By Fayaz Ahmad Paul
If you can quit for a day, you can quit for a lifetime (Benjamin Alire)
There is concern that the pandemic is having a negative impact on the mental health of the general population through a range of suggested mechanisms like fear, uncertainty, and anxiety, social distancing or social isolation, loneliness, and economic repercussions. Disasters such as the Severe Acute Respiratory Syndrome in 2003 contributed to increased anxiety, mood, and thought disorders, adjustment disorders, and post-traumatic stress disorders, resulting, in extreme cases, in suicidal behaviours examples are suicidal ideation, suicide attempts, and actual suicide, especially in cases of concomitant Substance use disorder. Various findings highlights that high levels of stress, isolation and unemployment due to the Covid-19 pandemic could cause up to 70,000 “deaths of despair” related to deaths to drug, alcohol, and suicide. High risk of mental illness was previously identified in individuals with existing or history of mental illnesses, but also vulnerable categories might be considered the elderly, children or adolescents, individuals from deprived areas and minority ethnicities.
Healthcare workers have been experiencing emotional overload due to several reasons, including both organizational issues relating to the shortage of suitable personal protective equipment, reduction in human resources and relentless work shifts, but also the burden developed by the fear of becoming infected and infecting relatives, high mortality rates, grieving the loss of patients and colleagues, separation from families. Those with Substance use disorder, who may experience changes in levels of drug use an increase is often seen as a reactive behaviour to negative impact of disasters; a shift to other substances if access to those previously used become limited; a relapse, if they had already recovered from alcohol/drug addiction. Risks of severe Covid and intensified mental health issues in people who use drugs include physical co-morbidity, e.g., lung or cardiovascular disease, HIV, viral hepatitis infections; psychological co-morbidity, example are, general distress, sleep disorders, anxiety, mood disorders, psychotic symptoms; and homelessness, incarceration, economic difficulties, and socioeconomic issues deriving from drug addiction.
The Covid-19 pandemic is already impacting drug markets, including shortages of numerous types of drugs at the street level, price increases for consumers on the black market and reductions in purity. Synthetic drugs’ availability, such as methamphetamine, is drastically reduced due to air travel restrictions and flight cancellations, while cocaine, mostly trafficked by sea, continues to be detected in various ports during the pandemic. Heroin and opioids seem to be pushed toward being trafficked along maritime routes. Finally, cannabis appears to be less available, due to restrictions on movement across regions and borders under coronavirus lockdown.
These disruptions are likely to grow and increase risks for people who use drugs, for example by increasing variability in drug purity, the likelihood of adulteration, and contamination of heroin supply with synthetic opioids, such as fentanyl. These issues can also encourage shifts to more at-risk drug using behaviours such as use of drugs such as street benzodiazepines, and synthetic cannabinoids. Additionally, the Covid-19 crisis is likely to increase the need to access drug treatment and services, e.g., extra demand for opioid substitution therapy and other medication. Access to drug services is being disrupted by self-quarantine, social distancing and other public health measures adopted for dealing with Covid-19. Similarly, community pharmacies are challenged by staff shortages, service disorganization, and self-isolation.
In response to the long-lasting and wide-ranging challenging effects of the pandemic, some harm-avoiding interventions have been adopted, including: more flexible take-home-medication treatment programmes for opioid addicted patients guidance for facilitating controlled substance prescribing; tele-health for monitoring drug-dependent patients; and access to virtual support groups through online meetings. During the Covid pandemic, tele-health has demonstrated to enable continuity of services, while protecting service providers from infection. However, in-person consultations are still needed for certain groups of patients where maintenance in treatment is at risk. Numerous Interventions addressing the health, psychological, and social effects of the pandemic are required.
Healthcare professionals like Psychiatric Social Workers and Clinical and Rehabilitation Psychologists have an important role in educating patients about the common psychological effects of a pandemic. Covid-19 together with general environmental factors, such as stress or trauma, may contribute to both a mental illness and a Substance Use disorders developing. A proactive approach to upscale our mental health care, emergency preparedness and response for people with Substance use disorder is urgently needed; mental health services should develop and evaluate clear remote assessment, care pathways for people at risk, psycho-education strategies, regarding self-harm/suicide, overdoses, and domestic violence and staff training to support new ways of working. Healthcare providers, including pharmacists, and public health policies are challenged to: develop strategies to implement prevention measures against transmission of Covid-19 in drug user’s settings.
Supporting healthcare workers with appropriate equipment, training on tele-health and caring for their safety with respect to protection against infection and spread of infection, preventing violence and burglary in drug treatment services, pharmacies would enable robust support against a possible mental health wave post-pandemic. Developing multidisciplinary support platforms could be helpful in reducing the mental distress due to misinformation and teaching problem-solving strategies to cope with the pandemic.
Fayaz Ahmad Paul Research Fellow in LGBRIMH Tezpur, Assam
