Changes in drug use in European cities during early COVID-19 lockdowns – A snapshot from wastewater analysis

Abstract

The COVID-19 outbreak has forced countries to introduce severe restrictive measures to contain its spread. In particular, physical distancing and restriction of movement have important consequences on human behaviour and potentially also on illicit drug use and supply. These changes can be associated with additional risks for users due to reduced supplies, limited prevention and harm reduction activities. Furthermore, there have been limitations in the amount of data about drug use which can be collected due to restrictions. To goal of this study was to obtain information about potential changes in illicit drug use impacted by COVID-19 restrictions. Wastewater samples were collected in seven cities in the Netherlands, Belgium, Spain and Italy at the beginning of lockdowns (March-May 2020). Using previously established and validated methods, levels of amphetamine (AMP), methamphetamine (METH), MDMA, benzoylecgonine (BE, the main metabolite of cocaine) and 11-nor-9-carboxy-Δ 9 -tetrahydrocannabinol (THC-COOH, main metabolite of tetrahydrocannabinol (THC)) were measured and compared with findings from previous years. Important differences in levels of consumed drugs were observed across the considered countries. Whilst for some substances and locations, marked decreases in consumption could be observed (e.g., 50% decrease in MDMA levels compared to previous years). In some cases, similar or even higher levels compared to previous years could be found. Changes in weekly patterns were also observed, however these were not clearly defined for all locations and/or substances. Findings confirm that the current situation is highly heterogeneous and that it remains very difficult to explain and/or predict the effect that the present pandemic has on illicit drug use and availability. However, given the current difficulty in obtaining data due to restrictions, wastewater analysis can provide relevant information about the situation at the local level, which would be hard to obtain otherwise.

Evolution of the Illegal Substances Market and Substance Users’ Social Situation and Health during the COVID-19 Pandemic

“…Substance use was estimated as usual by most, trending toward a decrease. Similar findings were seen in online surveys among substance users in Switzerland [ 23 ], Europe [ 24 ], and Canada [ 25 ], or in wastewater analyses in European cities [ 26 ]. In those countries, decreases were more frequent for stimulants (e.g., cocaine, MDMA), mainly due to the closure of the night scene.…”

Impact of COVID-19 Controls on the Use of Illicit Drugs and Alcohol in Australia

“…One focused on one city in Austria, 6 while another covered eight cities in Europe, albeit for only 1 week during the pandemic. 7 These papers showed that the use of the more popular drugs such as cocaine, amphetamine, and MDMA generally decreased in most cities. In the Austrian study, the use of the traditionally less popular methamphetamine increased during lockdown conditions.…”

Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19

“…Nevertheless, this inconclusive evidence relating to whether drug use has increased or decreased has subsequently been supported in a trans-European study (seven countries) using wastewater analysis to examine the impact of 'stay at home orders' measures on specific stimulant and cannabis use. This study found that the picture was heterogenous rather than uniform indicating that potential responses to changes in drug use patterns are therefore hard to predict [85].…”