Background:
The COVID-19 pandemic coincided with the highest number of overdose deaths recorded in the US, significantly impacted by fentanyl’s widespread emergence in the street drug supply. The impact of COVID-related policies on drug market dynamics and overdose vulnerability, particularly in regions like Appalachian Kentucky with historically high overdose rates, remains unclear.
Methods:
We conducted semi-structured interviews with 58 participants – including people who use drugs (PWUD), harm reduction staff, and law enforcement personnel – who lived, worked, and/or used drugs in Appalachian Kentucky since at least October 2019. Interviews explored drug demand, availability, purity, and cost across three periods: pre-COVID (October 2019-February 2020), COVID onset (March-May 2020), and prolonged COVID response (June 2020-present). Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.
Results:
Participants, predominantly non-Hispanic, white individuals, reported methamphetamine as the dominant drug across all three periods. Fentanyl adulteration in heroin and methamphetamine supply largely emerged during COVID onset and increased during the prolonged response. Despite minor disruptions initially, drug price and availability remained stable overall. Drug sources and transaction locations remained largely the same, with increases in “dead drops”. Participants identified isolation and economic stimulus payments during onset as key factors increasing drug use frequency and quantity. All participants reported decreased police presence at onset.
Conclusion:
The local street drug market appears to have rapidly adapted to pandemic-driven supply challenges through increased fentanyl concentration in the supply. While fentanyl adulteration of the drug supply appears to have substantially increased overdose mortality, it is possible that heightened drug use frequency and quantity during COVID may have also played a role in elevated overdose vulnerability. More research is needed to understand how street drug market dynamics affect consumer vulnerability to guide improved public health strategies. |