Short abstract:

As the COVID-19 pandemic took hold, drug healthcare had to radically change. This paper explores those changes that took place in opioid agonist treatment, but also why some of these changes were so easily reversible and its care unrealisable, and what this reveals for who is worthy of care.

Long abstract:

With the arrival of SARS-CoV-2 and the global pandemic that quickly ensued, healthcare had to radically change to reduce transmission risk. Although these were terrifying times, with instability also brought possibility. For the harm reduction community, the pandemic created an opportunity for doing care differently. Scholars, activists, and practitioners alike heralded it as a time of ‘emergent adaptation and experimentation’ (Grebely et al 2020). For Judy Chang and others at the International Network of People who Use Drugs (2020), the pandemic potentialized a ‘new normal’ – ‘an occasion to rethink the function of punishment, to reform the system and to work towards ending the war on drugs’.

In the UK, like many countries, tightly controlled opioid agonists (used in the treatment of opioid dependency) were made available to take home, removing stigmatising supervised consumption practices. A new long-acting formulation of opioid agonist also arrived at this time. Drawing on a survey and interviews with people who use, provide and commission drug services in the UK, this paper reflects on the freedoms, flexibilities, and new subjectivities these technologies enabled. But what happened? Participants also overwhelming remark that ‘everything is back to normal!’. Therefore, while exploring this air of potential, and, namely, as realised in new opioid agonist formulations and forms of prescribing, I also attempt to unpick what made some of these changes so easily reversible and its care unrealisable, and the politics this reveals for who is worthy of care.