If we take death as the ultimate harm, the UK has never been a more harmful place for people who use substances. Death rates from both drug– and alcohol-specific reasons are at their highest ever level. Moreover, some areas are experiencing their worst HIV outbreaks among injecting drug users in 30 years, and alcohol-related liver disease is rising steeply. As Covid-19 works to ‘expose and amplify’ existing inequalities, the fear is that these deaths and other harms will increase yet further. However, Covid-regulations have also brought changes to the sector, including long-sought flexibilities in treatment options and regimes, and stimulated new care networks and modes of connecting.

Perhaps one of the most notable changes is to Opioid Agonist Treatment (OAT). Following Public Health England emergency guidelines, some people in receipt of OAT no longer had to be supervised in taking their medication. Similar policies were announced in other UK nations. To reduce social contact, recipients were able to  take their OAT medication home and collect larger quantities to avoid having to visit the pharmacy every day; a move that harm reduction proponents and activists have been arguing for since OAT’s inception. In a fascinating conversation that took place in April 2020 between addiction psychiatrist, Professor Adam Winstock, and clinical advisor to Public Health England, Dr Mike Keheller, they spoke about how these changes may have ‘ripped up the rulebook’. That is, these changes may have (finally) disrupted paternalistic and even punitive modes of assessing risk and delivering treatment. While this might have been an off-the-cuff remark, it is nonetheless an intriguing provocation for thinking not only about how treatment and support may have changed and, in doing so, eschewed dominant forms of practice and policy, but what might be possible in the absence of constraint, of a ‘ripped up rulebook’.

As well as these ‘top down’, structural changes to treatment encapsulated in this change to OAT, which gets described by another leading practitioner, Dr Emily Finch, as a ‘natural experiment’ with ‘potential for a lot of learning’, this project is interested in the many more grassroots, ‘ground up’ innovations and experiments that emerged as service providers and users tried to adapt to a constantly changing situation. The project will look at the ways service providers had to modify and rework treatment and support to meet people’s needs in these fast-moving and challenging times (see, for example, purchasing of alcohol). But also, the project is driven by a commitment to understanding and relaying the ways people who use/d substances experimented with their own treatment during these times and enacted new modes of care and community.

It is vital that these innovations and quieter forms of care and survival are documented before they are lost, which is already feared by some. This project, then, is concerned with recording and learning from these experimental practices, both in policy and on the ground, for thinking about how treatment and support can be done better, to respond to and improve people’s lives as defined by them. This will take place in three stages.

Stage 1: UK-wide survey – the project will map short-term and long-term changes and innovations in treatment and support in response to Covid-19 through a UK-wide qualitative survey. The survey is open to all service providers and users in the UK who will be able to complete the survey online, or, on request, via email, post, or phone. 

Stage 2: Ethnographic inquiry at fieldsites – to establish how these experimental practices re-work existing treatment and support, and the role of service users’ own experimentations in these processes, the researcher will visit some of the most innovative projects to observe this work  and conduct interviews with those service users and providers involved. 

Stage 3: Workshops – extending the project’s interest in experimentality through its methodology, the project will bring together key stakeholders in a series of creative workshops to think through: what substance-use treatment and support infrastructures could look like in the future and how we can start to collectively build them. This will be an experimental space where, as one feminist group recently put it, ‘we can do and try “here” what we wish to see “out there”‘.