How is the COVID-19 pandemic changing our use of illegal drugs? An overview of ongoing research

Dr Will Lawn and Martine Skumlien

The COVID-19 pandemic is likely to have substantially affected our use of legal and illegal drugs. In the UK, we have adapted to the closure of pubs and restaurants by purchasing considerably more alcohol in supermarkets and off-licences[i], while hundreds of thousands of people have given up smoking cigarettes[ii]. In jurisdictions where recreational cannabis is legal, increased sales have been reported[iii] [iv]. Those with addictive disorders are thought to be particularly vulnerable to COVID-19[v], and harm reduction advice tailored to drug users has been disseminated[vi] [vii].

Although we are able to partially gauge fluctuations in legal drug use and effects on treatment services, it is more difficult to assess how illegal drug use patterns have changed as a result of the COVID-19 pandemic and the associated lockdown measures. Some nascent, albeit potentially unreliable, information has recently become available. However, there are a large number of ongoing surveys from around the globe which, in time, will reveal some of the COVID-19 related consequences on illegal drug use and markets. This brief article aims to introduce and collate them.

Anecdotal reports

Release[viii] have received anecdotal reports from the UK that the wholesale prices of heroin and cocaine have increased substantially since lockdown, that some heroin is of ‘low-quality’, and that fentanyl is more available. While in France, the price of cannabis resin surged following lockdown[ix].

Dr Karenza Moore, who researches club drug use in the North of England, has seen online forum reports of a ketamine drought and a greatly reduced demand for MDMA. She noted a marked drop in activity in online drug-focused party discussion groups during late March and April. However, people appear to be readying themselves for upcoming domestic parties, given the entire summer of festivals and clubbing has been wiped out.

Existing survey results

A survey by Crew, a Scottish drug treatment and education charity[x], found that 58% of their 300 respondents reported taking drugs more often, while 19% reported taking drugs less often, than before the pandemic. Reasons stated for increases in use were boredom, more time, stress, and isolation, amongst others. This was somewhat echoed in results from a survey conducted by the New Zealand Drug Foundation which found that increases in drug use were most commonly attributed to boredom and anxiety[xi].

Ivan Ezquerra-Romana, of harm-reduction organisation Drugs and Me[xii], recently conducted a survey with approximately 2,000 respondents, and found that use of cannabis and benzodiazepines has increased, while use of ketamine, MDMA and cocaine has remained stable or slightly decreased[xiii].

In Hungary, the majority of respondents from a survey carried out by Drugreporter[xiv] said that the price of most illegal drugs has remained stable. However, 40-60% of respondents reported that cannabis, MDMA and amphetamine have become less available[xv].

Relatedly, lockdown measures appear to have resulted in a switch towards online drug purchasing. In the Crew study, 18% of respondents reported using online methods more often than before to obtain drugs. Additionally, according to a recent EMCDDA report[xvi], there has been an overall increase in activity on three popular darknet drug markets since the beginning of 2020, mainly related to cannabis products. There was, however, a decline in demand for party drugs commonly used at social gatherings.

Ongoing studies

Several larger-scale surveys are currently being conducted and promise more detailed, reliable data in the future. The Global Drug Survey (GDS) is running a special COVID-19 edition of their survey[xvii]. GDS founder, Dr Adam Winstock says “we want to explore the intersection between changes in people’s use of alcohol and other drugs, and their mental health and relationships. We want to understand where increases or decreases are functional or maladaptive”. The current survey boasts 48,000 responses and data collection is ongoing, so this will represent a hugely informative resource for establishing how COVID-19 affects illegal drug use.

In Australia, the recently initiated Adapting to Pandemic Threats (ADAPT) study is specifically designed to assess the short and long-term impacts of COVID-19 on people who use illicit drugs[xviii]. Covering Europe, the EMCDDA is conducting its own COVID-19 drug survey, which is available in 20 different languages[xix]. In Canada, the Canadian Centre on Substance Use and Addiction (CCSA) recently conducted a survey with 2,000 respondents to determine how alcohol and cannabis use has been affected, and how this relates to changes in mental health, with results yet to be published[xx].

As part of the ALAMA-nightlife project, University College London (UCL) researchers Dr Meryem Grabski and Jon Waldren are continuing their longitudinal Electronic Music Scene Survey[xxi] in UK respondents: “We will ask participants about their experiences of nightlife and drug use pre and post the COVID-19 pandemic. We are especially interested to see whether young adults living in the UK change their substance use repertoire during the pandemic, and whether this is correlated with factors such as availability, price, quality, opportunity to or changes in desire to use substances.” In addition, both The Loop[xxii] [xxiii] and Release[xxiv] are assessing fluctuations in how people source their drugs, the price of drugs, and harm reduction strategies being employed by users and dealers. Indeed, The Loop recently reported that people who use ketamine are twice as likely to share snorting equipment than other drug users during the COVID-19 pandemic[xxv], and have provided ketamine-specific harm reduction advice.

Existing longitudinal studies, which carefully track drug use pre and post pandemic, will be particularly powerful tools in revealing the ramifications of COVID-19. The UCL CannTeen study[xxvi], which Dr Will Lawn works on, has an existing sample of teenage and adult cannabis users, who use other drugs as well. “We record each participant’s drug use every single day for an entire year, so we will very clearly be able to analyse how use patterns changed after March 2020, while supplementing this with specific questions about underlying reasons for change.” Additionally, both Martine Skumlien and Dr Will Lawn are collaborators on the C-CABANA survey[xxvii], which will explore changes in cannabis use patterns as a result of COVID-19, and how this relates to the mental health of the respondents, with a particular focus on apathy and anhedonia in teenagers.

Several existing, large-scale, drug-focused longitudinal studies are also being conducted in the US, Australia and Canada, which will be able to capture COVID-19 related changes in drug use trajectories, including the ABCD study[xxviii], ICPS[xxix], EDRS[xxx] and IDRS[xxxi]. These studies have accumulated several years’ worth of drug use data prior to the pandemic and will continue to collect data in the years to come.

Together, these studies will be able to evaluate the short and long-term impacts of COVID-19 on illicit substance use patterns across large parts of the Western world. We may see rapid drop-offs in use of party drugs like MDMA and cocaine and concomitant increases in use of typically relaxing drugs, like cannabis and benzodiazepines. In the long-term, production and transport of illegal drugs may well have lasting implications on availability and price, with unknown consequences on prevalence of use, drug preferences, associated harm, and treatment demand. Continued data collection and rapid dissemination of findings will be critical in tracking how COVID-19 influences illegal drug use in the months and years to come.

List of ongoing surveys investigating COVID-19 related changes in illegal drug use

Worldwide

Corona drug survey (CDS) – Psychotropic Substances Group of Charité – Universitätsmedizin Berlin
Drug markets during COVID-19 – Crew
INPUD survey on the health and rights of people who use drugs in a COVID-19 environment – International network of people who use drugs
Global Drug Survey – special edition on COVID-19 – GDS and University College London

ALAMA, Electronic Music Scene Survey – University College London
C-Cabana – University of Cambridge
CannTeen – University College London
Impact of coronavirus on drug purchases survey – Release
Khat and Covid – University of Hertfordshire

Europe

Trans-European COVID-19 and drug use survey Phase 1: lockdown – The Loop
Mini-European web survey on drugs: COVID-19 – EMCDDA

Australia

a) Ecstasy and related drugs reporting system (EDRS) – NDARC
b) Illicit drug reporting system (IDRS) – NDARC
c) Australians’ drug use: adapting to pandemic threats (ADAPT) – NDARC

United States

Adolescent Brain Cognitive Development (ABCD) study – NIH

Dr Will Lawn is a post-doctoral research associate in the Clinical Psychopharmacology Unit at University College London. He was awarded his PhD in 2016 for research about reward processing perturbations in nicotine and cannabis addictions. Subsequently, he co-ordinated the London site in the KARE clinical trial, which investigated whether ketamine can be used as a treatment for alcohol dependence. Since 2018 he has co-ordinated the CannTeen project which examines if and how teenagers are more vulnerable than adults to the short and long-term effects of cannabis. His main interest is cannabis addiction in teenagers.

Martine Skumlien is a PhD student at the University of Cambridge Department of Psychiatry. Her PhD research focuses on the effects of cannabis on reward processing and motivation, with particular emphasis on important developmental periods.

References

[i] https://www.theguardian.com/business/2020/apr/24/uk-lockdown-sends-retail-sales-to-record-low-but-alcohol-sales-rise

[ii] https://www.theguardian.com/society/2020/may/04/more-than-300000-uk-smokers-may-have-quit-owing-to-covid-19-fears

[iii] https://www.indy100.com/article/coronavirus-cannabis-marijuana-sales-legal-lockdown-9459851

[iv] https://www.bnnbloomberg.ca/ontario-online-pot-purchases-jump-600-amid-covid-19-pandemic-data-shows-1.1422369

[v] https://onlinelibrary.wiley.com/doi/full/10.1111/add.15080?campaign=wolearlyview

[vi] https://www.emcdda.europa.eu/publications/topic-overviews/covid-19-and-people-who-use-drugs_en

[vii] https://www.inpud.net/en/covid-19-crisis-harm-reduction-resources-people-who-use-drugs

[viii] https://www.release.org.uk/

[ix] https://www.reuters.com/article/us-health-coronavirus-france-cannabis/cannabis-street-prices-surge-under-coronavirus-lockdown-in-france-idUSKBN21E2AZ

[x] https://www.crew.scot/covid-19-survey-month-one-summary/

[xi] https://www.drugfoundation.org.nz/news-media-and-events/survey-identifies-drug-use-changes-during-lockdown