Cocaine and antidepressant use hits record high during the pandemic

Alarming data resulting from wastewater analysis in the Attica region were exclusively presented at the SNF DIALOGUES webcast “Substance Use: A Pandemic within a Pandemic,” on Wednesday, 21 April.

In the period between the beginning of the pandemic and March 2021, cocaine use appears to have tripled, according to data from the Analytical Chemistry Laboratory, University of Athens, which were based on wastewater analysis conducted at the Psyttalia Wastewater Treatment Plant (KELPS). “The increasing trend in cocaine use has been a concern to us since the first lockdown. In fact, back then, we’d agreed to keep on collecting samples on a daily basis for the whole of 2020, in order to monitor this phenomenon,” says Nikos Thomaidis, professor of Analytical Chemistry at the University of Athens, who has been analyzing the Greek capital’s wastewater for two decades now.

Wastewater-based epidemiology allows scientists to monitor, in near real-time, the use of drugs, medicine, and other products by the general population. The monitoring of psychotropic and narcotic substances in Attica’s wastewater started in 2010, just as Greece was signing its first bailout agreement, and continues to this day. Data analysis from this period suggests that social tensions and economic pressure contribute to the increased use of legal and illegal substances.

The data presented in the DIALOGUES, covering the period from 2010 to March 2021, show an alarming increase in cocaine consumption. Focusing specifically on the pandemic period, consumption levels amounted to 482 g/day in March 2019. By March 2020, when the first lockdown was imposed, this figure had nearly doubled (804 g/day), only to quadruple (1,837 g/day) later in the year, after the second lockdown was introduced in November. The rising trend continued well into March 2021, when consumption levels reached 2,396 g/day, five times the quantity detected in sewage water in March 2019. Looking at the data by year, 2020 marks the year with the highest levels of cocaine consumption since 2010.

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 “The increase in cocaine use during the first lockdown was linked to confinement and the first severe measures to control the coronavirus. We had hypothesized that the general decrease in activity might be correlated with an increase in the use of certain stimulants, like cocaine. Tellingly, the lifting of the restrictive measures was followed by a decline in use, but from September onwards, real-time wastewater analysis has indicated a resurgence in cocaine consumption, which coincides with an increase in drug seizures and arrests, not only in Greece but also Europe-wide. So it seems that the trafficking of this substance has possibly changed,” Thomaidis notes.

March 2021 saw the highest consumption of antidepressants compared to the year before the pandemic.

“The term ‘drugs’, which has become prevalent in the market, is inaccurate,” says Gerasimos Papanastasatos, sociologist and head of the KETHEA Research Department, who goes on to explain what the so-called psychotropic substances are. “In fact, psychoactive substances have the ability to interfere with and alter brain function. In this sense, they are not merely drugs. They can be stimulants, depressants, analgesics, hallucinogens, or sedative-hypnotics. Each of these categories has a completely different effect.”

Data on other substances, such as amphetamine and methamphetamine, also suggest increased use during the pandemic. Methamphetamine consumption, in particular, has been gradually increasing since 2010. This is an illicitly trafficked substance for which relatively low levels of use have been recorded in Greece compared to other European countries. However, there is a continuous increase in its use from year to year.

“To cope with the uncertainty of the pandemic, people are resorting to the certainty of the immediate effects induced by substance use,” says Thomaidis, who also points to alcohol consumption during the pandemic. “Regardless of whether this is connected to people with a drinking problem, alcohol sales appear to have skyrocketed all over the world. We are also seeing an increase in prescription drugs. We’re talking about antidepressants, but also anxiolytics and sedatives. There’s been a 30% increase, with consumption especially soaring at the beginning of the pandemic. The use of synthetic drugs also seems to have surged, hence the increased overdoses in the US, which is also true for methamphetamine use, given how the drug is made in trailers in the middle of nowhere,” explains Fred Muench, clinical psychologist and President of the Partnership to End Addiction in New York, highlighting the international dimension of the problem.

A sharp increase in consumption of antidepressants and sedatives

Equally alarming are the figures presented at the event regarding the use of sedatives and antidepressants, with March 2021 seeing the highest rate of antidepressant consumption compared to pre-pandemic levels, both in terms of popular sedatives (containing active ingredients such as oxazepam and alprazolam) and antidepressants as a whole.

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Oxazepam is a benzodiazepine that is mainly prescribed for the treatment of anxiety and is classified as a hypnotic/anxiolytic drug. Alprazolam is a similar substance, the use of which largely increased during the second wave of the pandemic. Prior to 2012, psychotropic substances belonging to these classes of drugs were detected in very small quantities in Athens’ wastewater. From 2012 to 2014, however, there was a dramatic change in the use of such drugs. According to professor Thomaidis, research conducted by the Analytical Chemistry Laboratory of the University of Athens at the time had shown that benzodiazepine use was systematically and strongly correlated with such socio-economic variables, as unemployment and income decline, among many others. This led the researchers to conclude that there is a direct link between what shows up in wastewater and the social, economic, and psychological/psychiatric status of the population.

Analysis of the data shows that oxazepam use almost doubled, with 1,056 g/day having been consumed in March 2020 and 1,843 g/day in March 2021. Similarly, the use of alprazolam, the most common sedating ingredient, has sharply increased, as shown in the graph above. The increase in antidepressant use is also rapid, with consumption levels amounting to 3,700 g/day in March 2019, 5,494 g/day in 2020, and 6,053 g/day in March 2021.

“The issue of substance abuse is not a moral one. The question is not about whether someone is committing a crime or not. Drug use is a personal choice, but drug abuse that turns into a habit isn’t always a choice,” says Gerasimos Papanastasatos, pointing to substance users and the issue of “next door users” – a common taboo topic. Upon discussing the feeling of uncertainty that plagues scientists and the subsequent impact it has on everyday life, Nikos Thomaidis opines: “If we realize that every crisis is dominated by uncertainty, we will be able to deal with any given situation differently. Life itself is full of uncertainty and if western societies manage to teach this to everyone, we might solve the addiction problem in the world, among many others.

The SNF DIALOGUES are curated and moderated by Anna-Kynthia Bousdoukou. The initiative is held through journalism nonprofit iMEdD (Incubator for Media Education and Development).