The impact of heroin illicit market in the framework of COVID 19 pandemic

摘要

We read with interest the commentary of Tittarelli et al1 on the current diffusion of higher-purityheroin in Italy and related rise of overdose cases1. The author discussed not only recent increasing trendin drug purity, but also on the presence of adulterants rising drug toxicity2-11 and on the possible risk ofthe presence of new psychoactive substances as even more hazardous adulterants12. In the context of thiscommentary, some short remarks as to the impact of heroin illicit market in the framework of COVID 19pandemic can be of interest. Indeed, within the extremely serious health emergency that we have beenexperiencing since the beginning of 2020, the rules set by the authorities during “lock down” have led to asignificant drop in the street sale of psychotropic drugs. A scenario that opens up the hypothesis that drugusers are turning to the illicit market present in the “dark web”, to obtain classic drugs such as cocaine,hashish or heroin. It is plausible that in a period of home confinement, habitual consumers of drugs ofabuse no longer search for psychoactive substances stimulating socialization in recreational environmentssuch as cocaine, amphetamines or designer drugs, but rather for compounds to be consumed in solitudeto ease confinement anxiety such as tranquilizers (e.g. benzodiazepines) or narcotics (e.g. prescription orillicit opioids and heroin). In this concern, the US National Institute on Drug Abuse (NIDA), has also recentlyaddressed the problem COVID-19, publishing on its website a focus on the possible implications for peoplewith drug use disorders, with special attention to heroin users13. NIDA highlighted the determined role ofthe scientific community and its vigilance on the damage that the pandemic can cause to heroin users, asthey are more vulnerable due to the effects that this substance has on the respiratory apparatus. Peoplewho consume high doses of heroin and more in general of opioids for therapeutic reasons or becausethey have an addiction, face a number of problems and threats to their lung health14. Since opioids andspecifically heroin act on the brain stem and reduce respiratory rate, their consumption not only putsat risk of a fatal or potentially lethal overdose, but can also cause a dangerous reduction in the bloodoxygen levels potentially harmful to the central nervous system: while brain cells can withstand shortperiods of poor oxygen supply, they can be seriously damaged when the situation persists. Since severalestablished studies demonstrate how chronic lung disease increases the risk of overdose mortality forheroin users, the reduced lung capacity caused by COVID-19 can seriously endanger heroin consumers.Therefore, physicians should be prepared to monitor the possible adverse effects of heroin consumptionin the treatment of drug addicts with COVID-19. In conclusion, the rise of heroin consumption, which isreported internationally15, the concomitant increase in its purity, the possible presence of toxic adulterantsshould be seriously taken into consideration by health professional in charge of treating opiates addictsat risk of contracting COVID-19.