Change in substance use patterns and behaviors due to COVID-19 and related restrictions among patients seeking treatment for substance use

Abstract

Background: Coronavirus disease 2019 (COVID-19) and related restrictions have affected individuals with opioid use disorders who are on treatment by affecting the opioid agonist treatment services worldwide. The study aimed to assess the changes in substance use patterns and associated behaviors among the patients on buprenorphine maintenance treatment (BMT) due to the first wave of COVID-19 in India (March–September 2020). Materials and Methods: The cross-sectional observational study was conducted in a community-based drug treatment center situated in northern India serving a slum population. Male opioid-dependent patients (n = 94), maintained on BMT for at least a year before the start of the COVID-related restrictions in India, were assessed for use of illicit opioids, diverted opioid agonist medications and other psychoactive substances, lapses, compliance to BMT, high-risk behaviors, socio-occupational and mental health, and impact of COVID-19 by comparing it with the immediate pre-COVID period (September 2019–February 2020). Result: There was no significant increase in the use of illicit opioid use, spending on illicit opioids, and lapse rate. Though treatment break was seen in 39.4% of subjects at the start of the COVID-19 restrictions, the proportion of those abstinent from illicit opioids remained constant. No significant increase in the use of illegally diverted buprenorphine and other substance use was noted. More than half (56.4%) of the patients abstained from all substances (excluding tobacco). However, a significantly higher proportion of participants reported financial loss, unemployment, and frequent anxiety and depressive symptoms during the COVID period. Conclusion: The study demonstrated that despite the restrictions, continuing treatment service can help retain patients, keep them abstinent, prevent other high-risk behaviors, and help them tide over economic hardships.