Changes in Drug Use Patterns during the COVID-19 Pandemic in Italy: Monitoring a Vulnerable Group by Hair Analysis

COVID-19 Pandemic as Subjective Repeated Strains and its Effects on Deviant Behavior in a Sample of Italian Youth

Although over the past 2 years several studies have been carried out on the psychological effects of the COVID-19 pandemic on young people, few of them investigated the pandemic as psychosocial strain and its effects on deviant behaviors. According to Agnew's General Strain Theory, a repeated objective psychosocial strain, such as the pandemic, exerts pressure on deviance when individuals associate with deviant peers and have weak attachment to parents. Using a sample of 568 young Italians (ages: 15-20 years; 65.8% females, 34.2% males) from north, central and south Italy, we tested for the possible correlation between COVID-19 as a repeated psychosocial strain, deviant behaviors and the role of some coping strategies not included in the Agnew's original theoretical formulation. Results back the thesis that, considering the COVID-19 pandemic as a repeated subjective strain, affect deviance results primarily through association with deviant peers and less through weak attachment with family. The mediating role of coping strategies was found to be weak. The predominant role of the peer group in the genesis of deviant responses to strain will be discussed.

Consumption of illicit drugs and benzodiazepines in six Spanish cities during different periods of the COVID-19 pandemic

Wastewater-based epidemiology (WBE) can provide objective and real time information about the use of addictive substances. A national study was conducted by measuring the most consumed illicit drugs, other drugs whose consumption is not so widespread but has increased significantly in recent years, and benzodiazepines in untreated wastewater from seven wastewater treatment plants (WWTPs) in six Spanish cities. Raw composite wastewater samples were collected from December 2020 to December 2021, a period in which the Spanish and regional governments adopted different restriction measures to contain the spread of the COVID-19 pandemic. Samples were analyzed using a validated analytical methodology for the simultaneous determination of 18 substances, based on solid-phase extraction and liquid-chromatography tandem mass spectrometry. Except for heroin, fentanyl, 6-acetylmorphine and alprazolam, all the compounds were found in at least one city and 9 out of 18 compounds were found in all the samples. In general, the consumption of illicit drugs was particularly high in one of the cities monitored in December 2020, when the restrictions were more severe, especially for cannabis and cocaine with values up to 46 and 6.9 g/day/1000 inhabitants (g/day/1000 inh), respectively. The consumption of MDMA, methamphetamine and mephedrone was notably higher in June 2021, after the end of the state of alarm, in the biggest population investigated in this study. Regarding the use of benzodiazepines, the highest mass loads corresponded to lorazepam. This study demonstrates that WBE is suitable for complementing epidemiological studies about the prevalence of illicit drugs and benzodiazepines during the COVID-19 pandemic restrictions.

The rising use of cognitive enhancement drugs and predictors of use during COVID-19: findings from a cross-sectional survey of students and university staff in the UK

Background

The use of psychoactive substances to increase cognitive performance while studying has been termed 'pharmacological cognitive enhancement' (PCE). In previous years, several large-scale national surveys have focused on their use by students at university, including drug types, prevalence rates, and predictive factors. The recent coronavirus pandemic brought about widespread structural changes for UK universities, as students were forced to adapt to home-based learning and in many cases reduced academic support. No study has yet focused primarily on the impact of pandemic social restrictions on PCE in students and academic staff, and whether personality and demographic factors reveal user profiles that predict use during the pandemic period.

Method

A convenience sample of 736 UK students and staff aged 18-54 (M = 22.2, SD = 5.2) completed a cross-sectional survey assessing PCE prevalence rates, polydrug use, perceived effects, academic self-efficacy and personality during the first year of social restrictions (March 2020 - February 2021) compared with the previous year (March 2019 - February 2020).

Results

There was a significant self-reported rise in the use of all drug types (all ps < 0.001) during social restrictions, particularly with Modafinil (+42%), nutraceuticals (+30.2%) and microdose LSD (+22.2%). Respondents also indicated stronger PCE effects for all substances, except alcohol, in comparison to the previous year. Polydrug use with modafinil and other prescription stimulants increased the most during social restrictions. Personality factors and gender identity reliably predicted PCE use and lower agreeableness was often the strongest predictor, followed by identifying as male and lower conscientiousness. Academic self-efficacy and student/academic staff status were not consistent predictors.

Conclusion

This is the first survey of UK students to investigate PCE during coronavirus social restrictions and to assess predictive factors. Findings reveal a rise in PCE use and polydrug use which we suggest is because of increased pressures on students created by the lockdown and reduced access to university resources.

Is there a relationship between abuse of alcohol and illicit drugs seen in hair results?

Combined use of alcohol and illicit drugs is a serious health and social problem. In this study, it was examined, whether a relationship between alcohol and drug abuse can be ascertained by comparison of alcohol marker and drug concentrations in hair. In the frame of a social support system for families with parental abuse of illicit drugs, hair samples were analyzed between 2011 and 2022 for methadone, heroin (6-acetylmorphine), cocaine, amphetamine, ecstasy (MDMA), cannabinoids (THC), and the alcohol markers ethyl glucuronide (EtG) and ethyl palmitate (EtPa). For 1314 hair samples from adolescent and adult family members, the hair results show a prevalence of combined occasional or regular drug use and social or abusive alcohol use of 41%-60% except heroin (35%). The drug concentrations were statistically compared in the three categories of abstinence or moderate drinking, social drinking, and alcohol abuse. For the most frequently detected drug cocaine (n = 703), a significant increase of the concentrations with rising alcohol consumption was found. The frequent detection of cocaethylene proved the preferred simultaneous intake of both substances. For THC (n = 489), no significant difference between the alcohol consumer groups was seen. Concerning the less frequently detected methadone (n = 89), 6-acetylmorphine (n = 92), amphetamine (n = 123), and MDMA (n = 105), no clear trend between drug and alcohol marker results was determined. It is concluded that the evaluation of hair results is an appropriate way to study the extent of combined drug-alcohol consumption and complements other studies based on acquisition of consumption data by interview or questionnaire.

The trend of poisonings before and after the COVID-19 pandemic

The COVID-19 pandemic has substantially affected people and healthcare systems. One of the main challenges was the reduction and change in the pattern of non-COVID-19 diseases and conditions. Moreover, due to the mental burden of the pandemic, the trend of poisonings and abuses changed. In this study, we aimed to assess the trends of poisonings from different agents before and during the COVID-19 pandemic using the interrupted time series method. This study was conducted at one of the main Tehran referral centers for poisoning, Baharloo Hospital. Pre-COVID-19 period was defined as April 2018 to January 2020 while the COVID-19 time was from February 2020 to March 2022. The total number of monthly poisoning cases in addition to eight categories of drugs/substances/agents were identified, including drugs (such as psychiatric drugs, cardiovascular drugs, and analgesics), opioids, stimulants, methanol, ethanol, cannabis, pesticides, and carbon monoxide. Interrupted time series analysis was performed to compare the pre-pandemic trend of total monthly cases from each category in addition to the proportion (%) of each one. In total, 13,020 cases were poisoned during the study period, among which 6088 belonged to the pre-pandemic period and 6932 were admitted during the COVID-19 era. There was no significant difference in terms of demographic characteristics of patients before and during the pandemic (p-value > 0.05). At the beginning of the pandemic, there was a sudden fall in the number of poisoning patients (- 77.2 cases/month, p-value = 0.003), however, there was a significant increasing trend during the COVID time (3.9 cases/month, p-value = 0.006). Most of the categories had a sharp decrease at the beginning of the pandemic except for methanol and ethanol which had increases, although not significant. Cannabis also had a significant change in slope (- 0.6 cases/month, p-value = 0.016), in addition to the sudden decrease at the beginning of the pandemic (- 10 cases/month, p-value = 0.007). Regarding the proportion of each category from total monthly poisoning cases, methanol, and ethanol had immediate rises of 4.2% per month and 10.1% per month, respectively (both significant). The pandemic had significant effects on the pattern of poisonings from different agents in Iran, the most important of which were alcohol (ethanol and methanol). These differences had policy implications that can be helpful for policymakers and healthcare systems in combating similar situations in the future.

A study into the nature and extent of polydrug use in driving recidivism behavior

OBJECTIVE

Polydrug use has become a frequent pattern of drug consumption in Europe, and this is considered a particularly dangerous risk factor for impaired driving. In Italy, persons whose license has been revoked or suspended due to the use of psychoactive drugs can reapply for a new driving license, depending on the judgment of the relevant local medical committee (CML). To regain a revoked license, offenders must remain drug free throughout an observation period. An important problem with enforcement of impaired driving is recidivism. The aim of the present study is to analyze the influence of polydrug use on driving recidivism.

METHOD

We report the findings of several years' experience at the forensic toxicology laboratory of the University of Macerata. Hair samples collected over a 7-year period by the CML from drug users were analyzed for cocaine, opiates, and cannabis using gas chromatography-mass spectrometry.

RESULTS

Three hundred thirty-five of the tested subjects were recidivists. Recidivism was more frequent among monodrug users (81%) compared with polydrug users (19%), but logistic regression showed that polydrug use is certainly a risk factor for recidivism compared to monodrug use (odds ratio [OR] = 1.99). The sex and age distribution of recidivist subjects showed a strong predominance of males in both groups, but there were no sex differences. There were more recidivist polydrug users than recidivist monodrug users in the younger age groups (OR = 2.012). Cocaine use was most prevalent in the recidivist monodrug group. All drugs analyzed were demonstrated to be a risk factor for recidivism among monodrug users, whereas only the cocaine and cannabis combination was shown to be a risk factor for recidivism among polydrug users (OR = 1.65 versus cocaine; OR = 1.30 versus Δ9-tetrahydrocannabinol). Almost all polydrug users became monodrug users, and cocaine was the most frequently detected drug in the subsequent test during the monitoring phase.

CONCLUSIONS

Our results show that polydrug use increases the risk of impaired driving recidivism and represents a considerable threat to road safety.

Restrictive measures and substance use reporting: New evidence from the COVID-19 pandemic

BACKGROUND

Since the beginning of the COVID-19 pandemic, several studies have been conducted on the impact of lockdown and containment measures on various aspects of individual and social behaviour, including substance use. The increasing body of literature investigating this phenomenon emphasizes the need for additional studies at the local level. We investigate changes in reported illicit drug consumption following changes in public measures limiting individual mobility in the province of Bergamo, one of the regions that faced the most severe consequences in terms of number of cases and death toll in the early stages of the pandemic.

METHODS

The empirical analysis is based on a unique dataset covering all people recorded by police forces as drug users between January 2019 and December 2021 in the province of Bergamo. Data relate to reports for illicit drug consumption and not criminal activities.

RESULTS

Estimates show that, during periods when individual mobility was severely limited, the probability of reported cannabis consumption decreased by 8-9%, while that of reported cocaine use increased by 6-12%. No significant changes emerge in the reported consumption of heroin or polysubstance. Furthermore, while reported cannabis use returned to pre-pandemic levels once the restrictive measures were eased, the increased likelihood of reported cocaine use appears to have been more long-lasting. These findings are robust to alternative estimation strategies and different model specifications. Our study also reveals significant gender, age and housing status disparities in reported drug use.

CONCLUSION

We provide a novel and distinctive perspective on the topic by using previously unexploited administrative data sources. We show that the relationship between restrictions and reported drug use varies by type of substance. Our methodology and findings can support the design of targeted policies for better resource allocation and improved public health outcomes.

Cannabis use in repeated representative cross-sectional studies on Italian adults after the COVID-19 pandemic

Lockdown measures in response to the COVID-19 pandemic in 2020 yielded dramatic changes in drug consumption. A cross-sectional study was conducted on a representative sample of 6003 Italian adults (18-74 years) in April-May 2020 - reporting information before lockdown and at the time of interview - and two years later (i.e., in February-March 2022). Italian adults using cannabis decreased from 7.0% in pre-pandemic to 5.9% during lockdown (percent change -15.7%) and to 6.7% in 2022 (-4.3%). The reduction was particularly evident among adults aged 55-74 years, whereas cannabis use strongly increased among those aged 18-34 years. In the last period considered (2022), cannabis use was significantly more frequent in men (adjusted odds ratio, OR = 1.43), adults aged 18-34 years (p-trend <0.001), individuals with a low or high level of education (OR = 1.42 and 1.46, respectively), those from Central or Southern Italy/islands (OR = 1.50 and 1.38, respectively), and those with an economic status above the average (OR = 3.07). In 2022, cannabis use was also more frequently reported in current smokers (OR = 3.52), current e-cigarette and heated tobacco product users (OR = 6.09 and 2.94, respectively), individuals with a risky alcohol consumption (OR = 4.60), gamblers (OR = 3.76), those with anxiety and depression (OR = 2.50 and 2.80, respectively), those using psychotropic drugs (OR = 8.96), those with a low quality of life (OR = 1.91), and those sleeping less (OR = 1.42). After the COVID-19 pandemic, cannabis use was more frequent in individuals with other addictive behaviours, and with anxiety and depressive symptoms.

Long-Term Impacts of the COVID-19 Pandemic on Drug/Alcohol Use Prevalence in a Population with Substance Use Disorders

As time passes, the long-term effects of the COVID-19 pandemic are becoming increasingly apparent. The extreme restrictions imposed during the pandemic have had detrimental impacts on the most vulnerable groups, such as individuals suffering from substance and/or alcohol disorders (SUDs). This study reports quarterly laboratory data on alcohol and drug use in 150 subjects with SUDs that were examined using hair analysis for 2 years before the start of pandemic until after the end of the Italian health emergency. Overall, it was found that the number of subjects who used heroin, cocaine, and MDMA all decreased during the 2020 and 2021 lockdowns, increasing during reopening and subsequently stabilizing close to pre-COVID levels. Cannabis use was less impacted, remaining stable throughout the pandemic. Alcohol and benzodiazepine use both increased significantly during the lockdowns, displaying an opposing trend. While benzodiazepine use progressively returned to baseline levels, alcohol remained at significantly increased levels, even in September 2022. Long-term heavy drinking combined with substance use should be seriously considered, since these results in several health and social problems alongside alcohol-related comorbidities. Thus, appropriate response plans should be implemented both during and after the pandemic, whilst focusing on those who are most vulnerable.

Alcohol and Drug Consumption among Drivers before and during the COVID-19 Pandemic: An Observational Study

Restrictions imposed during the COVID-19 pandemic might have changed recreational habits. In this study, the results of toxicological tests for alcohol and drugs in blood were compared among drivers stopped at roadside checks in the periods before (1 January 2018 to 8 March 2020) and after the lockdown measures (9 March 2020 to 31 December 2021). A total of 123 (20.7%) subjects had a blood alcohol level above the legal limit for driving of 0.5 g/l, 21 (3.9%) subjects tested positive for cocaine, and 29 (5.4%) subjects positive for cannabis. In the COVID-19 period, the mean blood alcohol level was significantly higher than in the previous period. Cannabis use, which was more frequent among younger subjects, was statistically associated with cocaine use. There has also been a quantitative increase in alcohol levels in the population with values above the legal limits, indicative of greater use of alcohol in the population predisposed to its intake.

Changes in secondary substance use after the onset of the COVID-19 pandemic among people who use cannabis: Findings from a web-based sample of adults in the United States

The coronavirus disease 2019 (COVID-19) pandemic has had widespread impacts on mental health and substance use. Increases in cannabis use have been documented in the United States, but little is known about how other substance use has changed among people who use cannabis. We sought to examine changes in alcohol, tobacco, opioid, and stimulant use during COVID-19 and explore how these changes relate to patterns of cannabis use. Data were obtained from a web-based survey of adults in the United States who use cannabis (n = 1,471) administered in September 2020. Using data reported in retrospective (prepandemic) and time-of-survey assessment periods, we explored changes in the prevalence of regular (≥ weekly) alcohol, tobacco, opioid, and stimulant use during COVID-19 among respondents who used medical and nonmedical cannabis. We used modified Poisson regression to examine cannabis-related correlates of increasing or decreasing secondary substance use during the pandemic. There was a slight but significant increase in ≥weekly alcohol use in the medical use group only (41.4%-47.0%, p = .034). ≥ Weekly tobacco, opioid, and stimulant use did not change significantly. Pandemic-concurrent shifts in secondary substance use depended on interacting cannabis-related factors including medical cannabis use, prepandemic cannabis frequency, and pandemic-concurrent frequency changes. For example, ≥ weekly prepandemic cannabis use was significantly and positively associated with decreasing opioid use frequency among the medical cannabis use group only. Assessments of the pandemic's effects on substance use should consider relationships between cannabis and other substances, which may differ according to cannabis-specific behaviors, motives, and contexts of use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Selective Changes in Medical Cannabis Use Early in the COVID-19 Pandemic: Findings from a Web-Based Sample of Adults in the United States

Background: The COVID-19 pandemic has had widespread impacts on mental health and substance use. While increases in nonmedical cannabis use during COVID-19 have been documented among people who use cannabis across a diversity of settings, changes in specific medical applications of cannabis during the COVID-19 pandemic have not been characterized. We sought to examine changes in the prevalence, frequency, and mode of use of medical cannabis for a range of commonly treated conditions and symptoms during COVID-19. Methods: Data were obtained from an online survey of a sample of adults in the United States who use cannabis (n=1886), administered in September 2020. This study was restricted to participants who self-reported past-year medical cannabis use (n=598). Using data reported in a retrospective (pre-COVID) and current assessment period, we examined changes in cannabis use prevalence, frequency, and inhalation as the primary mode of administration for 11 commonly treated conditions. Results: There were slight but statistically significant increases in weekly (from 21.4% to 23.4%) and daily (from 16.2% to 20.7%) self-reported medical cannabis use during COVID-19 (p<0.001). Anxiety was the only specific therapeutic purpose for which daily cannabis use increased statistically significantly during COVID-19 (18.5% to 25.4%; p=0.004). In multivariable logistic regression, the odds of increasing cannabis use for anxiety during COVID-19 were statistically significantly higher for women, respondents from Western states, and states with legal medical and nonmedical cannabis. Discussion: We detected slight shifts toward higher frequencies of medical cannabis use during COVID-19. Disaggregated by therapeutic indication, daily cannabis use to manage anxiety increased during the pandemic. There is a need to assess whether changes in cannabis use that coincided with the pandemic will be sustained over time, and how these changes are connected to mental health outcomes, particularly among women.

A Scoping Review on the Medical and Recreational Use of Cannabis During the COVID-19 Pandemic

Background/Introduction: The shelter-in-place orders and social distancing regulations on account of the COVID-19 pandemic have impacted lifestyles, including the use of cannabis. The purpose of this scoping review is to summarize both the gray and academic literature on the use of cannabis during the pandemic. Materials and Methods: A total of 11 databases, including 2 medical databases, 7 social science databases, and 2 gray literature databases were searched resulting in 316 titles and abstracts of which 76 met inclusion criteria. Results: Nine themes emerged: (a) prevalence and trends of cannabis use during COVID[1]19; (b) demographics; (c) profile of mode of consumption; (d) context of using cannabis (i.e., solitary use vs. in groups); (e) factors contributing to use; (f) factors inhibiting use; (g) adverse clinical and psychiatric outcomes of cannabis use during the pandemic; (h) similarities between EVALI (E-Cigarette or Vaping Product Use-Associated Lung Injury) and COVID-19 symptoms; (i) implications for policy and practice. Studies published until February 2, 2021 were included in this review. Discussion: Findings have highlighted that feelings of boredom, depression, and anxiety during the pandemic have contributed to an increase in the use of cannabis. Furthermore, accessibility to cannabis was noted to affect use during the pandemic. Adverse psychiatric and clinical outcomes were associated with the increased use of cannabis. Conclusion: Practitioners and policymakers are called to employ harm reduction strategies to respond to increasing cannabis use. There is a need for population-based studies and further examination of factors contributing to the increased use of cannabis during the pandemic and associated negative consequences.

Changes in the Care Activity in Addiction Centers with Dual Pathology Patients during the COVID-19 Pandemic

BACKGROUND

Health care provision during the COVID-19 pandemic and confinement has led to significant changes in the activity of addiction centers. These changes in healthcare activity may have had a greater impact on patients with dual pathology. The aim of this study is to compare the treatment indicators of patients with dual pathology in addiction centers during the pre-confinement, confinement, and post-confinement periods.

METHODS

A retrospective observational study was conducted for the period between 1 February 2019 and 30 June 2021. A total of 2785 patients treated in specialized addiction services were divided into three periods according to their time of admission: pre-confinement, confinement, and post-confinement.

RESULTS

During the pre-pandemic period, the addiction centers attended to an average of 121.3 (SD = 23.58) patients, decreasing to 53 patients during confinement (SD = 19.47), and 80.69 during the post-confinement period (SD = 15.33). The number of appointments scheduled monthly for each patient decreased during the confinement period, although this number increased after confinement. There was a reduction in the number of toxicological tests carried out both during and after confinement (except for alcohol).

CONCLUSIONS

The results show a reduction in the number of patients seen and the care activity delivered to dual diagnosis patients. These results, which were caused by the COVID-preventive measures, may affect the progress and recovery of dual patients. A greater investment is needed to bring the care activity up to the standards of the years prior to confinement.

The Pattern of Substance Use among People Who Use Drugs (PWUD) Receiving Treatment at University Malaya Medical Centre (UMMC) during the COVID-19 Pandemic and the Associated Factors

There was a change in the pattern of substance usage among people who use substances during the COVID-19 pandemic period. This study aims to determine the effects of the COVID-19 pandemic on the pattern of substance usage among people who use drugs (PWUD) receiving treatment at the University Malaya Medical Centre (UMMC) as well as levels of anxiety and depression together with coping mechanisms and the factors affecting the pattern of substance use during COVID-19 pandemic period. A cross-sectional study was applied. The questionnaire used was the Mini-European Web Survey on Drugs (EWSD): COVID-19, Hospital Anxiety and Depression Scale (HADS), and Brief COPE Scale. In total, 130 PWUD were recruited. Of the participants, 36.2% of PWUD had not used/stopped the usage of illicit drugs/alcohol, 26.2% increased their usage, 20% decreased, and 14.6% used the same amount of illicit substances/alcohol during the COVID-19 pandemic period/restrictions. In addition, 28.5% of PWUD had an increased intention to seek professional support for drug counseling/treatment during the COVID-19 pandemic period. The prevalence anxiety and depression symptoms in PWUD according to HADS was 33% and 41.5%, respectively, with depression (p = 0.05) and isolation status (adjusted OR = 2.63, p < 0.05) being associated with an increase in alcohol/illicit substance use during the COVID-19 pandemic. PWUD who had increased their intention to seek professional support had significantly higher odds (adjusted OR = 4.42, p < 0.01) of reducing their alcohol/illicit substance use during the COVID-19 pandemic period. There were increased odds of maintaining alcohol/illicit substance usage among PWUD who practiced dysfunctional coping (adjusted OR = 3.87, p < 0.025) during the COVID-19 pandemic period. In conclusion, depression, isolation status, dysfunctional coping, and intention to seek professional support affected the pattern of alcohol/illicit substance use during the COVID-19 pandemic period. Strategies, substance rehabilitation/counseling, and proper mental health screening and the associated risk factors must be emphasized to prevent a further epidemic of substance use during the pandemic.

Temporal monitoring of stimulants during the COVID-19 pandemic in Belgium through the analysis of influent wastewater

BACKGROUND AND AIMS

Wastewater-based epidemiology (WBE) is a complementary epidemiological data source to monitor stimulant consumption. The aims were to: (i) study intra- and inter-year temporal changes in stimulant use in Belgium during the first wave of the COVID-19 pandemic; and (ii) evaluate the effect of COVID-19 restrictive measures on stimulant consumption.

METHODS

The study population corresponded to the catchments of four wastewater treatment plants corresponding with four Belgian cities (i.e., Antwerp-Zuid, Boom, Brussels, Leuven). Daily 24-h composite influent wastewater samples collected over one week in September 2019 and March through June 2020 during the first wave of the COVID-19 pandemic were analyzed for biomarkers of amphetamine, cocaine, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA). Measured concentrations were converted to population-normalized mass loads by considering the daily flow rate and the catchment population size. Mobile network data was used to accurately capture population movements in the different catchment areas. Temporal changes were assessed with multiple linear regression models, and the effect of the COVID-19 interventions on stimulant consumption were investigated.

RESULTS

An increase in amphetamine use was observed in three cities during governmental restrictions, with highest consumption predominantly during lockdown. Similarly, cocaine consumption was higher after the pandemic started, with highest consumption noted during the lockdown period in Boom and Leuven. Consumption of MDMA was similar in Antwerp-Zuid, Brussels and Leuven throughout the entire sampled period. In Boom, the highest consumption was observed during the full lockdown period.

CONCLUSIONS

The present study shows the potential of WBE to assess the impact of stringent lockdown measures on stimulant use in Belgium. This paper shows that strong restrictive measures did not have a profound effect on stimulant consumption.

Profile of patients attending psychiatric emergency care during the coronavirus 2019 (COVID 19) pandemic: a comparative cross-sectional study between lockdown and post-lockdown periods in Lombardy, Italy

OBJECTIVE

To assess the long-term impact of early COVID-19 lockdown phase on emergency psychiatric consultations in two psychiatric emergency departments located in Italy.

METHODS

We conducted a cross-sectional study comparing the number and characteristics of emergency psychiatric consultations during post-lockdown with respect to the lockdown period. Sociodemographic data, clinical characteristics, referred symptoms, diagnosis, information on multiple psychiatric consultations and hospitalisation were collected.

RESULTS

A rise of almost 60% in emergency psychiatric consultations during the post-lockdown compared to the lockdown period was observed. Emergency psychiatric consultations in the post-lockdown period were associated with lower rates of cannabis (aOR = 0.42, p = 0.011) and cocaine use (aOR = 0.39, p = 0.011). Despite a lower occurrence of two or more psychiatric consultations was observed during post-lockdown phase (aOR = 0.44, p = 0.008), subjects who had anxiety disorders (aOR = 3.91, p = 0.000) and substance intoxication or withdrawal (aOR = 6.89, p = 0.000) were more likely to present to emergency psychiatric consultations during post-lockdown period compared to the lockdown one.

CONCLUSIONS

Substance intoxication or withdrawal and anxiety disorders increased after the COVID-19 lockdown. The findings of this study suggest to address more economic and professional sources to the mental health areas potentially more affected by the different phases of a pandemic.KEYPOINTSCOVID-19 pandemic and lockdown measures increased mental health unmet needs.According to our findings, a rise in emergency psychiatric consultations during the post-lockdown compared to the lockdown period was observed.Patients with substance intoxication or withdrawal syndrome and anxiety disorders were significantly more likely to present to emergency psychiatric consultations during post-lockdown.Lockdown was associated with higher rates of both cannabis and cocaine use disorders as well as of multiple psychiatric consultations.Alternative strategies to improve mental health such as e-health technologies should be promoted.

COVID-19 Lockdowns-Effect on Concentration of Pharmaceuticals and Illicit Drugs in Two Major Croatian Rivers

In order to prevent the spread of COVID-19, contingency measures in the form of lockdowns were implemented all over the world, including in Croatia. The aim of this study was to detect if those severe, imposed restrictions of social interactions reflected on the water quality of rivers receiving wastewaters from urban areas. A total of 18 different pharmaceuticals (PhACs) and illicit drugs (IDrgs), as well as their metabolites, were measured for 16 months (January 2020-April 2021) in 12 different locations at in the Sava and Drava Rivers, Croatia, using UHPLC coupled to LCMS. This period encompassed two major Covid lockdowns (March-May 2020 and October 2020-March 2021). Several PhACs more than halved in river water mass flow during the lockdowns. The results of this study confirm that Covid lockdowns caused lower cumulative concentrations and mass flow of measured PhACs/IDrgs in the Sava and Drava Rivers. This was not influenced by the increased use of drugs for the treatment of the COVID-19, like antibiotics and steroidal anti-inflammatory drugs. The decreases in measured PhACs/IDrgs concentrations and mass flows were more pronounced during the first lockdown, which was stricter than the second.

Long-term safety of ketamine and esketamine in treatment of depression

INTRODUCTION

Ketamine is an NMDA receptor antagonist that can produce rapid-acting antidepressant effects. Esketamine (Spravato), the S-enantiomer of racemic ketamine, was approved by the FDA for treatment-resistant depression in 2019. Here we review what is known about the long-term safety of both racemic ketamine and esketamine as therapies for psychiatric disorders.

AREAS COVERED

In this article, we conducted a safety review of ketamine and esketamine. In looking at ketamine and esketamine long-term safety effects, we considered data available from experimental studies and several phase-three clinical trials.

EXPERT OPINION

Based on available data, the most common side effects of ketamine/esketamine are generally transient, mild, and self-limited. These include dissociation, nausea, headache, elevated heart rate, and blood pressure. Treatment with esketamine may lead to an increased risk of lower urinary tract symptoms, such as dysuria or urgency. However, severe bladder pathology has not been reported among patients receiving doses of esketamine/ketamine in line with prescribing guidelines for depression. There is considerable data that ketamine at high doses can lead to long-term impairments in cognition. However, the esketamine clinical trials found that cognition generally remains stable or improves over time, suggesting that when used appropriately, there is no increased risk of cognitive impairment.

Patterns of Prescription Medicine, Illicit Drugs, and Alcohol Misuse among High-Risk Population: A Factor Analysis to Delineate Profiles of Polydrug Users

Polydrug use is a serious health and social problem worldwide. Treatment remains a challenge because it requires planning based on estimates of the nature and extent of drug consumption and the characteristics of the population in need. To this end, 103 subjects, who voluntarily asked to begin rehabilitation treatment, were monitored through hair analysis to investigate the nature and extent of their polydrug use. A factor analysis was carried out to delineate polydrug user profiles based on the following variables: age, sex, type of illicit drug use, type of prescription drug misuse, and amount of alcohol consumption. Twenty-three percent of subjects tested positive to more than one illicit drug (mainly cocaine), 44% to unprescribed drugs (mainly benzodiazepines), and 66% were hard drinkers. The profiles of drug users outlined included “single drug cocaine user”, and “single drug opiate user”. Moreover, a particularly problematic profile of cocaine users, common between genders and age groups, who combine high levels of alcohol and unprescribed benzodiazepines and opiates, emerged (“hard polydrug abusers”). From a treatment policy perspective, these findings support the importance of preventive analysis before rehabilitation treatment begins in order to identify different patterns of drug abusers to implement personalized multidisciplinary measures.

A Multicenter Study on the Impact of Gender, Age, and Dual Diagnosis on Substance Consumption and Mental Health Status in Outpatients Treated for Substance Use Disorders During COVID-19 Lockdown

Objective COVID-19 and lockdown measures impacted mental health globally and had a particular impact on patients with substance use disorders (SUD). However, the impact of gender, age, and dual diagnosis on consumption patterns and mental health during COVID-19 lockdown among patients with SUD has not been analyzed in depth. Therefore, this study aimed to examine substance use and mental health status during COVID-19 lockdown considering gender, age, and previous dual diagnosis in patients with SUD treated in different outpatient addiction clinics in Catalonia. Methods: Thirteen clinics participated and 588 patients were enrolled in the study, of whom 70.7% were men and 29.3% were women. The mean age was 48 ± 11.3 years, and 63.2% had dual diagnoses. Results: Men reported significantly more frequent alcohol and cocaine consumption during lockdown, while women experienced more anxiety and depressive symptoms. Younger patients more frequently reported consuming cocaine and cannabis, breaking the lockdown rule, worsened family relationships, and reduced incomes. Older patients more frequently reported maintaining abstinence. Previous dual diagnosis was more often associated with benzodiazepine use disorder, less active working during lockdown, and more anxiety and depressive symptoms than not having previous dual diagnosis. Conclusions: Both new psychiatric symptoms and general worsening of existing symptoms were frequent during the lockdown. Differences based on the gender, age, and dual diagnosis of outpatients treated for substance use disorders should be considered in the planning of protection measures such as home confinement.

Substance Use in Healthcare Professionals During the COVID-19 Pandemic in Latin America: A Systematic Review and a Call for Reports

Background

The COVID-19 pandemic has generated a remarkable change in the behaviour of Healthcare workers (HCWs) around the world. However, there is a lack of evidence on substance use among HCWs in Latin America. Therefore, this study aimed to determine the current frequency of substance use among Latin American among HCWs.

Methods

We searched 8 databases (PubMed, Scopus, ScientDirect, Web of Science, Cochrane, Scielo, LILACS and Latindex), 4 public prepublication servers (SocArXiv, medRxiv, bioRxiv and Preprints) and Google scholar from 1/9/2019 to 11/1/2021. We determined the frequency of each study based on original studies, scientific letters, and clinical trials in English, Spanish and Portuguese.

Results

A total of 17 175 study articles were identified from electronic databases and preprints, and 2 cross-sectional studies conducted in 2020 were included in the qualitative analysis. Both studies included HCWs but did not perform a differential analysis. The first was developed by the Pan-American Health Organization and included interviewees from 35 countries, while the second was conducted with 1145 Brazilian participants. Both studies showed increases in substance use during the pandemic, with alcohol being the most commonly used substance (30%), but PAHO's study reported a 13.8% increase in self-reported heavy-episodic drinking, with differences among genders (males, 15.4%), age groups (highest increase in the 40-49 age group, 16.5%) and area of residence (urban with 14%). The second study showed that 21 32% of participants reported initiating psychoactive substance use, 29.3% added some substance to their initial use and 4% of them had to replace the substance, mainly due to difficulty of access. Other substances of abuse that showed significant increases were tobacco (0.5%) and marijuana (0.3%).

Conclusion

Overall, despite the analysis of the 2 studies, the results provided are not a conclusive description of the frequency of substance use by HCWs in Latin America during the COVID-19 pandemic. Further research is required to understand the impact of the pandemic on drug abuse in the region.

Protocol Registration

The protocol has been registered on 30 November 2021 on the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CRD420212919700.

Potentiation of GABAergic synaptic transmission by diazepam acutely increases resting beat-to-beat blood pressure variability in young adults

Resting beat-to-beat blood pressure variability is a powerful predictor of cardiovascular events and end-organ damage. However, its underlying mechanisms remain unknown. Herein, we tested the hypothesis that a potentiation of GABAergic synaptic transmission by diazepam would acutely increase resting beat-to-beat blood pressure variability. In 40 (17 females) young, normotensive subjects, resting beat-to-beat blood pressure (finger photoplethysmography) was continuously measured for 5 to 10 min, 60 min after the oral administration of either diazepam (10 mg) or placebo. The experiments were conducted in a randomized, double-blinded, and placebo-controlled design. Stroke volume was estimated from the blood pressure waveform (ModelFlow) permitting the calculation of cardiac output and total peripheral resistance. Direct recordings of muscle sympathetic nerve activity (MSNA, microneurography) were obtained in a subset of subjects (N=13) and spontaneous cardiac and sympathetic baroreflex sensitivity calculated. Compared to placebo, diazepam significantly increased the standard deviation of systolic (4.7±1.4 vs. 5.7±1.5 mmHg, P=0.001), diastolic (3.8±1.2 vs. 4.5±1.2 mmHg, P=0.007) and mean blood pressure (3.8±1.1 vs. 4.5±1.1 mmHg, P=0.002), as well as cardiac output (469±149 vs. 626±259 ml/min, P<0.001) and total peripheral resistance (1.0±0.3 vs. 1.4±0.6 mmHg/l/min, P<0.001). Similar results were found using different indices of variability. Furthermore, diazepam reduced MSNA burst frequency (placebo: 22±6 vs. diazepam: 18±8 bursts/min, P=0.025) without affecting the arterial baroreflex control of heart rate (placebo: 18.6±6.7 vs. diazepam: 18.8±7.0 ms/mmHg, P=0.87) and MSNA (placebo: -3.6±1.2 vs. diazepam: -3.4±1.5 bursts/100Hb/mmHg, P=0.55). These findings suggest that GABA_A receptors modulate resting beat-to-beat blood pressure variability in young adults.

Substance use disorders during the COVID-19 pandemic: looking for new innovative approaches

BACKGROUND AND AIM

The destructive impact of the still ongoing COVID-19 pandemic on those struggling with substance use disorders (SUD) stems from the daunting challenges which SUD patients experience in terms of coping with their condition and receiving care in a timely fashion.

METHODS

Patients struggling with addiction are at particularly high risk, due to the underlying vulnerabilities in their conditions and the stigmatization they often suffer. New Psychoactive Substances stand out as a critical area of concern. The authors have conducted a broad-ranging search to assess the impact of SUDs, along with their related mental, physical, and behavioral symptoms, against the backdrop of the COVID-19, taking into account how drug trafficking and consumption trends have evolved as the emergency draws out, and the cyberspace comes to play an ever-bigger role.

RESULTS

Given that roughly 1.5%-5% of the global burden of disease can be ascribed to alcohol abuse and substance addiction, the role of pandemic-related potential contributing factors in the exacerbation and relapse of SUDs and behavioral addiction cannot be discounted and needs targeted measures tailored to the special needs of SUD patients. Escalating environmental stressors stemming from abnormal circumstances can undermine recovery efforts and threaten the very survival of countless SUD patients, increasing the likelihood of relapsing for those in recovery.

CONCLUSIONS

Policymakers and legislators have not yet put in place targeted measures and adjustments in the health care delivery mechanisms in order to countervail the pandemic impact on SUD sufferers, and the ever-evolving patterns of use and trafficking.

The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings

BACKGROUND

The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations.

METHODS

We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations.

RESULTS

Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated "beans" and "buttons". Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency.

CONCLUSIONS

The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.

Changes in the frequency and pattern of drugs detected among suspected drug users during the COVID-19 pandemic in Turkey

From March 13 until May 31, 2020, a complete lockdown in Turkey was planned and implemented by the government of Turkey. The vulnerable population with substance use disorders was affected more than others due to the social isolation measures meant to control the pandemic. This study presents detailed and broad data on drug abuse in suspected cases during the first wave of the COVID-19 pandemic in Turkey and compares the frequencies and patterns of drug abuse before and during the pandemic. The samples were screened by liquid chromatography-high resolution mass spectrometry and liquid chromatography-tandem mass spectrometry. Blood and urine samples of suspected users (n = 9669) were analyzed for drugs of abuse during the first wave of the COVID-19 pandemic and compared with their results (n = 8727) obtained just before the COVID-19 pandemic. The use of party drugs, such as MDMA and cocaine, and the classic illicit drug cannabis was significantly decreased and followed the same trend after complete lockdown was over. In contrast, methamphetamine use increased significantly during the lockdown period and continued after the lockdown. Interestingly, the number of tests that were positive for pregabalin as a misused licit drug increased, and this increase continued after the lockdown. The results showed a significant increase in drug abuse cases and changes in drug abuse trends, with an alteration toward more easily obtainable and lower-priced drugs. Using more dangerous and easily available licit and illicit drugs may cause serious health problems.

Patterns and motivations of polysubstance use: a rapid review of the qualitative evidence

INTRODUCTION

Polysubstance use-the use of substances at the same time or close in time-is a common practice among people who use drugs. The recent rise in mortality and overdose associated with polysubstance use makes understanding current motivations underlying this pattern critical. The objective of this review was to synthesize current knowledge of the reasons for combining substances in a single defined episode of drug use.

METHODS

We conducted a rapid review of the literature to identify empirical studies describing patterns and/or motivations for polysubstance use. Included studies were published between 2010 and 2021 and identified using MEDLINE, Embase, PsycINFO and Google Scholar.

RESULTS

We included 13 qualitative or mixed-method studies in our analysis. Substances were combined sequentially to alleviate withdrawal symptoms or prolong a state of euphoria ("high"). Simultaneous use was motivated by an intention to counteract or balance the effect(s) of a substance with those of another, enhance a high or reduce overall use, and to mimic the effect of another unavailable or more expensive substance. Self-medication for a pre-existing condition was also the intention behind sequential or simultaneous use.

CONCLUSION

Polysubstance use is often motivated by a desire to improve the experience based on expected effects of combinations. A better understanding of the reasons underlying substance combination are needed to mitigate the impact of the current overdose crisis.

Opioids in COVID-19: Two Sides of a Coin

Introduction: The treatment of most severe COVID-19 patients included the large-scale use of sedatives and analgesics-possibly in higher doses than usual-which was reported in the literature. The use of drugs that decrease mortality is necessary and opioids are important agents in procedures such as orotracheal intubation. However, these drugs seem to have been overestimated in the COVID-19 pandemic. We performed a review of the PubMed-Medline database to evaluate the use of opioids during this period. The following descriptors were used to enhance the search for papers: "Opioids", "COVID-19," "COVID-19 pandemic," "SARS-CoV-2," "Opioid use disorder," "Opioid dependence" and the names of the drugs used. We also evaluated the distribution of COVID-19 patients in Brazil and the applicability of opioids in our country during the COVID-19 pandemic. Results: Several positive points were found in the use of opioids in the COVID-19 pandemic, for instance, they can be used for analgesia in orotracheal intubation, for chronic pain management, and as coadjutant in the management of acute intensification of pain. However, high doses of opioids might exacerbate the respiratory depression found in COVID-19 patients, their chronic use can trigger opioid tolerance and the higher doses used during the pandemic might result in greater adverse effects. Unfortunately, the pandemic also affected individuals with opioid use disorder, not only those individuals are at higher risk of mortality, hospitalization and need for ventilatory support, but measures taken to decrease the SARS-CoV-2 spread such as social isolation, might negatively affect the treatment for opioid use disorder. In Brazil, only morphine, remifentanil and fentanyl are available in the basic health care system for the treatment of COVID-19 patients. Out of the 5,273,598 opioid units used in this period all over the country, morphine, fentanyl, and remifentanil, accounted for, respectively, 559,270 (10.6%), 4,624,328 (87.6%), and 90,000 (1.8%) units. Many Brazilian regions with high number of confirmed cases of COVID-19 had few units of opioids available, as the Southeast region, with a 0.23 units of opioids per confirmed COVID-19 case, and the South region, with 0.05 units. In the COVID-19 pandemic scenario, positive points related to opioids were mainly the occurrence of analgesia, to facilitate intubation and their use as coadjutants in the management of acute intensification of pain, whereas the negative points were indiscriminate use, the presence of human immunosuppressor response and increased adverse effects due to higher doses of the drug. Conclusion: The importance of rational and individualized use of analgesic hypnotics and sedative anesthetics should be considered at all times, especially in situations of high demand such as the COVID-19 pandemic.

Is talk cheap? Correspondence between self-attributions about changes in drinking and longitudinal changes in drinking during the coronavirus disease 2019 pandemic

Background

There are concerns that the coronavirus disease 2019 (COVID‐19) pandemic may increase drinking, but most accounts to date are cross‐sectional studies of self‐attributions about alcohol‐related impacts and the accuracy of those perceptions has not been investigated. The current study examined the correspondence between self‐attributions of pandemic‐related changes in drinking and longitudinally‐measured changes in drinking and alcohol‐related consequences in a sample of emerging adults.

Methods

In an existing ongoing longitudinal study on alcohol misuse (≥1 heavy episodic drinking day/month) in emerging adults, 473 individuals (M_age = 23.8; 41.7% male) received a supplemental assessment from June 17th to July 1st, 2020, during public health restrictions in Ontario, Canada. These intrapandemic data were matched to the most recent assessment prior to the pandemic (~8 months earlier). Self‐attributions about changes in drinking were assessed globally (i.e., increases/decreases/no change) and with higher resolution questions clarifying the magnitude of changes.

Results

Global self‐attributions about changes in drinking substantively paralleled longitudinal changes in weekly drinking days (DD). In the longitudinal data, individuals’ who self‐reported increases in drinking exhibited significant increases; individuals’ who self‐reported decreases exhibited significant decreases; and individuals who self‐reported no change exhibited nonsignificant changes. Higher resolution items likewise revealed longitudinal patterns of weekly drinking that were substantively consistent with self‐attributions. Heavy DD and alcohol‐related consequences exhibited similar patterns, but only individuals who self‐reported large increases in drinking exhibited increases on these outcomes. Individuals who reported large increases in drinking also exhibited significant increases in depression and posttraumatic stress disorder symptoms.

Conclusions

Self‐attributions about drinking closely corresponded to longitudinal changes in drinking, supporting the validity of self‐attributions in population‐level surveys, particularly in young adults. Notably, a subgroup was identified that exhibited pronounced increases for all alcohol‐related outcomes and concurrent increases in internalizing psychopathology.

Psychoactive Substance Use and Its Relationship to Stress, Emotional State, Depressive Symptomatology, and Perceived Threat During the COVID-19 Pandemic in Mexico

People can increase their use of psychoactive substances in response to stressful situations as a maladaptive mechanism for reducing negative affective states. It is therefore necessary to examine changes in the use of such substances and their relationship to mental health in light of the COVID-19 pandemic.

Objective: Evaluate the relationship between psychoactive substances and stress, emotional state, and symptomatology during the COVID-19 lockdown in Mexico.

Method: A national survey was conducted, using the free Google Forms platform, of residents of Mexico aged 18 and older. The survey was disseminated through social media.

Results: The sample comprised 4,122 individuals, mostly women (71.8%), with an age range of 18–81 years (M = 37.08, SD = 12.689), of which 46.8% were single, and 42.9% married. In general, there was a reduction in substance use during the first 2 months of the quarantine; the most commonly used substances were alcohol, tobacco, and tranquilizers. Respondents who described having greater use than before the pandemic presented greater stress, depressive symptomatology, and perceived threat than those who did not use substances.

Conclusions: Respondents who did not use substances reported lower levels of stress, depressive symptomatology, impact of the coronavirus pandemic, and perception of its threat. Women reported greater stress, depressive symptomatology, and emotional intensity than men.

Problematic alcohol use in young adults during the COVID-19 lockdown in Italy

This study investigated the individual and contextual correlates of problematic alcohol use among young adults during COVID-19 lockdown in Italy. Participants were 1533 young adults aged 18 to 26 (M_age = 23.12, SD_age = 2.11; 73.2% women), who completed an online survey during national lockdown. Inclusion criteria for this study were the age-range (18-26 y. o.), and living in Italy during COVID-19 lockdown. Participants with low or very low socioeconomic levels (vs. higher levels) were more at risk for problematic alcohol use, as well as participants who lived alone or with roommates/friends during lockdown. Conversely, participants who spent the lockdown with their family or partner were less at risk for problematic alcohol use. Finally, participants who had their job suspended due to pandemic (vs. other job conditions) were more at risk for problematic alcohol use during lockdown. Implications for research and clinical practice are discussed.

Hair Analysis to Evaluate Polydrug Use

Polydrug use is a frequent pattern of consumption in Europe. This behavior has mainly been analyzed within restricted groups; more rarely in large populations. Current polydrug use is less studied than simultaneous use. This study focused on the concurrent assumption of polydrug among drivers using hair matrix. Hair matrix, for its biological characteristics, allows to identify illicit drug use more often than other matrices, i.e., urine, and it provides information on the long-term use of them. Hair samples of subjects positive for opiates, cocaine and delta-9-tetrahydrocannabinol (Δ⁹-THC) collected by the forensic toxicology laboratory of the University of Macerata in the period 2010–2020, were analyzed using a gas chromatography-mass spectrometry method. Our results evidenced that a significant part of the examined population (12.15%) used polydrug. A strong predominance of males over females was evident. Polydrug users were more frequently young people. The abuse of two substances was predominant. Cocaine and Δ⁹-THC was the most common combination, followed by cocaine and morphine, and morphine and Δ⁹-THC. The timeframe of polydrug use was also analyzed. Our study shows that polydrug use is a very frequent behavior, and that hair analysis may be a powerful tool to obtain objective biological information of this complex phenomenon.

Lifestyle Interventions Improving Cannabinoid Tone During COVID-19 Lockdowns May Enhance Compliance With Preventive Regulations and Decrease Psychophysical Health Complications

Studies investigating the psychosomatic effects of social isolation in animals have shown that one of the physiologic system that gets disrupted by this environment-affective change is the Endocannabinoid System. As the levels of endocannabinoids change in limbic areas and prefrontal cortex during stressful times, so is the subject more prone to fearful and negative thoughts and aggressive behavior. The interplay of social isolation on the hypothalamic-pituitary-adrenal axis and cannabinoid tone triggers a vicious cycle which further impairs the natural body's homeostatic neuroendocrine levels and provokes a series of risk factors for developing health complications. In this paper, we explore the psychosomatic impact of prolonged quarantine in healthy individuals, and propose management and coping strategies that may improve endocannabinoid tone, such as integration of probiotics, cannabidiol, meditation, and physical exercise interventions with the aim of supporting interpersonal, individual, and professional adherence with COVID-19 emergency public measures whilst minimizing their psycho-physical impact.

Benzodiazepine Misuse: An Epidemic Within a Pandemic

Coronavirus disease 2019 (COVID-19) had deleterious effects on patients with mental health problems and several studies have shown a spike in the rates of depression, insomnia, and post-traumatic stress disorder. Anxiety and insomnia rates have also increased among both the general public and health care professionals. Benzodiazepines are some of the most commonly used drugs in the treatment of anxiety and insomnia. However, benzodiazepines are also misused, abused alone, or abused in combination with other drugs. Lockdowns and social distancing have also had negative consequences on patients with mental health problems. We assessed the extent of benzodiazepine use during the pandemic and interpreted its effects in the future. We conducted a literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and eight articles reviewed specifically reported worrying fluctuations in benzodiazepine use during the pandemic. We observed varied trends in the usage of benzodiazepines in various parts of the world. Some studies showed an increase in the consumption of benzodiazepine while others demonstrated a decrease in the prescription refills of benzodiazepine, which may be a result of gaps in mental health care. At this time, we can conclude that the current trend with benzodiazepine use is fluctuating and mental health professionals must continue to exercise caution before prescribing benzodiazepines. Future research is also warranted to be aware of the changing patterns and to avoid misuse and/or abuse at an epidemic level.

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

The outbreak of the COVID-19 pandemic and the measures taken for tackling it had the potential to lead to deep modifications in the supply of illegal drugs and to impact substance users’ health and social situation. To investigate this, we used mixed methods, i.e., quantitative data collected with a brief questionnaire from substance users receiving opioid agonist treatment in a treatment centre in Switzerland (N = 49), and qualitative data obtained using semi-structured phone interviews among a sub-group of participants (N = 17). We repeated data collection twice over four weeks to investigate trends over time (N = 51 and 14 at wave 2). Findings consistently showed the limited impact of the COVID-19 outbreak on the illegal substance market. Over the two waves, the supply, price and purity of three main illegal substances did not significantly vary. Substance use was estimated as usual by most, trending toward a decrease. The impact of the pandemic on participants’ social situation and health was appraised as low to medium. Nevertheless, a minority of participants reported higher impact and multivariate analyses showed a more important impact for those who were female, younger, and not using multiple substances. This process was implemented quickly and provided an understanding of the short-term impact of the pandemic on drug markets and users.

Psychiatric Emergencies During the Covid-19 Pandemic: A 6-Month Observational Study

BACKGROUND

The new SARS-CoV-2 has caused an ongoing pandemic. Health prevention measures to contain the outbreak are profoundly affecting the physical and mental health as well as personal freedom of the population.

AIM

To evaluate psychiatric emergencies in a 6-month period during the COVID-19 pandemic in 2020 compared to those of the corresponding period of the previous year.

METHODS

This monocentric observational study preliminarily collected variables of the urgent psychiatric consultations (UPCs) carried out in emergency room (ER) from 1-3-2020 to 31-8-2020 and the socio-demographic and clinical characteristics of patients who required UPCs in the 6-month period, comparing these data with those collected from 1-3-2019 to 31-8-2019. The data, collected in alpha-numeric code, were statistically analyzed through STATA 12-2011.

RESULTS

This research reported a reduction of both UPCs and hospital psychiatric admissions. Concomitantly, we observed an increase of UPCs required by people already being treated by psychiatric and other health services, residents in psychiatric facilities and non-Italians. In 2020, differently from 2019, the most frequent reasons for urgent psychiatric consultations were aggressive behavior and adjustment disorders with anxiety and depressive mood.

CONCLUSION

This preliminary study suggests that, during the COVID-19 epidemic, urgent psychiatric consultations in ER were reduced, except for the most vulnerable people due to their clinical and/or social conditions.