in Europe have a substance use and mental health order.

The relationship between substance use and mental health is complex and can mean additional difficulties for both the person and their families. These issues may be worsened by external stresses during periods of crisis, making the COVID-19 pandemic an even more difficult time.

COVID-19 and Dual Diagnosis

COVID-19 is a new illness and we are still learning about the long term impact it will have. We know that the pandemic could impact on the most vulnerable in society such as marginalised groups or people who have pre-existing health concerns.
The COVID-19 pandemic will mean that most people’s lives will change, but in time this will pass. Life style changes due to the pandemic may impact on some areas of society more than others, with people with dual diagnosis being particularly vulnerable during this time for a number of personal and societal factors.

How will the COVID-19 pandemic impact on people with Dual Diagnosis?

Mental Health

People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population. Read more here on minding your mental health during the coronavirus outbreak.

People may experience additional risks when using drugs

People who use drugs are at increased risk of developing problems from the virus due to possible pre-existing health concerns. Drug use can also weaken a person’s immune system making them more susceptible to infection.
Overdose risks also increase if a person has COVID-19, with opioid users being at greater risk. Opioids, such as heroin, slow down and can stop a person from breathing. COVID-19 causes breathing difficulties and therefore there may be an increase in the risk of overdose for people who use heroin.

Overdose in isolation is of concern due to the likelihood of the person not being able to access the appropriate medical support.

Distancing measures and the chain of supply of illicit drugs

International and local travel restrictions may lead to a disruption in the chain of supply of drugs. Many countries, including Ireland, are now enforcing stricter policies on movements within communities. This in turn can affect the availability of illicitly sourced drugs medications which will impact on people who have dual diagnosis. Changing ones drug of choice or using new substitutes available on the market is a risk for a person’s mental and physical health.

Withdrawal symptoms

If people with dual diagnosis experience difficulties acquiring drugs they frequently use, it could trigger clinical complications such as withdrawal symptoms. This may also exacerbate other psychological or psychiatric difficulties.
In some cases, the lack of substances can exacerbate symptoms of other concurrent psychiatric disorders, such as; symptoms of anxiety, depression, psychosis, self-harm or suicide behaviours.

Withdrawal symptoms may be so severe that people may use substances to stop or relieve symptoms. If substances of choice are not available then people may use alternatives or new components that become available on the market.Suddenly stopping drug use and withdrawing from drugs and alcohol can be dangerous. Alcohol withdrawals in those people who are severely dependant can be fatal in some cases.

Medication

A disruption to the supply of medications due to difficulties in the prescription, production and distribution of drugs such as methadone, buprenorphine, naltrexone, naloxone, disulfiram, or stimulants etc could lead to relapses, binge use of substances and the exacerbation of psychiatric symptomology.

People should take all medication, as prescribed while in isolation. Local supports have been implemented to support the distribution of medication to those isolating during the pandemic.
If going to an isolation facility, people are advised to bring all their own medicines to the facility. People should plan their medication supply for one month, although this amount may not be necessary. They should bring the rest of their current month’s supply of medicines and a prescription for any medicines which they may need re-prescribed

Service restrictions and harm reduction

People with dual diagnosis may be used to attending harm reduction services that could be limited by quarantine and social distancing measures. Online supports are being developed so do stay in touch with your service. People need to remember that they may be vulnerable to infection if they don’t use new sterile equipment.

Marginalisation

Many people with dual diagnosis live in situations of marginality, and the restrictions and strict health policies of quarantine could represent a serious challenge for people to comply with these measures. These measures are essential for their well-being and the well-being of others.
People with dual diagnosis may also have difficulties accessing mainstream health services due to a sense of stigmatising and shame but particularly during this current crisis they should continue to present to these services when necessary. Services are there to help and support you. New arrangements have been put in place to make it easier to get help. For example, more flexible access to methadone and easier access to accommodation if homeless.

Relapse

Stressful situations increase the risk of relapse among people with dual diagnosis. Relapsing into drug use could be particularly dangerous for people in isolation in terms of overdose