A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic

Abstract

Background and Aims: COVID-19 has infected more than 77 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing, and "lockdown" measures have affected drug and alcohol supply chains and subsequently their availability, price, and use patterns, with possible downstream effects on presentations of SUDs and demand for treatment. Given the lack of multicentric epidemiologic studies, we conducted a rapid global survey within the International Society of Addiction Medicine (ISAM) network in order to understand the status of substance-use patterns during the current pandemic. Design: Cross-sectional survey. Setting: Worldwide. Participants: Starting on April 4, 2020 during a 5-week period, the survey received 185 responses from 77 countries. Measurements: To assess addiction medicine professionals' perceived changes in drug and alcohol supply, price, use pattern, and related complications during the COVID-19 pandemic. Findings: Participants reported (among who answered "decreased" or "increased") a decrease in drug supply (69.0%) and at the same time an increase in price (95.3%) globally. With respect to changes in use patterns, an increase in alcohol (71.7%), cannabis (63.0%), prescription opioids (70.9%), and sedative/hypnotics (84.6%) use was reported, while the use of amphetamines (59.7%), cocaine (67.5%), and opiates (58.2%) was reported to decrease overall. Conclusions: The global report on changes in the availability, use patterns, and complications of alcohol and drugs during the COVID-19 pandemic should be considered in making new policies and in developing mitigating measures and guidelines during the current pandemic (and probable future ones) in order to minimize risks to people with SUD.

Keywords: COVID-19; addiction; behavioral addiction; global survey; illicit drug market; substance use disorder.

Figure 1

Global distribution of the respondents to the survey. The survey involves 177 respondents from 77 countries around the world, ranging from 1 to 13 participants from each country, demonstrated as a color spectrum from orange to dark red.

Figure 2

Changes in alcohol and drug use during the COVID-19 pandemic reported by 177 respondents from 77 countries globally. Respondents were asked to report changes in alcohol, amphetamines, cannabis, cocaine, opiates, prescribed opioids, and sedative-hypnotics use with the following options: Increased, Decreased, Not changed, I do not know, and Number of users is very low/none. Countries' names are sorted in alphabetical order, and the number of respondents from each country is in parentheses following the country name. Each response is indicated as a single dot for no change or up and down triangles for increased and decreased answers, respectively, with a minor jitter for better visualization. The reported answers are represented as −1 for decreased, 1 for increased, and 0 for no change. I do not know and Number of users is very low/none answers are not shown in the figure. The mean of all responses, regardless of their originated countries and without considering those who did not know the answer or reported very low/none number of users, alongside the average answers of all countries, regardless of the number of respondents in each country, are addressed in the last two rows below the countries' names (Pres. Opioids: prescription opioids).

Figure 3

Changes in alcohol and drug supply during the COVID-19 pandemic reported by 177 respondents from 77 countries globally. Respondents were asked to report changes the supply of alcohol, amphetamines, cannabis, cocaine, and opiates through the following options: Increased supply, decreased supply, no change, and I do not know. Countries' names are sorted in alphabetical order, and the number of respondents from each country is in parentheses following the country name. Each response is indicated as a single dot for no change or up and down triangles for increased and decreased answers, respectively, with a minor jitter for better visualization. The reported answers are represented as −1 for decreased, 1 for increased, and 0 for no change; I do not know answers are not shown. The mean of all responses, regardless of their originated countries and without considering those who did not know the answer, alongside the average answers of all countries, regardless of the number of respondents in each country, are addressed in the last two rows below the countries' names.

Figure 4

Changes in alcohol and drug prices during the COVID-19 pandemic reported by 177 respondents from 77 countries globally. Respondents were asked to report changes in alcohol, amphetamines, cannabis, and opiates prices through the following options: Price increased, Price decreased, Price did not change, and I do not know. Countries' names are sorted in alphabetic order, and the number of respondents from each country is in parentheses following the country name. Each response is indicated as a single dot for no change or up and down triangles for increased and decreased answers, respectively, with a minor jitter for better visualization. Reported answers are represented as −1 for decreased, 1 for increased, and 0 for no change; I do not know answers are not shown in the figure. The mean of all responses, regardless of their originated countries and without considering those who did not know the answer, alongside the average answers of all countries, regardless of the number of respondents in each country, are addressed in the last two rows below the countries' names.

Figure 5

Changes in mortality, morbidity, and overdose in people with SUD during the COVID-19 pandemic reported by 177 respondents from 77 countries around the world. Respondents were asked to report changes in morbidity or mortality rates in people with SUD and changes in fatal and non-fatal overdose episodes through the following options: Increased, Decreased, I do not know, I do not like to answer, and Not applicable. Countries' names are sorted in alphabetical order, and the number of each country's respondents is mentioned in front of the names. Each response is indicated as a single dot for no change or up and down triangles for increased and decreased answers, respectively, with a minor jitter for better visualization. The reported answers are represented as −1 for decreased, 1 for increased, and 0 for no change; I do not know, I do not like to answer, and Not applicable answers are not shown in the figure. The mean of all responses, regardless of their originated countries and without considering those who did not know the answer, alongside the average answers of all countries, regardless of the number of respondents in each country, are addressed in the last two rows below the countries' names (SUD, Substance Use Disorder).

Figure 6

Changes in risky behaviors including shifting to injection, using shared drug use equipment, needle sharing, and risky sexual behaviors during the COVID-19 pandemic period, reported by 177 respondents from 77 countries globally. Respondents were asked to report changes in risky behaviors (injection, shared drug use equipment, needle sharing, and risky sexual behaviors) through the following options: Yes, No, I do not know, I do not like to answer, and Not applicable. Countries' names are sorted in alphabetical order, and the number of each countries' respondents is mentioned in front of the names. The numbers of respondents who reported Yes or No answers to each question are demonstrated inside the bars (If nothing is written, it indicates that there was only one response within Yes and No answers). The percentages shown by the bars are also based on only Yes or No answers. The mean percentages of all responses, regardless of their originated countries and without considering those who reported other than Yes and No answers, alongside the mean percentage answers of all countries, regardless of the number of respondents in each country, are addressed in the last two rows below the countries' names (Risky Sex. Beh., Risky Sexual Behaviors).

Figure 7

Severity of being affected by COVID-19 outbreak among people with SUDs reported by 177 respondents from 77 countries. Addiction medicine professionals were asked to report how seriously people with SUDs in their countries have been affected by the COVID-19 pandemic using a range of between 1 and 10: 1 representing Not affected, demonstrated with yellow at the beginning of the spectrum, and 10 representing Severely affected at the end of the spectrum, indicated with blue. Responses were collected beginning April 4, 2020 and through a 5-week period.