Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 21;19(14):8883.
doi: 10.3390/ijerph19148883.

Illicit Substance Use and the COVID-19 Pandemic in the United States: A Scoping Review and Characterization of Research Evidence in Unprecedented Times

Anh Truc Vo  1 , Thomas Patton  2 , Amy Peacock  3 , Sarah Larney  4 , Annick Borquez  2
Affiliations

Illicit Substance Use and the COVID-19 Pandemic in the United States: A Scoping Review and Characterization of Research Evidence in Unprecedented Times

Anh Truc Vo et al. Int J Environ Res Public Health. .

Abstract

We carried out a scoping review to characterize the primary quantitative evidence addressing changes in key individual/structural determinants of substance use risks and health outcomes over the first two waves of the COVID-19 pandemic in the United States (US). We systematically queried the LitCovid database for US-only studies without date restrictions (up to 6 August 2021). We extracted quantitative data from articles addressing changes in: (a) illicit substance use frequency/contexts/behaviors, (b) illicit drug market dynamics, (c) access to treatment and harm reduction services, and (d) illicit substance use-related health outcomes/harms. The majority of 37 selected articles were conducted within metropolitan locations and leveraged historical timeseries medical records data. Limited available evidence supported changes in frequency/behaviors/contexts of substance use. Few studies point to increases in fentanyl and reductions in heroin availability. Policy-driven interventions to lower drug use treatment thresholds conferred increased access within localized settings but did not seem to significantly prevent broader disruptions nationwide. Substance use-related emergency medical services' presentations and fatal overdose data showed a worsening situation. Improved study designs/data sources, backed by enhanced routine monitoring of illicit substance use trends, are needed to characterize substance use-related risks and inform effective responses during public health emergencies.

Keywords: COVID-19; harm reduction; illicit drugs; scoping review; substance use.

PubMed Disclaimer

Conflict of interest statement

The funders had no role in the study design, conduct, and reporting of this review. A.P. has received untied educational funds from Seqirus and Mundipharma for post-marketing surveillance of pharmaceutical opioids; these organizations had no role in study design, conduct and reporting, and funding was for work not presented here.

Figures

Figure 3
Figure 3
Summary evidence for changes in illicit substance use frequency associated with the pandemic. PCP = Phencyclidine. LSD = Lysergic Acid Diethylamide. MDMA = Methylenedioxy-Methamphetamine. GHB = Gamma Hydroxybutyrate. PLHIV = People Living with HIV. MSM = Men Who Have Sex with Men. CT = Connecticut. MN = Minnesota. IL = Illinois [26,27,28,29,31,32,33].
Figure 4
Figure 4
Summary evidence for changes in illicit substance use contexts and behaviors. MOUD= Medications for Opioid Use Disorders. CT= Connecticut [26,33].
Figure 5
Figure 5
Summary evidence for illicit drug market changes. MOUD= Medications for Opioid Use Disorders. LSD = Lysergic Acid Diethylamide. EDM = Electronic Dance Music. NY = New York [25,34].
Figure 7
Figure 7
Summary evidence for substance use-related health outcomes. ED= Emergency Department. EMS= Emergency Medical Services. NC = North Carolina. PA = Philadelphia. KT = Kentucky. OH = Ohio. CT = Connecticut. VT = Vermont [39,48,51,53,54,55,56,59,60].
Figure 1
Figure 1
PRISMA literature review process. * Final categories for included articles are not mutually exclusive and articles may be classified in one or more sections.
Figure 2
Figure 2
Study designs of selected articles by publishing date.
Figure 6
Figure 6
Summary evidence for changes in substance use treatment and harm reduction services access. MN = Minnesota [31,43].
See this image and copyright information in PMC

References

    1. Linas B.P., Savinkina A., Barbosa C., Mueller P.P., Cerda M., Keyes K., Chhatwal J. A Clash of Epidemics: Impact of the COVID-19 Pandemic Response on Opioid Overdose. J. Subst. Abus. Treat. 2021;120:1085158. doi: 10.1016/j.jsat.2020.108158. - DOI - PMC - PubMed
    1. United Nations Office on Drugs and Crime . World Drug Report 2021. United Nations Office on Drugs and Crime; Vienna, Austria: 2021.
    1. Woolf S.H., Chapman D.A., Sabo R.T., Zimmerman E.B. Excess Deaths from COVID-19 and Other Causes in the US, March 1, 2020, to January 2, 2021. JAMA. 2021;325:1786–1789. doi: 10.1001/jama.2021.5199. - DOI - PMC - PubMed
    1. Wang H., Paulson K.R., Pease S.A., Watson S., Comfort H., Zheng P., Aravkin A.Y., Bisignano C., Barber R.M., Alam T., et al. Estimating Excess Mortality Due to the COVID-19 Pandemic: A Systematic Analysis of COVID-19-Related Mortality, 2020–2021. Lancet. 2022;399:1513–1536. doi: 10.1016/S0140-6736(21)02796-3. - DOI - PMC - PubMed
    1. Ciccarone D. The Triple Wave Epidemic: Supply and Demand Drivers of the US Opioid Overdose Crisis. Int. J. Drug Policy. 2019;71:183–188. doi: 10.1016/j.drugpo.2019.01.010. - DOI - PMC - PubMed

Publication types