Josh Torrance (PhD student and Assistant Teacher, School for Policy Studies)
Much of this research is based on personal emails and conversations with the police and other agencies. As such, not all of the facts presented are referenceable.
Covid-19 will present a major challenge to both drug users and drug treatment agencies over the coming months. There are 320,000 problematic drug users in the UK, many of whom have weaker immune systems than the general public – and therefore a diminished chance of recovery from the virus. People who inject drugs and street homeless communities are at particular risk; viral infections spread quickly through these populations. On the face of it, the pandemic might seem like a fantastic opportunity for problematic users to become drug-free, but the reality is much more complex.
Impact on individuals
A significant proportion of crack cocaine and heroin smokers suffer from Chronic Obstructive Pulmonary Disease, a serious respiratory condition; it is possible that spice, another synthetic chemical that is burnt and inhaled, may pose similar risks to people that use it. To prevent deaths, it is crucial that information on how to prevent the spread of Covid-19 is properly disseminated to these communities. The International Network of People who Use Drugs have already put together a comprehensive harm reduction leaflet on improving hygiene if you choose to use drugs during this crisis.
Impact on drug markets and supply routes
At the time of writing, it is too early to estimate the full impact Covid-19 will have on drug markets, but their adaptability should not be underestimated. There is a strong possibility that drug supply routes will be disrupted, but to what extent depends on a variety of factors. Police resources are currently more stretched than ever, and conversations with officers paint a picture of focus being shifted away from drug enforcement efforts as a result of this crisis.
Cannabis is now mostly grown within the UK, meaning supply could remain relatively continuous throughout the crisis. Early police reports indicate that cocaine and heroin shipments are continuing to enter the UK – although prices are increasing, with a kilo of cocaine rising from £33,000 to £45,000 in the last two weeks of March, and a kilo of ketamine rising from £5,000 to £9,000 over the same period. Wholesale heroin prices have also gone up considerably. The supply of spice has been reduced, in part because obtaining the chemicals from China has become more difficult.
A rise in retail prices will result in dependent users struggling to afford their previous levels of use. These issues are be compounded as various sources of income are reduced due to the lockdown: those in precarious employment positions may lose their job; people who raise money through begging are earning less thanks to quiet metropolitan areas, people who shoplift cannot steal from shops that are closed; people who sell sex are struggling to find clients willing to be in close contact. There is anecdotal evidence that heroin and crack cocaine dealers in Bristol are now offering £5 bags as standard – because their customers are struggling to scrape together the £10 that a usual bag would cost. There are also national reports of £10 bags that are half the size they were three weeks ago.
A strict lockdown would make it more difficult for dealers to reach their customers. There are already numerous accounts of dealers using food delivery networks and disguising themselves as key workers to continue trading. The incredibly efficient dial-a-dealer services, who can typically deliver drugs quicker than a pizza, appear to be continuing unabated for now. County Lines activity does appear to have slowed down, with adult dealers doing more of the leg work rather than exploiting children. If the lockdown does indeed end in May, any disruption to drug supply would be short lived.
Impact on purity of illicit substances and drug taking behaviour
There is evidence that users are stockpiling supplies, which is in turn contributing to price rises. Policy experts Ian Hamilton and Alex Stevens have speculated that those who are stockpiling their drug of choice are likely to end up using more than usual. The lockdown is resulting in boredom, increased psychological stress and isolation – which could trigger higher levels of drug use. Group therapy meetings – like Alcoholics Anonymous – are now mostly taking place online, but service users have reported that videoconferencing meetings are inevitably less effective than face-to-face sessions. Those who struggle with technology will certainly experience reduced levels of support.
Illicit drugs in general are very likely to become more adulterated as time progresses. A post-lockdown ‘return to normal’ could lead to an increase in overdose deaths, if batches of heroin become unexpectedly strong. However, there are signs that some people are changing their behaviours: there are anecdotal reports of some drug users who are now refusing to share crack pipes and needles, wearing gloves while purchasing drugs or planning to stick to their methadone prescriptions rather than use heroin.
Wider social impacts of COVID19 and drug use
We can anticipate increasingly desperate forms of acquisitive crime being committed as it becomes harder to fund large habits. Early police reports suggest that violence within the homeless population is already rising rapidly. Physical withdrawal from heroin, alcohol or benzodiazepines can be very dangerous, sometimes lethal. Instead of helping an individual stop using drugs, a sudden cessation of use is likely to induce chaotic patterns of behaviour that have serious knock-on effects for the wider public.
The homeless population in Bristol have been given beds in hotels, after Local Authorities across the UK received an order from the Home Office to offer shelter to all street homeless individuals immediately. While this is hugely commendable step, it needs to be recognised that they could become a hotbed of problematic behaviours and may make it remarkably easy for dealers to reach their customers. On the flipside, it should also make it easier for support agencies to access those in need. They are mostly being staffed by the regular hotel staff, with some support from other agencies. Hotel staff are having to adapt quickly, essentially being required to learn a new set of skills overnight under incredibly challenging circumstances. Vulnerable people could be at risk from intimidation and abuse if they are suddenly forced to live in close quarters with their perpetrators.
Impact on the drug and alcohol support workforce
Drug treatment workers have been designated as ‘key workers’ under new government guidelines and agencies are already putting new procedures in place. Agencies are now holding appointments online, offering home delivery of clean injecting equipment, and giving service users a weeks’ worth of methadone at a time in order to help contain the spread. It likely that large numbers of heroin users will emerge from the woodwork, seeking a methadone prescription in order to help them remain stable. Treatment agencies need to be ready to respond to this potential influx of service users. They are already suffering from crippling budget cuts, and Covid-19 could hardly have come at a worse time. Pharmacies have just been given emergency powers during the crisis, allowing them to dispense methadone without a prescription. This is a huge step forward which will lighten the load for GPs and treatment agencies. Given that liberalised access to methadone is evidenced to reduce a variety of harms, there is a real opportunity here for prescribing regulators to learn lessons for the future.
Covid-19 has presented drug users and support agencies with a variety of unprecedented problems. It is possible that this crisis has very suddenly increased the harms associated with using drugs. It is crucial that the gravity of this situation does not get missed by local authorities and the Home Office, who are working at breakneck speed on a range of other things. The most vulnerable in our society must not be forgotten in the noise. Emergency funding needs to be made available to help the relevant agencies adapt.