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Federal government websites often end in. The site is secure. Preview improvements coming to the PMC website in October Learn More or Try it out now. Marien Hospital Eickel, Herne, Germany. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Background: In response to the COVIDpandemic, a lockdown was established in the middle of March by the German Federal Government resulting in drastic reduction of private and professional traveling in and out of Germany with a reduction of social contacts in public areas. Methods: A questionnaire was anonymously filled in by subjects with substance-related disorders, typically attending low-threshold settings, drug consumption facilities, and inpatient detoxification wards from a range of locations in the Western part of Germany. Participants had to both identify their main drug of abuse and to answer questions regarding its availability, price, quality, and routes of acquisition. Results: Data were obtained from participants. A minority of participants reported decreased availability 8. A shift to the use of novel psychoactive substances including NSO were reported only by single subjects. Discussion: Present findings may suggest that recent pandemic-related imposed restrictions may have not been able to substantially influence either acquisition or consumption of drugs within the context of polydrug users including opiates attending a range of addiction services in Germany. The aim of this was to prevent new infections and to reduce stress on the health care system, especially the intensive care units 1. The lockdown included a drastic reduction of personal traffic by aircraft, car, or train across international borders, while the transport of commercial goods, e. From July 1, , the restrictions regarding traveling were partially reduced both in Germany and in the European Union. Given these restrictions within public and private life, one could argue whether the availability of illegal drugs was reduced in parallel with the COVID pandemic. For example, cocaine and heroin available in Germany typically arrive from South America and Afghanistan, respectively. Within the context of a general reduction of international traveling, one could expect decreased trafficking of these drugs to Europe and to Germany in particular. Within the context of online drug acquisition, a shift to novel psychotropic drugs NPS 4 as a substitute for common illicit drugs \[e. Soon after the first lockdown measures had been introduced in most European countries, several studies were conducted on their impact on legal and illegal drug use. This included wastewater analyses in several large cities, which for example found decreased use of MDMA, amphetamines, and cocaine 7 , 8. Other studies, for example, documented increased cannabis consumption by cannabis users 9 , local shortages of heroin supply, or an increase in alcohol consumption 7. It is important to note that some results were heterogeneous and variable between places, drug types, and types of users investigated. The principal aim of the present study was to collect data from users of illicit drugs, regarding the availability of their preferred substances within the context of the COVID pandemic; in addition, we tried to ascertain participants' strategies for coping with the anticipated reduced drug availability; it was hypothesized here that these strategies included self-referral to addiction services, online purchase of drugs, and a shift to the use of remaining drugs, especially NPS and NSO. In order to investigate these issues, a survey was carried out on clients in contact with the drug addiction health care system, with a special focus on those clients currently using illegal drugs e. For this multicenter investigation, 14 institutions were included, and 12 agreed to participate; most of these institutions had already collaborated in previous clinical addiction research projects In some of these institutions, the survey was also carried out in associated outpatient addiction services, e. All facilities were situated in the Federal state North Rhine Westphalia: seven of them in the Ruhrgebiet, a metropolitan region; one in the large city of Cologne; and four which recruited about one fifth of the sample analyzed from smaller towns in rural areas. For this survey a self-administered questionnaire with 37 items was designed. The questionnaire included questions regarding basic sociodemographic variables age, sex , and presented a list of 15 legal or illegal psychotropic substances for which subjects should indicate the number of consumption days during the previous 30 days. The drugs presented were those identified as those used most frequently by drug users, in a comprehensive survey carried out recently Subjects were then asked to identify their main drug open question ; regarding that main drug, they were then asked whether a its availability, price, or quality had changed after lockdown; b its use with regard to frequency of use; shift to legal substances, including alcohol; shift to illegally acquired medications, such as benzodiazepines and pregabalin; shift to NPS and NSO had changed; c a formal drug-related treatment opioid maintenance or detoxification treatment had been initiated, due to lockdown-related drug acquisition issues; and d drugs had been purchased online ever purchased online, frequency of purchases, purchase for the first time during the lockdown. All these questions went with predefined answering options. To fill in the survey, subjects needed 10—15 min. The survey was carried out between April 20 and September 9, The survey was developed by the addiction research team, partially based on the German version of the European Addiction Severity Index \[EuropASI 11 \] and discussed with single patients. A formal pilot phase was not carried out. Participation was strictly anonymous and on a voluntary basis; no financial compensation for study participation was provided. The inclusion criterion was current e. Statistical analyses were carried out using descriptive statistics, in terms of absolute frequencies and percentages. The total number of participants was The mean age of the remaining clients was Most participants were multiple drug users including illicit drugs, alcohol, and benzodiazepines, but excluding nicotine with an average of 3. Data from the three largest groups with respect to their main drug heroin, cannabis, and cocaine were further analyzed. The first set of statements concerned the availability of the main drug, its quality, and its price during the present COVID pandemic see Table 1. Conversely, only a small minority heroin About a third of the participants evaluated the quality of heroin Conversely, only The second set of statements related with changes in the pattern of drug use associated with the COVID pandemic see Table 2. Most subjects e. Only a very small number of participants reported a shift to the use of NPS: one client shifted from cannabis as the main drug to synthetic cannabinoids and another shifted from the main drug heroin to NSOs. Shift to other substances and initiation of a formal drug treatment because of problems with availability of the main drug during the COVID pandemic. A third set of statements concerned the initiation of treatment in the context of the COVID pandemic as a consequence of changed availability or price in the context of the lockdown. The fourth set of items concerned the possible shift from street trafficking of drugs to an increase of drug ordering via smartphone or personal computer see Table 3. Conversely, online acquisition of illicit drugs during the pandemic was only carried out by single individuals, i. The federal state of North Rhine Westphalia, in which the present study was conducted, is a densly populated region in the Western part of Germany. The total 12 month prevalence of illegal drugs is 7. It was estimated that 1. Besides cultivation within the state, cannabis is supplied mainly through importation from the neighboring Netherlands, where a considerable share of the consumed amphetamine, methamphetamine, and MDMA is also produced; important routes for the supply of heroin and cocaine from outside of Europe are via the large ports and airports of Belgium and the Netherlands It was anticipated that lockdown measures and closing of borders would influence the quantity and quality of illicit drugs for users in contact with the drug treatment and low-threshhold services for drug addicts. The quality of these drugs was evaluated as worse by Furthermore, only a small minority switched from their main drug to legal drugs, especially alcohol, or to illegally acquired medications such as benzodiazepines or gabapentinoids. Only one subject whose main drug was cannabis switched to synthetic cannabinoids, one heroin addict switched to NSOs, and only a few subjects initiated treatment due to a reduced availability of their main drug. In our sample, the lifetime experience of ordering illegal drugs online was low, e. Basic sociodemographic and clinical data e. Typical low-threshold addiction facilities' clients polydrug, including opiates, users. However, drug addicts might define cocaine or cannabis as their main illegal drug, especially in the case of maintenance treatment. However, consistent with recent inpatient detoxification treatment data from Western Germany 10 , a growing problem of gabapentinoid misuse, predominantly among opioid addicts 16 — 18 , with three participants having identified pregabalin as their main drug, was highlighted here. Current results are not fully consistent with recent findings about drug abuse during the COVID pandemic 7 , Conversely, the EMCDDA expert opinions regarding availability and price of drugs, albeit not supported by empirical evidence, yielded a heterogeneous picture, with different situations in the different EU countries. Indeed, the price of cannabis was suggested to have increased in several EU member states, in parallel with a decrease in its availability. However, the European Web Survey focused on users of illicit drugs, not only on subjects with a clear drug addiction status. A further document, elaborated by the EMCDDA in cooperation with Europol 19 , concluded that the European drug supply scenario had not significantly reduced during the Covid pandemic. In fact, while air trafficking was vastly reduced, the transport of commercial goods by ship, air freight, and so on had somehow continued during the pandemic, and this may have facilitated the transportation of drugs such as cocaine and heroin. In addition, the domestic production of cannabis in some European countries was not restricted by the COVID pandemic These issues may explain the lack of an overall significant reduction of drug supply during the pandemic, although there may have been illegal drug acquisition issues in some places. In addition, even during the lockdown, several important drug seizures were successfully carried out in EU countries Lockdown measures made it more difficult to meet with dealers and friends and this may have led to a breakdown of the local street market for drugs. This could have facilitated the occurrence of other forms of drug trafficking, especially buying of illegal drugs online and delivery of drugs by post and parcel services. According to the EMCDDA 19 , however, there was only a small increase in drug buying from the darknet during the pandemic. Consistently with this, online drug acquisition activities during the pandemic were carried out here only by single individuals. Difficulties handling the web and especially the darknet 20 , 21 with the related money transfer issues may have limited the availability of the online acquisition option in the current population of marginalized polydrug drug addicts with minimal resources. Conversely, the online option, which may well-include access to messenger services facilitating drug orders and deliveries, may be an easier option for those with a regular income and a routine use of the web. This extends to online individual or group therapy 22 , As for NSOs, only one heroin user shifted here to the use of these substances; this is fully consistent with recent German data 15 , but it contrasts with reports from the USA, where an opioid epidemic is occurring 5. There was also only a small shift toward more alcohol use. Previous studies in the general population in the United States or elsewhere found no sustained increase of alcohol use 24 or even decreases due to the discontinuation of social drinking events 8 , and on the individual level, large proportions of subjects either increased or decreased their alcohol use during the pandemic. It must be stressed that in the present study increased alcohol use per se was not investigated, but rather the COVIDrelated shifts away from the main drug. Finally, although long-term follow-up German studies have suggested that on and off treatment episodes alternate in the life of opiate addicts 25 , the substantially unchanged levels of drug availability did prompt the need for the initiation of a new treatment e. According to the study design, questionnaires were handed out to those subjects who satisfied the study inclusion criteria; however, to respect anonymity, there were no specific checks to assess whether questionnaires were de facto filled in by the individuals themselves. No measures were taken here to increase the response rate. In addition, the main drug was self-reported by the interviewees, not by the clinician. However, current sociodemographic and clinical data were here fully consistent with those characterizing samples taken from addiction services in Germany Current findings may support the idea that at least in the first part of the pandemic-related imposed restrictions may not have been able to substantially influence the demand, acquisition, and consumption of drugs within a context of polydrug users, including users of opiates, attending a range of addiction services in Germany. Further studies, focusing on the issues relating to the persistence of the current pandemic, should be carried out to assess the impact of confinement on these vulnerable clients drug intake. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. All authors contributed to the article and approved the submitted version. During the last three years he participated in clinical trials financed by the pharmaceutical industry. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer SC declared a shared affiliation with one of the authors, FS to the handling editor at time of review. As a library, NLM provides access to scientific literature. Front Psychiatry. Published online Apr Ulrich W. This article was submitted to Addictive Disorders, a section of the journal Frontiers in Psychiatry. Received Dec 31; Accepted Mar 4. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. PDF K. Abstract Background: In response to the COVIDpandemic, a lockdown was established in the middle of March by the German Federal Government resulting in drastic reduction of private and professional traveling in and out of Germany with a reduction of social contacts in public areas. Keywords: COVID, drug availability, cocaine, heroin, cannabis, novel synthetic opioids, novel psychotropic substances, pregabalin. Methods and Materials For this multicenter investigation, 14 institutions were included, and 12 agreed to participate; most of these institutions had already collaborated in previous clinical addiction research projects Results The total number of participants was Table 1 Availability, price, and quality of the main drug. Open in a separate window. Table 2 Shift to other substances and initiation of a formal drug treatment because of problems with availability of the main drug during the COVID pandemic. Table 3 Online acquisition of illicit drugs. Discussion The federal state of North Rhine Westphalia, in which the present study was conducted, is a densly populated region in the Western part of Germany. Conclusions Current findings may support the idea that at least in the first part of the pandemic-related imposed restrictions may not have been able to substantially influence the demand, acquisition, and consumption of drugs within a context of polydrug users, including users of opiates, attending a range of addiction services in Germany. Data Availability Statement The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Footnotes Funding. References 1. COVID and substance use disorders: recommendations to a comprehensive healthcare response. Basic Clin Neurosci. COVID the hidden impact on mental health and drug addiction. New psychoactive substances — a challenge for the addiction treatment services. Novel opioids: systematic web crawling within the e-psychonauts' scenario. Fentanyl, fentanyl analogs and novel synthetic opioids: a comprehensive review. Sci Total Environ. Hohengeren: Schneider-Verlag; Ergebnisse des Epidemiologischen Suchtsurvey IFT-Berichte Bd. Results of the Epidemiological Survey of Substance Abuse. IFT-Reports Vol. American Psychiatric Association. EU Drug Markets Report Luxemburg: Publications Office of the European Union; High lifetime, but low current, prevalence of new psychotropic substances NPS use in German drug detoxification treatment young inpatients. Prog Neuropsychopharmacol Biol Psychiatry. Bonnet U, Scherbaum N. How addictive are gabapentin and pregabalin? A systematic review. Eur Neuropsychopharmacol. Schifano F, Chiappini S. Pregabalin: a range of misuse-related unanswered questions. CNS Neurosci Ther. Chiappini S, Schifano F. CNS Drugs. The deep web; why it matters for addiction psychiatry. Hum Psychopharmacol. Schifano F. Brain Sci. Evidence synthesis of digital interventions to mitigate the negative impact of the COVID pandemic on public mental health: a rapid meta-review. J Med Internet Res. Clinicians' perceptions of rapid scale-up of telehealth services in outpatient mental health treatment. Telemed J E Health. Am J Psychiatry. Scherbaum N, Specka M. Factors influencing the course of opiate addiction. Int J Methods Psychiatr Res. Copy Download. Shift to illegally acquired medications, maintenance drugs. Purchase of main drug over the internet during the pandemic.
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