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• Behind the scenes of COVID-19- Thoughts about illicit drug use during a pandemic
  Fiona L Daly
  Published on: 2 September 2020

• Published on: 2 September 2020

  Behind the scenes of COVID-19- Thoughts about illicit drug use during a pandemic

  • Fiona L Daly, ST3 Emergency Medicine Bristol Royal Infirmary

  The enforcement of lockdown in the UK in March 2020 saw businesses shut up shop and most of the general population barricade themselves in the safety of their homes. NHS and community facilities had to implement downgraded versions of their services to comply with social distancing with a reduced workforce available to deliver these services. One such cohort affected by these measures is those who take recreational drugs, either socially or habitually.

  The number of people who use recreational drugs regularly is unknown. NHS Digital data states that there were 14,053 patients admitted to hospital with ‘poisoning by illicit drugs’ in England in 2018. 53% of these patients were male and two-thirds fell into the 16-44yrs age bracket. Men were more than twice as likely to use cannabis or cocaine compared to women and older age groups were more likely to use opiates alone (1).

  One in 12 adults were found to have taken an illicit drug between 2016 and 2017 (1). Whilst lockdown may have caused many inconveniences to the everyday lives of most of us, many habitual drug users have found themselves with additional stressors extending beyond contracting COVID-19 itself. This may not be someone’s chosen path in life but it is the reality that many are living with. This lifestyle is intertwined with medical and psychological difficulties which may necessitate NHS support.

  If your first thought upon waking is how you are going to obtain your next fix, then how are...

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  The enforcement of lockdown in the UK in March 2020 saw businesses shut up shop and most of the general population barricade themselves in the safety of their homes. NHS and community facilities had to implement downgraded versions of their services to comply with social distancing with a reduced workforce available to deliver these services. One such cohort affected by these measures is those who take recreational drugs, either socially or habitually.

  The number of people who use recreational drugs regularly is unknown. NHS Digital data states that there were 14,053 patients admitted to hospital with ‘poisoning by illicit drugs’ in England in 2018. 53% of these patients were male and two-thirds fell into the 16-44yrs age bracket. Men were more than twice as likely to use cannabis or cocaine compared to women and older age groups were more likely to use opiates alone (1).

  One in 12 adults were found to have taken an illicit drug between 2016 and 2017 (1). Whilst lockdown may have caused many inconveniences to the everyday lives of most of us, many habitual drug users have found themselves with additional stressors extending beyond contracting COVID-19 itself. This may not be someone’s chosen path in life but it is the reality that many are living with. This lifestyle is intertwined with medical and psychological difficulties which may necessitate NHS support.

  If your first thought upon waking is how you are going to obtain your next fix, then how are you going to orchestrate daily life during lockdown? Although drug dealers are not exempt from social isolation, they are unlikely to have their usual presence on the street and drug-seeking may be more difficult. With international travel currently limited there is likely to have been adaptations to the mechanisms via which drugs are acquired and sold. Smaller drug packages are likely to be on offer to maintain transactions, especially to those who have lost usual sources of income. To address shortages of supply there may be more ‘cutting’ of active substance with other substances, potentially with toxic side-effects. These factors are likely to end up being the most detrimental to a vulnerable end-user.

  Perhaps the paucity of supply of the usual drug abused by an individual forces them towards different, more easily available substances to which they go on to become addicted to. For those who have become addicted to prescribed medication, the cost of obtaining such drugs is likely to have sky rocketed.

  Conversely, this scenario of desperation may not be replicated in those whom partake only in occasional recreational drug use. Staying at home may cause a decrease in social drug use from lack of opportunities to see friends, bans on festivals and parties, closure of nightclubs or because an individual is at home with their family. The rising use of video-based social gatherings could, however, trigger increasing drug use.

  This complete disruption to normal life, however, could prove an opportunity for periods of abstinence and detox. There is an increased presence of information upon social media platforms reaching out to patients who may be suffering with drug addiction during this time. Many habitual drug users who are previously homeless have been accommodated in hotels, paid for by local councils, to protect them during COVID-19 pandemic (2). This has given many a well-needed source of stability with the opportunity to recuperate and achieve positive lifestyle changes. Community drug project workers have had an active presence in such hotels providing socially-distanced needle-exchange programmes, opiate substitute therapy, community naloxone provision and nursing staff to monitor those symptomatic of COVID.

  This change in social circumstance may also have contributed to 56.6% fewer attendances to Emergency Departments (ED) in April 2020 compared to the same month in 2019 (3). High Intensity Users (HIUs), those whom attend ED more than five times per year, make up a significant proportion of this case load (4). Drug-related HIU attendances are likely are likely to have fallen in line with other non-COVID presenting complaints.

  If analysis of current statistics proves a reduction in ED attendances related to drug use, including overdose, withdrawal, changes to mental health and death from drug toxicity, then there could be more evidence to increase funding and provision of services to this cohort of the population. And if that is the case, at least there is one small positive found at the end of the NHS rainbow.

  References
  1. https://digital.nhs.uk/data-and-information/publications/statistical/sta... ---- https://files.digital.nhs.uk/publication/c/k/drug-misu-eng-2018-rep.pdf
  2. https://www.theguardian.com/society/2020/may/16/rough-sleepers-must-not-...
  3. https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/05...
  4. https://www.rcem.ac.uk/docs/RCEM%20Guidance/Guideline%20
  %20Frequent%20Attenders%20in%20the%20ED%20(Aug%202017).pdf

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  Conflict of Interest:
  None declared.

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