COVID-19 & Drugs: a Conversation with EMCDDA

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EMCDDA Director Alexis Goosdeel shares how COVID-19 has affected the drug situation, the lessons learned and the role of professionals

EMCDDA Director Alexis Goosdeel

EMCDDA Director Alexis Goosdeel has been working in the field of public health at the national, European and international level for more than 30 years – photo: EMCDDA, all rights reserved

There has been a crucial actor in the field of drugs in the pandemic: the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The EMCDDA has reacted in a very proactive way, providing information and analysing  trends in the areas of drug use, the provision of drug-related services and the evolution of drug markets. Moreover, the agency has been one of the main voices  calling for more attention and support for addiction services in the times of COVID-19.

Alexis Goosdeel joined the EMCDDA in 1999 as project manager working in the area of EU enlargement and international relations. From 2005, he headed the agency’s Reitox and international cooperation unit. Mr Goosdeel has been  Director of the agency since 2016 and his mandate was recently renewed until 2025.


 

We know that the COVID-19 crisis disrupted the provision of addiction services in Europe. Which services were most affected and how did they cope with the situation?

As has been the case for many general healthcare providers during this public health crisis, drug services have needed to remain operational under restricted conditions. This has often required significant adaptations to established service delivery models.

A new EMCDDA briefing published in May — Impact of COVID-19 on drug services and help-seeking in Europe — provided insight into how services adapted and innovated during the fast-changing crisis. According to our preliminary findings, there was a decline in the availability of European drug services during the first two months of the pandemic, both those providing treatment and those providing harm reduction interventions. Drug services were generally affected in similar ways to other frontline health services.

In some countries or regions, drug services were reported to have been discontinued or closed down, including specialised outpatient and inpatient treatment services. In particular, services that were not able to implement the required national protection measures were closed in a number of countries. As face-to-face counselling and visits to clinics were generally stopped, or significantly reduce, from the start of containment measures, telemedicine by phone or video was widely embraced as an alternative across European drug services. This option was particularly implemented for treatment clients engaged in psychological counselling (such as for cannabis or cocaine users) as well as for first service contacts and long-term stable opioid substitution treatment (OST) clients.

Many residential treatment facilities, such as therapeutic communities, were reported to be following a similar approach to other non-drug-related residential care facilities, such as retirement homes. This included closing access to the programmes for new clients and a reduction in group activities within facilities. In most cases, external visits were suspended, and exits for clients finishing their therapeutic journey were delayed. A particular therapeutic challenge for residential drug services has been the need to reduce or stop interventions requiring social proximity or group therapy, which often constitute an important part of the therapeutic process in these facilities.

The EMCDDA study highlights how a wide range of adaptations and innovations were introduced by drug services in Europe. In some countries, both NGOs and civil society organisations were seen to be playing a particularly important role, specifically with regard to ensuring the continuity of frontline harm-reduction interventions.

What has been the role of the EMCDDA during this pandemic? How did the agency manage to gather reliable and updated information?

As an immediate response, the EMCDDA activated its business continuity plan and all staff began teleworking in mid-March. Shortly afterwards, we set up a taskforce on COVID-19 to coordinate scientific activities and related communication on the pandemic. Since March, we have moved many of our key activities online, including our experts’ network meetings, Management Board and Scientific Committee meetings, risk assessments on new psychoactive substances and the European Drugs Summer School.

Our role during the pandemic has been threefold: to ensure the availability of reliable and up-to-date information and resources on a complex and rapidly evolving situation; to assess the initial impact of the pandemic on the European drug situation, market and services; and to share timely information on both risks and best practice, where these are available.

As a first step, the agency rapidly published an online briefing in April on the Implications of COVID-19 for people who use drugs and drug service providers (which has been widely translated and viewed close to 40 000 times). An online COVID-19 resources hub was also established to provide access to key public health guidelines and policy documents in different languages. The full range of EMCDDA materials on COVID-19 can be found on a dedicated topics page.

A number of activities were set in motion in order to assess the impact of the pandemic on the drugs situation, markets and responses. An online version of the EMCDDA trendspotter methodology was used to rapidly assess the impact of COVID-19 on drug use, drug-related harms and drug services. Two trendspotter reports with pertinent findings were published within 6 weeks from start to finish: the first as mentioned above on the Impact of COVID-19 on drug services and help-seeking in Europe and the second on the Impact of COVID-19 on patterns of drug use and drug-related harms in Europe.

For these studies, data were collected from a wide range of European networks involved in the drugs field, including the national focal points of the Reitox network. This included multiple focus groups with European drug professionals, researchers and representatives of advocacy groups, including one virtual facilitated group of 10 Italian drug professionals, as these were in the eye of the COVID-19 storm at the time of study. In addition, we carried out a web survey among people who use drugs, with over 11 000 respondents, to collect information on changes in drug use patterns during confinement.

In addition, two studies were undertaken on the impact of COVID-19 on drug markets: one produced with Europol on EU Drug Markets: Impact of COVID-19 and the other on Drug supply via darknet markets.

Finally, in response to the situation, we were able to rapidly launch a series of COVID-19-related webinars, primarily geared towards practitioners working in the field, and focusing on topics including drug prevention, drug use and harms, services, policy and darknet markets.

EMCDDA Headquarters

EMCDDA Headquarters in Lisbon (Portugal) – image: Shutterstock

How do you envisage the drug situation after the COVID-19 pandemic in terms of demand and supply of drugs? What awaits us?

Regarding demand for drugs…

Firstly, the data currently available suggest that there have been some changes in drug consumption patterns during the initial phases of the COVID-19 pandemic in Europe, mostly resulting from the implementation of confinement and social distancing measures. There is an urgent need to continue to monitor developments in this area closely — especially with respect to the establishment of particularly damaging or risky patterns of use.

 

We can assume that it will be necessary to wait some months, if not years, for any medium- to longer-term implications to become clear. A more distant perspective may also enhance our understanding of whether the current disruption will have any long-lasting implications. With the easing of confinement measures and the gradual emergence of a new social reality, many uncertainties exist and a wide range of questions remains to be answered. For example, some people have abstained from, or decreased, drug use during the lockdown because of limited opportunities, reduced availability of drugs or difficulties accessing drugs. As restrictions are removed, access to drugs through the usual channels (e.g. known dealers, friends) may resume or not.

Regarding supply of drugs…

Our recent joint analysis with Europol on the immediate impact of COVID-19 on the EU drug market found higher prices, local shortages and reduced purity for some drugs, while noting continued violence among suppliers and distributors. But the situation continues to be subject to rapid change as the pandemic endures. Measures are being updated according local circumstances and needs across Member States (e.g. travel/traffic suspension, weekend bans, legal goods supply chain measures, border measures).

On the subject of the wholesale market, as highlighted in the published analysis, organised crime remained active and resilient during the early months of the pandemic by adapting transportation models, trafficking routes and concealment methods. Drug trafficking by maritime shipping continued at levels similar to the pre-pandemic period, although obviously smuggling by couriers using commercial aviation has been significantly affected. The movement of bulk quantities of drugs between EU Member States did not cease, despite the introduction of border controls, and was only temporarily disrupted mainly because the cross-border passage of licit goods was maintained and commercial goods continued to flow. The disruption to the logistics of drug supply in Europe is most evident at the retail distribution level, because of social distancing measures.

It is reasonable to expect that there will be residual restrictions on travel in place after the tightest restrictions are lifted. Air passenger transport will gradually increase but is unlikely to quickly go back to pre-COVID-19 levels. The international movements of drug traffickers and high-level members of organised crime groups (OCGs) within Europe to source and transit countries are currently limited because of the travel restrictions. Despite this, large-scale drug importations continue, presumably arranged through secure communication channels. In the post-pandemic period, there may be less reliance on face-to-face meetings at this level.

Drugs in Europe

As one-to-one encrypted communication services or social media apps are increasingly being used, monitoring and interdiction will become much more challenging – photo: Shutterstock, licence: CC

With street dealing severely limited by restrictions on movement, consumers and dealers increasingly turned to alternative methods (e.g. use of darknet markets, social media platforms and encrypted communication apps), with cashless payments and fewer face-to-face interactions. While the restrictions will gradually be lifted, it is very likely that some of the new practices will persist, as they may be a more convenient way to conduct business. An increase in the use of digital, communication and cyber-based technologies by drug trafficking organisations is expected.

This leads to the issue of the potential economic recession and the possible implications for the EU drug market. The long-term projections of negative economic consequences are likely to have an exaggerated effect on dependent drug users, potentially resulting in higher levels of drug-related (violent) crime; however, different communities, cities and countries are likely to see disproportionate manifestations of this. It is expected that much of the population will have less disposable income available and this may mean less money to buy drugs, especially as drugs are likely to become more expensive. This could lead users to increase their alcohol intake or seek out less expensive alternative substances, such as NPS or more damaging routes of administration, like injecting.

The longer-term effects of the COVID-19 pandemic are likely to have implications for the laundering of illicit drug proceeds; the likely economic downturn may lower barriers for engagement in corruption and other practices facilitating the drugs business. For example, cash-rich criminal organisations may take control of financially troubled legitimate businesses to further their criminal activities, either immediately or in the long term.

What are the lessons learned during this crisis and what changes could or should these lessons bring about in the near future?

Clearly, the exercise of collecting, analysing, understanding and interpreting data has little value if it does not allow us to learn lessons for the future. Only by doing this will we be better prepared for similar events. There are many lessons to be learned but undoubtedly the pandemic has revealed that we need to modernise our data collection, be able to produce evidence much faster and, very importantly, employ the new evidence to boost timely and proactive responses.

 

As one-to-one encrypted communication services or social media apps are increasingly being used, monitoring and interdiction will become much more challenging. A key question is whether more people will become used to new forms of purchasing their drugs and whether they will continue with these in the post-COVID-19 lockdown period.

The EMCDDA and Europol are working closely together to identify the lessons learned from the past, and from current situations, in terms of how we might better anticipate emerging threats and ensure that we act quickly to meet immediate and longer-term data needs to inform policy, decision-making and operational responses. There is now a critical need to identify areas where rapid adaptations to operational responses and future policies are required.

The EMCDDA issued a joint statement on 26 June (International day against drug abuse and illicit trafficking), with the Directors of Europol and the European Centre for Disease Prevention and Control. In it, they invite the EU institutions and Member States to carry out a number of measures ‘Learning the lessons from COVID-19 to strengthen the EU’s preparedness in the perspective of a possible new outbreak of the epidemic’. The statement concludes that: ‘The way in which the different services and authorities have been working together in the European Union in the times of this pandemic has shown that the “balanced approach” of the EU drugs policy has contributed to care and to protect, rather than to punish’.

As pointed out by the EMCDDA, addiction professionals have played an essential role during the pandemic. How do you think their role could be strengthened in the future?

One important lesson we have learned during the pandemic is the central role played by frontline drug professionals, alongside other health professionals in ensuring service continuity for their clients. However, in many European countries, drug workers were not prioritised as essential health workers and, as such, were not given access to adequate personal protective equipment (PPE) and tools. This urgently needs to be addressed at national level, particularly as we prepare for a possible second wave of the pandemic.

We also note that professionals are in direct contact with clients and can perceive changes and emerging problems even before they are captured by the data. For example, in the trendspotter study focus groups with front-line workers, we heard about the emerging needs of the most marginalised groups, such as the homeless, people without access to technology, people without regular contact with health services and victims of domestic violence.

Professionals at all levels — from those in health services and therapeutic communities to those active in outreach units — report having used their creativity and informal networks to better respond to the emerging needs. New ways of collaboration and experience-sharing across European professionals should be fostered. The EMCDDA hopes to support this in the future, whether through online platforms and training, webinars or other mechanisms to encourage multilingual interactions and exchanges among professionals at all levels.

Could you give any piece of advice for treatment service providers in Europe?

We are all still learning from this pandemic, which continues to evolve. What we have seen during the first phases of the emergency, is faster decision-making processes. Providers of opioid substitution treatment (OST) acted rapidly to change the way in which they provided medication (e.g. mobile OST) and responded to new treatment demands (e.g. new induction procedures), while most countries relaxed regulations on take-home OST for stable patients (e.g. prescribing for larger quantities or longer periods). Therapeutic communities quickly drew up protocols to ensure the safety of clients and of visiting relatives and, as mentioned, some counselling and therapies were delivered online. These changes now need to be evaluated to see whether they brought benefits to clients and could be maintained in the ‘new normal’.

On behalf of Dianova, we would like to thank Alexis Goosdeel and his team for their tireless work during the lasts months to face the pandemic by putting people at the centre and by supporting civil society organizations that work in the field of addictions.