How COVID-19 is affecting the vulnerable heroin using population
by Natasha Hall
The heroin-using population is a vulnerable group during the COVID-19 pandemic. Physical distancing measures, which may lead to solo injecting and a reduced heroin supply, which may lead to substitution of more potent drugs, have the potential to increase the risk of fatal and non-fatal overdose in this population.
The supply of heroin has been reduced during the COVID-19 pandemic. This is due to a reduction in precursor product availability from China and the closure of borders between countries. (1) However, heroin use and addiction will continue throughout the pandemic. In fact, due to physical distancing and the closure of many recreational, social, public and community spaces, the determinants which contribute to addiction such as social isolation, unemployment and poverty are heightened, and the heroin using population becomes more vulnerable. In 2001, when there were heroin shortages in Australia, heroin was substituted for other drugs such as cocaine, methamphetamine and benzodiazepines, which have less fatal overdose risk. (2) However, in the last few years there has been a more potent substitute street drug for heroin, known as fentanyl. This increased potency means that small amounts of the drug can be transported by drug traffickers more easily and smaller doses can lead to fatal overdoses.
Fentanyl use is contributing to the opioid crisis in the United States and fentanyl is on the rise in Australia. From 2013 to 2015, fentanyl use out of the Sydney Medically Supervised Injecting Room (MSIR) increased by 1000%; heroin use increased by 70%. (3) Secondly, although the MSIRs in Sydney and Melbourne remain open during the pandemic, physical distancing rules in other parts of Australia may force heroin users to inject alone, increasing their risk of fatal overdose. (4)
In the United States the negative effects of COVID-19 on the opioid-using population are already being seen. The Next Harm Reduction group found a 300% increase in its opioid overdose reporting system in March 2020. (5) A huge increase like this will put significant strain on the already stretched emergency departments and ambulance services.
The COVID-19 pandemic has created a new crisis for injecting drug users which we, as public health professionals, must understand and address if we are to prevent otherwise avoidable deaths among this vulnerable population. Continual monitoring of fentanyl use, opioid overdoses and keeping harm reduction programs open are prudent to ensure the COVID-19 pandemic does not worsen the opioid epidemic.
- Hamilton K. Sinaloa Cartel Drug Traffickers Explain Why Coronavirus Is Very Bad for Their Business. Vice News. 2020 26/03/2020. https://www.vice.com/en_au/article/bvgazz/sinaloa-cartel-drug-traffickers-explain-why-coronavirus-is-very-bad-for-their-business (accessed 20/04/2020)
- Degenhardt L, Day C, Dietze P, et al. Effects of a sustained heroin shortage in three Australian States. Addiction. 2005;100(7):908-20.
- Latimer J, Ling S, Flaherty I, et al. Risk of fentanyl overdose among clients of the Sydney Medically Supervised Injecting Centre. International Journal of Drug Policy. 2016:111.
- Davidson PJ, McLean RL, Moss AR, et al. Fatal Heroin-Related Overdose in San Francisco, 1997-2000: A Case for Targeted Intervention. Journal of Urban Health. 2003;80(2):261-73.
- Mallin A. Officials worry of potential spike in overdose deaths amid COVID-19 pandemic. ABC news. 2020 15/04/2020. https://abcnews.go.com/US/officials-worry-potential-spike-overdose-deaths-amid-covid/story?id=70149746 (accessed 20/04/2020)
Author profile: Natasha is a PhD candidate in Deakin University’s School of Health and Social Development. She works in the area of opioid use disorder and focuses on management and treatment of opioid use disorder, including the barriers to accessing treatment.