On 27 April 2020, The Guardian reported that, “Across Australia, the COVID-19 crisis has prompted a seismic reckoning in addiction medicine”. Sensationalist headline or an accurate reflection of the impact of COVID-19 restrictions on substance use?
Jokes abound on social media about increased alcohol consumption, home schooling forcing “the teachers” to drink; 9.00 am ‘happy hours’ and the advent of the quarantine cocktail aptly named “The Quarantini”. While the jesting nature of these memes can incite a giggle, an epidemic of arguably equal force to COVID is continuing to brew. I say continuing, because these problems existed in our homes long before COVID. Social distancing and isolation measures have exacerbated an already existing epidemic.
As the restrictions placed on the community unfold, the potential for harms associated with alcohol and other drugs is increased. In the wake of other mass traumas, such as natural disasters (including the recent bushfires) we have observed an overall increase in substance use. In addition to the effect that the lockdown has had on the overall population, individual stressors such as loss of employment, home schooling, caring for vulnerable people and even just the mere uncertainty and lack of control over the situation is placing people under stress.
This stress is one of the biggest driving forces that leads to an increase in substance use.
For people who use drugs and alcohol, reduced or non-existent supply (due to closed borders and limited travel) and limited access to drugs during the pandemic have led people to substitute their drugs of choice or to change their patterns of use. Failure to access their usual supply is forcing many into withdrawal. There has been an increased demand for opioid replacement therapy and a surge in the number of people seeking inpatient withdrawal services.
The provision of health care services, within an already overloaded system, has been challenged and health workers have had to respond quickly to the changing conditions and requirements implemented by both State and Federal Governments to prevent the spread of COVID-19. This has placed a burden on all healthcare workers, especially those who already deal with vulnerable groups. The capacity of Public Hospital inpatient withdrawal services has decreased due to social distancing requirements, and access to residential rehabilitation has virtually ceased all together. Fellowship groups such as AA and NA have moved online.
Front line health care workers are encouraged to screen for substance use disorders now more than ever and a number of screening tools are available (e.g. CAGE and AUDIT). Being aware of support services available to people who use drugs and alcohol is also important, as is timely referral to an appropriate service.
Consultation drug and alcohol liaison services exist in most Public Hospitals. The St Vincent’s Hospital Drug and Alcohol Specialist Advisory Service (DASAS) is a free telephone service for health professionals in NSW to call. DASAS provides a 24/7 service which advises on clinical diagnosis and management of patients with alcohol and other drug related problems. The service is available on 02 9361 8006 (Sydney metropolitan) and 1800 023 687 (Regional and Rural NSW).
Australian States and Territories operate local alcohol and other drug telephone services that offer support, information, counselling and referral services for individuals, family and friends, health care workers and business/community groups. The National Alcohol and Other Drug hotline can be reached on 1800 250 015. This service will automatically direct callers to the alcohol and other drug information service in the appropriate State or Territory.