The hidden footprint of the pandemic: A three-year analysis of the impact of COVID-19 confinements on substance addiction

Introduction

It has been studied how the COVID-19 pandemic led to higher rates of substance abuse and relapse. However, few longitudinal studies have been conducted to examine the clinical course of incident patients with substance use disorders (SUDs) in the context of the pandemic.

Aim

To assess the subsequent evolution of incident cases of SUD diagnosed during the confinements in the psychiatric emergency department.

Methods

Retrospective clinical information was obtained on all patients diagnosed with SUD in the psychiatric emergency department during the two confinements in Spain (N = 156). Sociodemographic characteristics and clinical variables related to consumption were extracted from electronic health records in the period 2020–2023. Clinical severity was established with the number of hospital admissions, emergency department visits and suicidal behaviors.

Results

Incidence was higher in men without previous psychiatric comorbidity. Patients in methadone maintenance therapy showed greater adherence to follow-up, although the group that achieved the longest abstinence were male cocaine users. In terms of dose, the prescription of antidepressants and antipsychotics increased, especially long-acting formulations. Greater clinical severity was observed in cocaine and polydrug users, as these were the groups with the highest number of suicide attempts. Finally, only half of the patients were followed up to the end of the 18-month observation period.

Conclusion

Delay in the first outpatient psychiatric follow-up visit, return to the emergency department and increased prescription of psychotropic medication were associated with greater clinical severity. Cocaine and polydrug use are an additional risk factor for suicidal behavior in this population.