Substance Use & The COVID-19 Pandemic
Since the first human case of COVID-19 in Wuhan City, China, in December 2019, the deadly corona virus has become a global phenomenon infecting 77.1 million and taking the lives of 1.6 million people across the planet (John Hopkins University, 2020). What started as a novel respiratory infection has quickly progressed into a worldwide crisis impacting all age demographics, socioeconomic classes, races, and genders. Alongside the unprecedented global crisis has brought economic struggles, social isolation, and raised challenges for the mental health of all citizens. These universal adversaries are likely to increase unhealthy coping strategies such as substance use to ease the pain of those hit hardest; meanwhile, limit access to available health care along the way. Thus, this raises an important question for academic inquiry, how has the COVID-19 pandemic impacted substance use across borders?
Substance Use in the Pandemic
Alcohol, tobacco, narcotics, and internet dependence are amongst the world’s most common and problematic addictions that influence the lives of many (Sun et all, 2020). The COVID-19 pandemic’s social and economic impacts have undoubtedly induced widespread uncertainty and maladaptive psychological reactions, which are likely to increase addictive behaviours, including substance use, especially amongst those who struggle with addiction (Sun et al, 2020; Marsden et al, 2020; Gritsenko et al, 2020). Previous studies have reported on the impacts that calamity such as natural disasters, terrorist attacks, war, and the SARS epidemic have on increasing addictive behaviours like drug use, alcohol consumption, and extensive internet use (Sun et al, 2020). With this pre-existing knowledge on the effects of crisis on substance use, it is unsurprising that many inquiries have already been made into the COVID-19 pandemic specifically.
Pandemic related quarantines, policies, and restrictions are associated with negative financial outcomes on living conditions and tend to increase mental health risks, especially when people face unemployment (Gritsenko et al, 2020). In particular, evidence about the psychological effects of coronavirus point to conditions of post-traumatic stress disorder (PTSD), suicidal tendencies, depression, fear, stigma, boredom, and stress concerning the loss of life-sustaining resources (Gitsenko et al, 2020). “Substance use, especially tobacco, alcohol, cannabis, and prescription drugs, tends to be increased as a means of coping and self-medication” (Gitsekso et al, 2020, p. 2). According to Marsden and colleagues, poverty, insecurity, and poor mental health will be severely augmented by COVID-19 social distancing protocols which will affect those with addictive disorders greatly as evidence shows addiction is increased when socially pleasurable stimuli are scarce (Marsden et al, 2020). Many scholars have theorized that COVID-19 related stress, anxiety, psychological trauma, and social isolation associate with increases in the consumption of substances both licit and illicit. This is especially concerning because increased substance use has the potential to intensify the financial and psychological problems faced by pandemic stressors.
Research conducted in Australia shows that the purchasing of alcohol has increased amongst Australian consumers, evident in recent credit and debit card debts from the Commonwealth Bank of Australia (Colbert et al, 2020). Online alcohol sales experienced amplified growth in Australia, whereby alcohol retailers have reported a staggering 50% to 500% increase in sales compared to 2019 (Colbert et al, 2020). Additionally, research conducted via self-report online surveys inquiring into the substance use habits amongst adolescent demographics in Canada during the pandemic demonstrates that alcohol consumption increased amongst this age group since prior to the pandemic (Dumas et al, 2020). The same Canadian study also demonstrates that the frequency of cannabis use amongst adolescents increased during the context of COVID-19 (Dumas et al, 2020). Furthermore, the adolescents who took the Canadian survey reported that most substance use occurred within a peer context (either virtually or face-to-face), particularly amongst those concerned with maintaining or enhancing their social status with peers (Dumas et al, 2020). However, adolescents who self-reported more fear, anxiety, and social insecurity due to COVID-19 were more likely to engage in private substance use (Dumas et al, 2020).
Throughout the COVID-19 pandemic, face-to-face interactions have greatly reduced and, as a result, online communication and services have quickly amplified. Due to the reduction of in person activities, internet use has inevitably increased globally to avoid virus transmission (Sun et al, 2020). For example, The World Health Organization implemented the “Play apart Together” campaign during March 2020, promoting the use of video games as safe alternatives to social contact and as a stay-at-home strategy (Sun et al, 2020). However, a major consequence of this policy could be an increase in online gaming addictions, particularly amongst adolescence. Examining where the virus originated, online self-report questionnaires were used to survey the Chinese nation on COVID-19 impacts on addictive behaviours within the general population (Sun et al, 2020). The results collected from online surveys demonstrated a greater increase in internet use and an increase in severe internet addiction commencing from the pandemic (Sun et al, 2020).
The use of illicit drugs can significantly and rapidly transform during market disruptions (Dietze & Peacock, 2020). Due to the border restrictions imposed by COVID-19, many traditional supply routes for the international importation and exportation of illicit substances will be hindered; likely reducing the available supply in non-producer countries and increasing stockpiles in producer countries (Dietze & Peacock, 2020). Supply chains to illicit drug users may face disruptions alongside the pandemic due to border restrictions and physical distancing measures. However, Dietze & Peacock (2020) suggest that the absence of preferable drug choices may turn addicts to sourcing alternative substitutes including pharmaceutical opiates like fentanyl, alcohol, and/or tobacco. In Australia, the past has demonstrated that shortages of heroin supply were almost always substituted with fentanyl or suppliers “cutting” their supply with more dangerous and precarious substances to increase stock (Dietze & Peacock, 2020). Thus, the limits of illicit drug supply imposed by COVID-19 border restrictions may impose greater risks for addicts.
Health Care Challenges
Studies have shown that global crisis and economic recessions are associated with increases in psychological distress in addition to relapses in alcohol and substance use disorders (SUDs), which often require medical care (Yang et al, 2020). Research during the COVID-19 pandemic specifically finds increased rates of psychological distress such as anxiety, trauma, suicidal ideation, depression, maladaptive substance use, and increased rates of opioid overdose globally (Yang et al, 2020). As a result, throughout the pandemic there has been disparities in outpatient visits and challenges in treatment for SUDs alongside restrictive changes to health care policies such as partial closures and limited access (Yang et al, 2020; Lopez-Pelayo et al, 2020).
During March 2020, Massachusetts became a primary focus of the COVID-19 pandemic in the United States, with a large and early outbreak of the virus – ranking third highest in per capita infections of that time (Yang et al, 2020). The state experienced many stressors such as “state and federal declarations of emergency, closures of non-essential businesses, schools and child-care facilities, and a burgeoning unemployment rate” (Yang et al, 2020, p. 101). Increases in outpatient visits for SUDs increased amongst non-Hispanic Whites during the initial COVID-19 surge within the state, concentrated in primary care facilities (Yang et al, 2020). Recent research in the United States documents that although racial minorities face disproportionate health, socioeconomic, and psychological stress related to COVID-19 impacts, these communities experience inequalities in treatment access to primary care facilities, particularly for mental health and SUDs (Yang et al, 2020). These statistics remain consistent after controlling for clinical need, educational level and poverty status, which is especially problematic (Yang et al, 2020). Indeed, although these patients may have required medical care for SUDs or overdose during the initial surge, due to their inaccessibility to primary care, this option was less attainable for racialized communities.
Stemming from the challenges in providing timely care for patients with SUDs during the COVID-19 pandemic, a variety of alternative approaches to treatment have been implemented in innovative ways to adhere to social distancing measures and restrictive health care policies. For example, telemedicine for SUDs has taken a central role in limiting face-to-face consultations between both patients and health care providers as a means to minimize virus transmission; whilst, providing continuity of care (Lopez-Pelayo et al, 2020). Through telemedicine, mobile electronic consultations connect health care practitioners (HCPs) with addiction specialists globally; meanwhile, connect HCPs to their clients virtually (Sahu, 2020). Telemedicine also proposes the potential of increased adherence to treatment for SUDs, since logistical barriers associated with physical attendance to treatment are removed (Lopez-Pelayo et al, 2020). Howevery, Lopez-Pelayo and colleagues (2020) warn about the long-term effectiveness of telemedicine, since many of the new pandemic-initiated alternatives to traditional health care were implemented hastily with little trial.
Disasters, recessions, and global crisis have long been associated with increases in distress and psychiatric disorder; therein, higher rates of anxiety and depressive disorders as a consistent finding (Yang et al, 2020). Resulting from the uncertainties felt by the COVID-19 pandemic, studies show that many citizens turn to substance use for coping with the pains felt by calamity, particularly amongst those with previous SUDs. Marsden and colleagues (2020) suggest that natural experimental designs such as qualitative research, process evaluations, and longitudinal surveys will be needed to fully understand the impacts of the COVID-19 pandemic on subsequent addiction and substance use.
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