How do you think COVID-19 (coronavirus) might affect people who use drugs? 

“We have a rapidly developing situation regarding the impact of coronavirus on health services, but it is worth taking a moment to consider the impact on UK illicit drug markets. As governments begin to close borders and reduce the movement of people, how will this impact on supply routes of illicit drugs and their availability across UK markets?

What can previous ‘drug droughts’ tell us? In the past, when we’ve seen significant reductions in the availability and purity of heroin, the result has been changing patterns of use, with more people seeking drug treatment. During these periods we have also seen other, more worrying trends such as heroin being cut with other drugs and bulking agents. I would be particularly concerned if opioid NPS began to appear in heroin supplies given their high potency and unpredictability.”


Is this likely to have an impact on treatment?

“On the positive side, a reduced availability of heroin could mean that more people might seek treatments such as opioid substitution therapy. This requires careful planning by services, for any potential increase treatment demand may be in the context of reduced capacity due to staff sickness or quarantine. Flexible approaches to delivering care will be essential.”


A few years ago, when heroin purity was low, there was concern about what would happen when purity started to increase and whether this would lead to more overdoses.

“Absolutely, after the last heroin drought ended, heroin purity increased, and this appears to have been one factor in the increase in drug related deaths. So, coming back to the current situation, initially there is a risk of adulteration and of poorer quality heroin, then, when coronavirus passes and assuming heroin supplies are reinstated, that brings its own risks as well.”


We know that some drug using populations can be vulnerable to respiratory disorders. Is there any specific advice for people who use drugs?

“This is a very important point. People who use heroin and also have impaired lung function are at greater risk of respiratory depression. This is particularly true for vulnerable groups such as people who are homeless, and particularly roofless, but also for the aging cohort who characterise heroin users in the UK. These vulnerable populations face a double risk. They are at increased risk of catching coronavirus and suffering the symptoms of COVID-19, while at the same time, continued heroin use will exacerbate the risk of overdose and respiratory depression. Services will have a critical role to play in disseminating public health and harm reduction messages as well as offering rapid access to naloxone and treatments including opioid substitution treatment.”


Dr Owen Bowden-Jones is a medical doctor, psychiatrist and researcher with more than 20 years’ experience of helping people with mental health and substance misuse problems on their journey to recovery. You can follow him @OwenBowdenJones

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