Supplying synthetic opioids during a pandemic: An early look at North America

Abstract

International commerce and travel have been restricted in order to limit the spread of COVID-19. The illegal trafficking in drugs, which is often concealed in other commercial activity, will be affected by these disruptions. This is particularly true for precursor chemicals, controlled substances of synthetic origin, and new psychoactive substances coming from Asia. China hosts large and under-regulated pharmaceutical and chemical sectors that provide many of the active ingredients used both in legitimate medicines and illicit fentanyl and methamphetamine. Unregulated producers and vendors in China have been supplying drug trafficking organizations in Mexico or using the internet and postal service to directly sell fentanyl to buyers in North America. The magnitude of supply shortages and interrupted trade of chemicals and synthetic drugs coming from China will depend on the breadth and depth of COVID-19’s disruptions. In turn, this could impact vulnerable drug-using populations. Drawing on historical accounts of prior supply disruptions, this commentary offers some initial speculation as to the possible effects of COVID-19 on the supply of synthetic drugs like fentanyl and precursor chemicals supplied to North America from China, which may have important lessons for other parts of the globe. Prior supply disruptions coincided with elevated prices and reduced purities of street drugs as well as increases in the number of users entering treatment. However, it is challenging to predict how developments will unfold given the unprecedented nature of this pandemic. A short-term breakdown in supply chains, interrupted trade, or social distancing mandates may not have much of an effect on the availability of synthetic drugs. Yet, disruptions in trade for months or years could shape how drugs are supplied or used. Drug policy will need to evaluate market indicators as soon as they are available but responding now with expanded medication therapies, like methadone, may help save lives. The drug policy landscape could look different in a post-COVID world.

Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada

“…Socioeconomic instability due to decreased income generation opportunities, and shifting drug markets due to changes in global drug trafficking [ 14 ], may also exacerbate vulnerability among PWUD, both indirectly, by affecting drug use patterns, and directly, through increased risk of overdose from contaminated or increasingly potent supplies [ 37 – 39 ]. Preventing harms, both in the immediate wake of Big Events and in the longer term, requires continued operation and funding of harm reduction services and monitoring of the drug supply, including through scale-up of drug checking services [ 40 ], which were accessed by a limited number in our sample.…”

“The Drug Sellers Were Better Organized than the Government”: A Qualitative Study of Participants’ Views of Drug Markets during COVID-19 and Other Big Events

“…While the impact of big events on PWUD is well documented, less is known about the effects of big events on drug markets. Some have speculated since legal and illegal markets might be linked, it was conceivable that the global slowdown in commercial activity and transportation, which are central to drug markets, could disrupt the circulation of chemical precursors required to produce fentanyl and fentanyl analogs, thereby affecting the drug supply [8]. This assessment seems to be confirmed by a study of PWUD in Georgia that showed that the perceived availability of drugs was reduced during the COVID-19 lockdown, with participants switching to alternative substances if their drug of choice was not available [9].…”

Hospital discharges for substance-related injuries before and during the COVID-19 pandemic: a descriptive surveillance study using administrative data

“…[13][14][15][16][17][18] In addition, border closures, supply chain disruptions and increased pricing have altered the availability and toxicity of the illegal drug supply. 13,[19][20][21][22] As the pandemic continues to evolve and impose changes to human behaviour, as well as access to support programs and services, the injury epidemiology and substance use patterns in Canada may also change. 23,24 Studies conducted during the pandemic have shown an increase in substance-related hospital discharges, as well as overall changes in the injury landscape during the pandemic.…”