Pandemic effects the Illicit Drug Supply

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Editors note: This is an excerpt from the most recent UN report on International Drug Traffic.

The COVID-19 crisis is taking its toll on the global economy, public health and our way of life. The virus has now infected more than 3.6 million people worldwide, killed 250,000 and led Governments to take drastic measures to limit the spread of coronavirus disease 2019. Roughly half of the global population is living under mobility restrictions, international border crossings have been closed and economic activity has declined drastically, as many countries have opted for the closure of nonessential businesses.
Drug trafficking relies heavily on legal trade to camouflage its activities and on individuals being able to distribute drugs to consumers. The measures implemented by Governments to counter the COVID19 pandemic have thus inevitably affected all aspects of the illegal drug markets, from the production and trafficking of drugs to their consumption.
Having said that, the impact of those measures varies both in terms of the different business models used in the distribution of each type of drug and the approaches used by different countries to address the pandemic. These range from the closure of international border crossings, while allowing domestic travel, to moderate-to-strict shelter-in-place orders, or a complete lockdown of all activities, including suspension of essential services other than for emergencies. The impact on actual drug production may vary greatly depending on the substance and the geographical location of its production.
Based on the most recent data from government authorities, open sources, including the media, and the network of UNODC field offices, the evidence available suggests the following ongoing dynamics in the impact of the COVID-19 pandemic on the illicit drug markets.
Measures implemented to prevent the spread of COVID-19 are having a mixed impact on the drug supply chain The impact of the measures implemented to address the COVID-19 pandemic appears to have been most homogenous to date at the very end of the drug supply chain, in the destination markets. Many countries across all regions have reported an overall shortage of numerous types of drugs at the retail level, as well as increases in prices, reductions in purity and that drug users have consequently been switching substance (for example, from heroin to synthetic opioids) and/or increasingly accessing drug treatment. Some countries in the Balkans and in the Middle East, where measures are not so strict during the day, have, however, reported less disruption.
The overall impact on bulk supply is reportedly more heterogenous, both across drugs and across countries. Increased controls resulting from the implementation of measures to fight the spread of COVID-19 have had double-edged consequences on large-scale drug supply. Some countries, such as Italy and countries in Central Asia, have experienced a sharp decrease in drug seizures. Other countries, such as Niger, have reported a cease in drug trafficking. There have also been reports of organized criminal groups involved in drug trafficking becoming distracted from their usual illicit activities by emerging crime linked to the COVID-19 pandemic; for example, cybercrime and trafficking in falsified medicines in the Balkan countries.
On the other hand, other countries, including the Islamic Republic of Iran and Morocco, have reported large drug seizures, indicating that large-scale drug trafficking is still taking place, and some have reported an increase in interdiction resulting from increased controls. An example of an increase in drug enforcement is seen in the United Kingdom of Great Britain and Northern Ireland, where an improvement in the interdiction of “county lines” activities, a trafficking modus operandi particular to COVID-19 and the drug supply chain: from production and trafficking to use
that country in which young disadvantaged people are exploited, has been reported. “Fortuitous” drug interceptions in countries such as Egypt have also resulted in mid-scale drug seizures made during street controls, and reports from Nigeria indicate continued drug trafficking, with a possible increase
in the use of postal services.

Pandemic and Panic

Recovery Radio Podcast

Editors Note: This is part two of the most recent UN report on international drug use.

Drug shortages have been reported and could have negative health consequences for people with drug use disorders
Many countries have reported drug shortages at the retail level, with reports of heroin shortages in Europe, South-West Asia and North America in particular. Drug supply shortages can go together with an overall decrease in consumption (for example, of drugs that are mostly consumed in recreational
setting such as bars and clubs) but may also, especially in the case of heroin, lead to the consumption of harmful domestically-produced substances, as well as more harmful patterns of drug use by people with drug use disorders. In terms of alternatives, some countries in Europe have warned that heroin
users may switch to substances such as fentanyl and its derivatives. An increase in the use of pharmaceutical products such as benzodiazepines and buprenorphine has also been reported, to the extent that their price has doubled in some areas.
Harmful patterns deriving from drug shortages include an increase in injecting drug use and the sharing of injecting equipment and other drug paraphernalia, all of which carry the risk of spreading blood-borne diseases, such as HIV/AIDS and hepatitis C, and COVID-19 itself. Risks resulting from drug overdose may also increase among people who inject drugs and who are infected with COVID-19.
Some countries have reported that the activities of organizations providing support to people who use drugs have been severely affected. In response to a reduction in the accessibility of treatment service provision during the lockdown, some countries have increased low-threshold services and reduced barriers for obtaining opiate-substitution medication; for example, allowing pharmacies to dispense methadone, as in the United Kingdom. Other countries, however, have reported difficulties in maintaining services for drug users.
Economic difficulties caused by COVID-19 could change drug consumption for the worse In the long run, the economic downturn caused by the COVID-19 crisis has the potential to lead to a lasting transformation of the drug markets. The economic difficulties caused by the COVID-19 crisis may affect people who are already in a position of socioeconomic disadvantage harder than others.
This could lead to an increase in the number of people resorting to illicit activities linked to drugs in order to make a living (production, transport, etc.) and/or being recruited into drug trafficking organizations.
Based on the experiences of the economic crisis of 2008, it is fair to assume that the economic downturn may lead to reductions in drug-related budgets among Member States, an overall increase in drug use, with a shift towards cheaper drugs, and a shift in patterns of use towards injecting drugs and to substances with an increased risk of harm due to a greater frequency of injections.

Know the Risks of Meth

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Methamphetamine (meth) is a powerful, highly addictive drug that causes devastating health effects, and sometimes death, even on the first try.

Meth is easy to get addicted to and hard to recover from. Meth is a dangerous, synthetic, stimulant drug often used in combination with other substances that can be smoked, injected, snorted, or taken orally. Someone using meth may experience a temporary sense of heightened euphoria, alertness, and energy. But using meth changes how the brain works and speeds up the body’s systems to dangerous, and sometimes lethal, levels—increasing heart rate, blood pressure, body temperature, and respiratory rate. Chronic meth users also experience anxiety, confusion, insomnia, paranoia, aggression, visual and auditory hallucinations, mood disturbances, and delusions.

The Rise of Meth Use in the United States

The number of fatal overdoses involving meth has more than tripled (PDF | 336 KB) between 2011 and 2016, according to the CDC. Use is also on the rise between 2016-2018 for most age groups. In 2018, more than 106,000 adults aged 26 or older used meth—a 43 percent increase over the previous year.

Short-term Effects of Meth

Even taking small amounts of meth, or just trying it once, can cause harmful health effects, including:

  • Increased blood pressure and body temperature
  • Faster breathing
  • Rapid or irregular heartbeat
  • Loss of appetite, disturbed sleep patterns, or nausea
  • Bizarre, erratic, aggressive, irritable, or violent behavior

Long-term Health Risks of Meth

Chronic meth use leads to many damaging, long-term health effects, even when users stop taking meth, including:

  • Permanent damage to the heart and brain
  • High blood pressure leading to heart attacks, strokes, and death
  • Liver, kidney, and lung damage
  • Anxiety, confusion, or insomnia
  • Paranoia, hallucinations, mood disturbances, delusions, or violent behavior (psychotic symptoms can sometimes last for months or years after quitting meth)
  • Intense itching, causing skin sores from scratching
  • Severe dental problems (“meth mouth”)

COVID-19: Potential Implications for Individuals with Substance Use Disorders

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As people across the U.S. and the rest of the world contend with coronavirus disease 2019 (COVID-19), the research community should be alert to the possibility that it could hit some populations with substance use disorders (SUDs) particularly hard. Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder (OUD) and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health. Additionally, individuals with a substance use disorder are more likely to experience homelessness or incarceration than those in the general population, and these circumstances pose unique challenges regarding transmission of the virus that causes COVID-19. All these possibilities should be a focus of active surveillance as we work to understand this emerging health threat.NIH has posted a compilation of updates for applicants and grantees, including a Guide Notice on administrative flexibilities and accompanying FAQs.

SARS-CoV-2, the virus that causes COVID-19 is believed to have jumped species from other mammals (likely bats) to first infect humans in Wuhan, capital of China’s Hubei province, in late 2019. It attacks the respiratory tract and appears to have a higher fatality rate than seasonal influenza. The exact fatality rate is still unknown, since it depends on the number of undiagnosed and asymptomatic cases, and further analyses are needed to determine those figures. Thus far, deaths and serious illness from COVID-19 seem concentrated among those who are older and who have underlying health issues, such as diabetes, cancer, and respiratory conditions. It is therefore reasonable to be concerned that compromised lung function or lung disease related to smoking history, such as chronic obstructive pulmonary disease (COPD), could put people at risk for serious complications of COVID-19.

Co-occurring conditions including COPD, cardiovascular disease, and other respiratory diseases have been found to worsen prognosis in patients with other coronaviruses that affect the respiratory system, such as those that cause SARS and MERS. According to a case series published in JAMA based on data from the Chinese Center for Disease Control and Prevention (China CDC), the case fatality rate (CFR) for COVID-19 was 6.3 percent for those with chronic respiratory disease, compared to a CFR of 2.3 percent overall. In China, 52.9 percent of men smoke, in contrast to just 2.4 percent of women; further analysis of the emerging COVID-19 data from China could help determine if this disparity is contributing to the higher mortality observed in men compared to women, as reported by China CDC. While data thus far are preliminary, they do highlight the need for further research to clarify the role of underlying illness and other factors in susceptibility to COVID-19 and its clinical course.

Vaping, like smoking, may also harm lung health. Whether it can lead to COPD is still unknown, but emerging evidence suggests that exposure to aerosols from e-cigarettes harms the cells of the lung and diminishes the ability to respond to infection. In one NIH-supported study, for instance, influenza virus-infected mice exposed to these aerosols had enhanced tissue damage and inflammation.

People who use opioids at high doses medically or who have OUD face separate challenges to their respiratory health. Since opioids act in the brainstem to slow breathing, their use not only puts the user at risk of life-threatening or fatal overdose, it may also cause a harmful decrease in oxygen in the blood (hypoxemia). Lack of oxygen can be especially damaging to the brain; while brain cells can withstand short periods of low oxygen, they can suffer damage when this state persists. Chronic respiratory disease is already known to increase overdose mortality risk among people taking opioids, and thus diminished lung capacity from COVID-19 could similarly endanger this population.

A history of methamphetamine use may also put people at risk. Methamphetamine constricts the blood vessels, which is one of the properties that contributes to pulmonary damage and pulmonary hypertension in people who use it. Clinicians should be prepared to monitor the possible adverse effects of methamphetamine use, the prevalence of which is increasing in our country, when treating those with COVID-19.  

Other risks for people with substance use disorders include decreased access to health care, housing insecurity, and greater likelihood for incarceration. Limited access to health care places people with addiction at greater risk for many illnesses, but if hospitals and clinics are pushed to their capacity, it could be that people with addiction—who are already stigmatized and underserved by the healthcare system—will experience even greater barriers to treatment for COVID-19.  Homelessness or incarceration can expose people to environments where they are in close contact with others who might also be at higher risk for infections. The prospect of self-quarantine and other public health measures may also disrupt access to syringe services, medications, and other support needed by people with OUD.  

We know very little right now about COVID-19 and even less about its intersection with substance use disorders. But we can make educated guesses based on past experience that people with compromised health due to smoking or vaping and people with opioid, methamphetamine, cannabis, and other substance use disorders could find themselves at increased risk of COVID-19 and its more serious complications—for multiple physiological and social/environmental reasons. The research community should thus be alert to associations between COVID-19 case severity/mortality and substance use, smoking or vaping history, and smoking- or vaping-related lung disease. We must also ensure that patients with substance use disorders are not discriminated against if a rise in COVID-19 cases places added burden on our healthcare system. 

As we strive to confront the major health challenges of opioid and other drug overdoses—and now the rising infections with COVID-19—NIDA encourages researchers to request supplements that will allow them to obtain data on the risks for COVID-19 in individuals experiencing substance use disorders.

Finland Ends Homelessness

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In Finland, the number of homeless people has fallen sharply. The reason: The country applies the “Housing First” concept. Those affected by homelessness receive a small apartment and counselling – without any preconditions. 4 out of 5 people affected thus make their way back into a stable life. And: All this is cheaper than accepting homelessness.

Finland is the only country in Europe where homelessness is in decline

In 2008 you could see tent villages and huts standing between trees in the parks of Helsinki. Homeless people had built makeshift homes in the middle of Finland’s capital city. They were exposed to harsh weather conditions.

Since the 1980s, Finnish governments had been trying to reduce homelessness. Short-term shelters were built. However, long-term homeless people were still left out. There were too few emergency shelters and many affected people did not manage to get out of homelessness: They couldn’t find jobs – without a housing address. And without any job, they couldn’t find a flat. It was a vicious circle. Furthermore, they had problems applying for social benefits. All in all, homeless people found themselves trapped.

But in 2008 the Finnish government introduced a new policy for the homeless: It started implementing the “Housing First” concept. Since then the number of people affected has fallen sharply.

Finland has set itself a target: Nobody should have to live on the streets – every citizen should have a residence.

And the country is successful: It is the only EU-country where the number of homeless people is declining.

How everyone is given residence in Finland

It is NGOs such as the “Y-Foundation” that provide housing for people in need. They take care of the construction themselves, buy flats on the private housing market and renovate existing flats. The apartments have one to two rooms. In addition to that, former emergency shelters have been converted into apartments in order to offer long-term housing.

“It was clear to everyone that the old system wasn’t working; we needed radical change,” says Juha Kaakinen, Director of the Y-Foundation.

Homeless people turn into tenants with a tenancy agreement. They also have to pay rent and operating costs. Social workers, who have offices in the residential buildings, help with financial issues such as applications for social benefits.

Juha Kaakinen is head of the Y-Foundation. The NGO receives discounted loans from the state to buy housing. Additionally, social workers caring for the homeless and future tenants are paid by the state. The Finnish lottery, on the other hand, supports the NGO when it buys apartments on the private housing market. The Y-Foundation also receives regular loans from banks. The NGO later uses the rental income to repay the loans.

“We had to get rid of the night shelters and short-term hostels we still had back then. They had a very long history in Finland, and everyone could see they were not getting people out of homelessness. We decided to reverse the assumptions.” (Juha Kaakinen, Director of the Y-Foundation)

That’s how the “Housing First” concept works

The policy applied in Finland is called “HousingFirst”. It reverses conventional homeless aid. More commonly, those affected are expected to look for a job and free themselves from their psychological problems or addictions. Only then they get help in finding accommodation.

“Housing First”, on the other hand, reverses the path: Homeless people get a flat – without any preconditions. Social workers help them with applications for social benefits and are available for counselling in general. In such a new, secure situation, it is easier for those affected to find a job and take care of their physical and mental health.

The result is impressive: 4 out of 5 homeless people will be able to keep their flat for a long time with “Housing First” and lead a more stable life.

In the last 10 years, the “Housing First” programme provided 4,600 homes in Finland. In 2017 there were still about 1,900 people living on the streets – but there were enough places for them in emergency shelters so that they at least didn’t have to sleep outside anymore.

Providing people with apartments is cheaper than leaving them on the street

Creating housing for people costs money. In the past 10 years, 270 million euros were spent on the construction, purchase and renovation of housing as part of the “Housing First” programme. However, Juha Kaakinen points out, this is far less than the cost of homelessness itself. Because when people are in emergency situations, emergencies are more frequent: Assaults, injuries, breakdowns. The police, health care and justice systems are more often called upon to step in – and this also costs money.
In comparison, “Housing First” is cheaper than accepting homelessness: Now, the state spends 15,000 euros less per year per homeless person than before.

No miracle cure – but a high success rate

With 4 out of 5 people keeping their flats, “Housing First” is effective in the long run. In 20 percent of the cases, people move out because they prefer to stay with friends or relatives – or because they don’t manage to pay the rent. But even in this case they are not dropped. They can apply again for an apartment and are supported again if they wish.

Of course, there is no guarantee for success. Especially homeless women are more difficult to reach: They conceal their emergency situation more often: They live on the streets less frequently and rather stay with friends or acquaintances.

Original Source/Author:  Kontrast.at/Kathrin Glösel 

Know the Risks of Marijuana

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Marijuana use comes with real risks that can impact a person’s health and life.

Marijuana is the most commonly used illegal substance in the U.S. and its use is growing. Marijuana use among all adult age groups, both sexes, and pregnant women is going up. At the same time, the perception of how harmful marijuana use can be is declining. Increasingly, young people today do not consider marijuana use a risky behavior.

But there are real risks for people who use marijuana, especially youth and young adults, and women who are pregnant or nursing. Today’s marijuana is stronger than ever before. People can and do become addicted to marijuana.

“Approximately 1 in 10 people who use marijuana will become addicted. When they start before age 18, the rate of addiction rises to 1 in 6.”

Know the risks before you use.

Marijuana Risks

Marijuana use can have negative and long-term effects:

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Brain health: Marijuana can cause permanent IQ loss of as much as 8 points when people start using it at a young age. These IQ points do not come back, even after quitting marijuana.

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Mental health: Studies link marijuana use to depression, anxiety, suicide planning, and psychotic episodes. It is not known, however, if marijuana use is the cause of these conditions.

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Athletic Performance: Research shows that marijuana affects timing, movement, and coordination, which can harm athletic performance.

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Driving: People who drive under the influence of marijuana can experience dangerous effects: slower reactions, lane weaving, decreased coordination, and difficulty reacting to signals and sounds on the road.

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Baby’s health and development: Marijuana use during pregnancy may cause fetal growth restriction, premature birth, stillbirth, and problems with brain development, resulting in hyperactivity and poor cognitive function. Tetrahydrocannabinol (THC) and other chemicals from marijuana can also be passed from a mother to her baby through breast milk, further impacting a child’s healthy development.

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Daily life: Using marijuana can affect performance and how well people do in life. Research shows that people who use marijuana are more likely to have relationship problems, worse educational outcomes, lower career achievement, and reduced life satisfaction.