Understanding emerging trends in illicit drug use, markets and harms with the COVID-19 pandemic in Australia

Long-term trends in use and harm arising from illicit substances are relatively well-understood but can be significantly impacted by major market disruptions.

Author: Dr Amy Peacock, Drug Trends Program Lead

This piece originally appeared in Connections, a joint publication of the collaborative network of alcohol and other drug research centres; National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney; National Drug Research Institute (NDRI) at Curtin University; and National Centre for Education and Training on Addiction (NCETA) at Flinders University.

Long-term trends in use and harm arising from illicit substances are relatively well-understood but can be significantly impacted by major market disruptions. The COVID-19 pandemic is an unparalleled event in modern times, precipitating widespread government interventions to close borders and restrict social interactions. The current situation has profound implications for drug markets and supply, as well as prevention, treatment and harm reduction responses.

The impact of the current COVID-19 pandemic on people who use illicit drugs has not been quantified. However, it is reasonable to assume that constraints on gathering and movement have disproportionally impacted people who use illicit drugs. Primary hypotheses relate to potential changes in:

  1. Markets (e.g., restricted supply and distribution with border closures and movement restrictions);
  2. Procurement (e.g., shift to non-face-to-face means of obtaining drugs and changes in purchasing behaviours, including buying larger quantities);
  3. Use (e.g., changes in frequency of use and switching to different substances);
  4. Harms (e.g., changes in dependence, withdrawal and overdose risk);
  5. Access to drug treatment and harm reduction services (e.g., difficulties accessing services with rising demand, restrictions on face-to-face contact, and staff redeployment); and
  6. Broader determinants of health (e.g., exacerbation of existing problems with mental health, physical health and employment).

Whilst many people who use illicit drugs may not experience significant problems associated with their use, COVID-19 restrictions may bring new challenges which could elevate risk of problematic use and harms. 

People who use illicit drugs may also be particularly vulnerable to contracting COVID-19 due to underlying health issues, stigma, social marginalisation and higher economic and social vulnerabilities, including issues around access to housing and health care. Transmission risk may be particularly elevated due to behaviours associated with drug use (e.g., sharing drug use equipment), contexts of drug use (e.g., individuals congregating together), and the predominant mean of treatment and harm reduction provision (e.g., in-person for most therapies previously).

A range of harm reduction resources have been developed for people who use illicit drugs and efforts are being made to rapidly adapt service delivery. However, there is an urgent need to quantify the impact of COVID-19 on people who use illicit drugs to identify the acute needs of this population, and the potential longer-term effects as the pandemic continues to unfold.

There are a range of research projects being undertaken which will provide these critical insights, testament to the strong and responsive research capacity in the alcohol and drug sector in Australia. With respect to projects being undertaken at the National Drug and Alcohol Research Centre with collaborators, we have recently launched the Australians’ Drug Use: Adapting to Pandemic Threats (ADAPT) Study.

ADAPT is one of the largest online surveys of its kind in Australia, providing critical, timely information about how people who use illicit drugs can be supported during and after the COVID-19 pandemic. The project, which commenced in late April, comprises an online cross-sectional survey of people who were regularly using illicit drugs prior to COVID-19. Embedded within this is a longitudinal cohort where participants can consent to complete follow up surveys in two months, four months, six months, one year, two years and three years.

The Drug Trends Program is also responding to COVID-19 through existing projects, such as the Ecstasy and Related Drugs Reporting System (EDRS) and Illicit Drug Reporting System (IDRS), which are key to identifying emerging problems in substance use in Australia. With support from our collaborators at the National Drug Research Institute, University of Queensland, Burnet Institute, and University of Tasmania, these projects will collect important information on COVID-19 impacts for PWUD through telephone interviews, with attention particularly focused on changes in treatment and harm reduction service engagement.

With the support of our collaborators, we are also adapting existing cohort studies (e.g., the Australian Parental Supply of Alcohol Longitudinal Study; APSALS) to be able to capture COVID-19 impacts. In the case of APSALS, we will be exploring changes in alcohol and other substance use since COVID-19 among young Australians, with comparison to previously reported annual data collected from this sample over 10 years.

Responses to the COVID-19 pandemic to protect public health will have profound implications for illicit drug use and related harms for years to come. Research efforts from all within the sector across Australia will help facilitate adjustments to drug policy and clinical practice during the immediate COVID-19 crisis but also into the longer-term as restrictions are lifted.

For more information about the ADAPT Study visit the project website www.adaptstudy.org.au or contact the study team, adaptstudy@unsw.edu.au.

For more information about how Drug Trends and APSALS are responding to COVID-19 go here.

A paper on ‘Illicit drug use and harms in Australia in the context of COVID ‐19 and associated restrictions: Anticipated consequences and initial responses’ has also been published Drug and Alcohol Review. You can read it here.