Times of crisis often see a rise in the use of illicit drugs and other intoxicating substances — from cocaine and heroin to pills and alcohol. This has been shown by many historical reviews.
The coronavirus pandemic is no different. Frequently dubbed a crisis, the pandemic has created challenges for public health initiatives, national and global economies and societies as a whole.
The ramifications of national lockdowns for drug users, however, remain an untold story. That's not for want of trying, though.
International bodies such as the United Nations Office of Drugs and Crime (UNODC), the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), universities and initiatives like the Global Drug Survey, have been collecting data for months.
But as even they themselves have sometimes admitted, it is far too early to get a clear picture of the situation. The EMCDDA describes its own European Web Survey on Drugs, which includes data from April 8 to May 25, as "a rapid assessment … a snapshot."
A lot of the data is science mixed with anecdotal evidence. So, for instance, users will say — anecdotally — that there's no point taking "party drugs" when you're stuck at home on your own, or that sniffing drugs helps you pass the time.
But researchers need more hard data and time to compare usage before and after lockdowns. So, anecdotal evidence is then only partially verified by things like wastewater analysis.
For example, the EMCDDA's preliminary findings suggest that the closure of the nighttime economy affected the use of cocaine and MDMA, commonly known as ecstasy, and that "decreases in the use of these drugs have been confirmed by wastewater studies in a number of European cities."
Beyond those caveats: A crisis stack
In the USA, the pandemic slapped one crisis on top of another. The country was only just starting to deal with an opioid addiction and overdose crisis that was claiming around 130 lives per day. That was largely down to legal prescription pain relievers, but also street heroin and synthetic opioids, like fentanyl. In 2018, about 32,000 Americans died from opioid overdoses.
Back in early April, before the worst of the pandemic had become apparent in the US, American medical practitioners William C. Becker and David A. Fiellin wrote about their concerns in the journal Annals of Internal Medicine.
"Given that infection epidemics disproportionately affect socially marginalized persons with medical and psychiatric comorbid conditions — characteristics of those with opioid use disorder (OUD)," they wrote, "we are gravely concerned that COVID-19 will increase already catastrophic opioid overdose rates."
In an opinion piece in the same journal, the director of the US National Institute of Drug Abuse (NIDA), Dr. Nora Volkow, included people who vape as a high-risk group.
A primary concern was "direct challenges to respiratory health," writes Volkow.
Volkow says "preclinical studies show that e-cigarette aerosols can damage lung tissue, cause inflammation and diminish the lungs' ability to respond to infection."
Compromised lung function from COVID-19, writes Volkow, could also put people who have opioid or methamphetamine and other psychostimulant use disorders at risk, because chronic respiratory disease increases the risk of fatal overdoses, including for "those who use opioids therapeutically."
So that's prescription drugs, as well as illicit street drugs.
Solitary drug use
Anecdotal evidence from the US suggests heroin users and addicts may also be at increased risk because of social distancing and isolation measures. For one, it's been harder to get support and access to recovery programs.
Peter Grinspoon, a medical practitioner writing for the Harvard (university) Health Blog, says that users who "had been using drugs with a friend are now using them alone."
So, there is often no one there to call an ambulance in the event of an overdose, or administer Naloxone, a medicinal drug that reverses the effects of opioids, such as low breathing.
As a consequence, writes Grinspoon, police have been finding drug users dead — and alone — in their apartments.
Not 'merely' anecdotal evidence
Researchers in the UK, meanwhile, have been running the initial stages of a study into the use of other illicit drugs, such as cannabis and cocaine, during lockdown.
Tammy Ayres of Leicester University and Craig Ancrum at Teeside University are lecturers in criminology. Writing for the website The Conversation, they reported a variety of user experiences.
Some users said they had taken more drugs in lockdown because they had "more time on their hands … and there's not much around at the moment to make anyone feel good."
That correlates with the European Web Survey on Drugs, where users cited boredom and anxiety about COVID-19 as reasons for illicit drug consumption.
In an email to DW, Ancrum wrote that "as someone with unique access to drug dealers and buyers, I can confirm that the quotes are reliable and not merely anecdotal." But the study group is "small," he says.
Others in the Ayres and Ancrum study say they have avoided using banknotes to snort drugs, because "you could be hoovering corona straight up your nose." Buyers and sellers have also spoken about carrying hand sanitizer and timing trades with "essential travel," like buying groceries.
So there's a broad spectrum of findings, and both users and dealers appear to have found "work-arounds," which suggests usage continues unabated.
"I have observed no drop in sales from any of our respondents, in particular in respect of cocaine and cannabis," says Ancrum.
Alternative highs and lows
During the 2008 global economic crisis, studies found drug users switched to cheaper drugs to meet a dwindling budget.
The coronavirus lockdown has hit many people's budgets — not least in major European and US cities but also, for instance, in Afghanistan, where opiates are cultivated and harvested.
Shortages could arise due to further restrictions on travel or access to chemicals, such as acetic anhydride, a key ingredient in the production of heroin.
Transport routes from Iran via Turkey to Europe may also be affected after the current harvest. Future reports will have to study what effects, if any, are felt there.
Decrease in prisons
But shortages could lead to desperate measures.
Past crises have seen users injecting more — which raises other health risks, including the spread of disease, especially when needles are shared among users — and the rise of cheap alternatives like "sisa." Sisa is a methamphetamine that can be cooked up in a kitchen using ephedrine, hydrochloric acid, ethanol and car battery fluid. That drug was big in Greece after the 2008 crash.
For now, Ancrum says, consumption habits among those he and Ayres have asked "have not changed in respect of substances," but he says there may be changes in other areas, such as with SCRAs, for example.
SCRAs, or synthetic cannabinoid receptor agonists, include drugs like Spice and K2, which are commonly, but not exclusively, found in prisons. That's partly because the synthetic substances are harder for authorities to detect in mandatory drug tests.
It's interesting to note that drug use in prisons appears to have gone down during the early stages of lockdown.
An EMCDDA report in May suggested that restrictions on visits and other outside contacts has "indirectly led to a decrease in the availability of drugs in some prisons, and this has sparked violent reactions from some prison inmates in France, Italy, Spain and the United Kingdom."
In China, the lockdown appears to have reduced the number of new, registered drug users. Production and demand for methamphetamines in the Asia-Pacific region, including Thailand, the Philippines, Australia and New Zealand, however, appears to have suffered little impact from COVID-19 restrictions. In the Middle East and Northern Africa, demand for cannabis appears to have gone up as well. But the UNODC says reliable information on drug consumption in Africa "remains scarce."
The International Day Against Drug Abuse and Illicit Trafficking, also known as World Drug Day is marked annually on June 26. The theme of World Drug Day 2020 is "Better Knowledge for Better Care."