Use o illici d ugs, alcohol and obacco in Spain and Po ugal du ing he
COVID-19 c isis in 2020 as measu ed by was ewa e -based epidemiology
And ea Es é ez-Dan a
a
,Lube usBijlsma
b
, Rica do Capela
c,d
, Ra ael Cela
a
, Albe o Celma
b
, Félix He nández
b
,
Unax Le xundi
e
, João Ma ias
,RosaMon es
a
, Go ka O i e
g,h,i,j,k
,Aile eP ie o
l,m
, Miguel M. San os
c,d
,
Rosa io Rodil
a,
⁎, José Beni o Quin ana
a,
⁎
a
Depa men o Analy ical Chemis y, Nu i ion and Food Sciences, Ins i u e o Resea ch on Chemical and Biological Analysis (IAQBUS), Uni e sidade de San iago de Compos ela, Cons an ino Candei a S/N,
15782 San iago de Compos ela, Spain
b
En i onmen al and Public Heal h Analy ical Chemis y, Resea ch Ins i u e o Pes icides and Wa e , Uni e si y Jaume I, A da Sos Bayna s/n, 12071 Cas ellón, Spain
c
CIMAR/CIIMAR, In e disciplina y Cen e o Ma ine and En i onmen al Resea ch, G oup o Endoc ine Dis up e and Eme ging Con aminan s, Uni e si y o Po o, A enida Gene al No on de Ma os s/n,
4450-208 Ma osinhos, Po ugal
d
FCUP-Depa men o Biology, Facul y o Sciences, Uni e si y o Po o, Rua Do Campo Aleg e, 4169-007 Po o, Po ugal
e
Bioa aba Heal h Resea ch Ins i u e, Osakide za Basque Heal h Se ice, A aba Men al Heal h Ne wo k, A aba Psychia ic Hospi al, Pha macy Se ice, c/Ala a 43, 01006 Vi o ia-Gas eiz, Ala a, Spain
Eu opean Moni o ing Cen e o D ugs and D ug Addic ion, 1249-289 Lisbon, Po ugal
g
NanoBioCel G oup, Labo a o y o Pha maceu ics, School o Pha macy, Uni e si y o he Basque Coun y UPV/EHU, Paseo de la Uni e sidad 7, Vi o ia-Gas eiz 01006, Spain
h
Biomedical Resea ch Ne wo king Cen e in Bioenginee ing, Bioma e ials and Nanomedicine (CIBER-BBN), Vi o ia-Gas eiz, Spain
i
Uni e si y Ins i u e o Regene a i e Medicine and O al Implan ology - UIRMI (UPV/EHU-Fundación Edua do Ani ua), Vi o ia-Gas eiz, Spain
j
Singapo e Eye Resea ch Ins i u e, The Academia, 20 College Road, Disco e y Towe , Singapo e
k
Bioa aba, NanoBioCel Resea ch G oup, Vi o ia-Gas eiz, Spain
l
Depa men o Analy ical Chemis y, Facul y o Science and Technology, Uni e si y o he Basque Coun y (UPV/EHU), Leioa, Basque Coun y, Spain
m
Resea ch Cen e o Expe imen al Ma ine Biology and Bio echnology (PIE), Uni e si y o he Basque Coun y (UPV/EHU), Plen zia, Basque Coun y, Spain
HIGHLIGHTS
•WBE was applied o s udy d ug use in 4
Spanish and 2 Po uguese loca ions.
•Gene ally, low impac obse ed on sub-
s ances use owing o COVID-19 es ic-
ions
•The main excep ion was a no able de-
c ease in cocaine use in Cas ellón (Spain).
•High consump ion o amphe amine in he
Basque Coun y
•Two MDMA (ecs asy) dumping e en s
in o he sewage ne wo k de ec ed
GRAPHICAL ABSTRACT
ABSTRACTARTICLE INFO
Gues edi o : Phong Khanh Thai The COVID-19 pandemic sp ead apidly wo ldwide in he yea 2020, which was ini ially es ained by d as ic mobili y
es ic ions. In his wo k, we in es iga ed he use o illici d ugs (amphe amine, me hamphe amine, ecs asy, cocaine
and cannabis), and lici subs ances o abuse (alcohol and obacco) du ing he ea lie mon hs (Ma ch–July 2020) o
he pandemic es ic ions in ou Spanish (Bilbao and i s me opoli an a ea, Vi o ia-Gas eiz, Cas ellón and San iago
de Compos ela) and wo Po uguese (Po o and Vila do Conde) loca ions by was ewa e -based epidemiology (WBE).
The esul s show ha no me hamphe amine was de ec ed in any o he loca ions moni o ed, while amphe amine
use was only de ec able in he wo loca ions om he Basque Coun y (Bilbao and i s me opoli an a ea and Vi o ia-
Keywo ds:
D ugs o abuse
Nico ine
E hanol
Was ewa e su eillance
Science o he To al En i onmen 836 (2022) 155697
⁎Co esponding au ho s.
E-mail add esses: osa io. [email protected] (R. Rodil), jb.quin [email protected] (J.B. Quin ana).
h p://dx.doi.o g/10.1016/j.sci o en .2022.155697
Recei ed 23 Feb ua y 2022; Recei ed in e ised o m 27 Ap il 2022; Accep ed 30 Ap il 2022
A ailable online 4 May 2022
0048-9697/© 2022 The Au ho s. Published by Else ie B.V. This is an open access a icle unde he CC BY license (h p://c ea i ecommons.o g/licenses/by/4.0/).
Con en s lis s a ailable a ScienceDi ec
Science o he To al En i onmen
jou nal homepage: www.else ie .com/loca e/sci o en
Gas eiz), wi h high es ima ed a e age usage a es (700–930 mg day
−1
1000 inhabi an
−1
). The emaining subs ances
we ede ec ed in all he in es iga ed ca chmen a eas. Ingene al, no ema kable changes we e oundin popula ion no -
malized loads compa ed o o me yea s, excep o cocaine (i.e. i s main me aboli e, benzoylecgonine). Fo his d ug,
a no able dec ease in use was disce nible in Cas ellón, while i s usage in Po o and San iago de Compos ela
seemed o con inue in a ising end, al eady ini ia ed in o me yea s. Fu he mo e, wo e en s o ecs asy
(3,4-me hylenedioxyme hamphe amine, MDMA) dumping in he sewage ne wo k we e confi med by enan io-
me ic analysis, one in San iago de Compos ela jus p io he lockdown and he second one in he Bilbao and
i s me opoli an a ea in July a e elie ing he mo e s ingen measu es. The la e could also be associa ed
wi h a police in e en ion. The compa ison o WBE wi h (web) su ey da a, which do no p o ide in o ma ion
a a local le el, poin s owa ds con adic o y conclusions o some o he subs ances, he eby highligh ing he
need o s able WBE ne wo ks capable o nea eal- ime moni o ing d ug use.
Co ona i us
Lockdown
1. In oduc ion
COVID-19 is an in ec ious illness caused by he i us SARS-CoV-2 cha -
ac e ized by dis up ing no mal immune esponses (Yang e al., 2020),
which has sp ead wo ldwide and has caused o e 6 million dea hs
(Adam, 2022). Due o he apid ansmission o he i us in ea ly 2020,
mos coun ies imposed lockdowns and pe ime e closu es, a ec ing
mobili y, and limi ing essen ial ac i i ies. Subsequen ly, he closu e o
ba s, pubs, clubs, es au an s e c. changed he way alcohol and obacco
we e pu chased, which could ha e a ec ed hei use. The obliged sel -
isola ion p oduced a change in ou li es yle ha could ha e had a psycho-
logical impac on human heal h (B ooks e al., 2020) and encou aged he
use o ce ain subs ances, like alcohol o pha maceu icals, a home (Rehm
e al., 2020;San omau o, 2021). As ega ds o illici d ugs, hese es ic ion
measu es ha e had an impo an impac on he logis ics o d ugs a ficking
(Eu opean Moni o ing Cen e o D ugs and D ug Addic ion, 2020a).
Despi e his, access o hem has no been o ally a ec ed since, new dis i-
bu ion s a egies ha e been adop ed o o e come he es ic ions, such as
he use o da kne ma ke s (Eu opean Moni o ing Cen e o D ugs and
D ug Addic ion, 2020b).
Di e en su eys ha e been unde aken in o de o assess he use o il-
lici and/o lici subs ances du ing he COVID-19 pandemic (Callinan
e al., 2020;Eu opean Moni o ing Cen e o D ugs and D ug Addic ion,
2020c;Obse a o io Español de las D ogas y las Adicciones, 2020a).
Howe e , such me hods a e no , on hei own, able o cap u e he eal im-
pac o he pandemic o e d ug use (Palama and Acos a, 2020). The
analysis o was ewa e can gi ean addi ional and ep esen a i e es ima ion
o human consump ion o lici and illici subs ances du ing he pandemic.
This me hodology, known as was ewa e based epidemiology (WBE), uses
was ewa e as an anonymized, in eg a ed and dilu ed sample o u ine o a
pa icula loca ion o ob ain comp ehensi e esul s, which can be hen
comple ed wi h su eys esul s ( an Wel e al., 2016). WBE has been suc-
cess ully used in s udying spa ial and empo al di e ences o illici d ug
use (Bijlsma e al., 2021;González-Ma iño e al., 2020;Zucca o e al.,
2005). Since 2010, The Eu opean Moni o ing Cen e o D ugs and D ugs
Addic ion (EMCDDA) (Eu opean Moni o ing Cen e o D ugs and D ug
Addic ion, 2021), h ough he Sewage Analysis Co e g oup Eu ope
(SCORE), is ca ying ou an annual moni o ing o illici d ug use in many
Eu opean ci ies (SCORE, 2021), whe e di e en consump ion ends ha e
been obse ed among Eu opean coun ies (González-Ma iño e al., 2020).
A Spanish le el, he ESAR-Ne (www.esa ne .es) ne wo k has also been es-
ablished o coo dina e Spanish WBE ac i i ies in close coope a ion wi h
he Spanish Plan Nacional Sob e D ogas and di e en o he ins i u ions
(Bijlsma e al., 2018, 2021;Es é ez-Dan a e al., 2021a;López-Ga cía
e al., 2020;Mon es e al., 2020).
Nowadays, he scope o WBE has been ex ended o many applica ions,
such as he es ima ion o alcohol and obacco consump ion (Cas iglioni
e al., 2014;López-Ga cía e al., 2020;Mon es e al., 2020;Rod íguez-
Ál a ez e al., 2015) and he human exposu e o chemicals such as plas i-
cize s (Es é ez-Dan a e al., 2021b;González-Ma iño e al., 2017;Lopa do
e al., 2019), pes icides (Rousis e al., 2016)o flame e a dan s (Been
e al., 2017). Recen ly, WBE was employed in many coun ies o de ec
SARS-CoV-2 (Bi ins e al., 2020;Lundy e al., 2021). WBE has also been
used o measu e he impac o he COVID-19 pandemic on illici d ug and
pha maceu icals use in Aus alia (Bade e al., 2020, 2021), Ty ol (Aus ia)
(Reins adle e al., 2021), A hens (G eece) (Alygizakis e al., 2021), Cen al
I aly (Di Ma can onioe al., 2022), and in 7 ci iesac ossEu ope(Beene al.,
2021).
In his wo k he impac o he COVID-19 pandemic in 2020 on he use o
fi e illici d ugs (amphe amine (AMP), me hamphe amine (MAMP), ec-
s asy (3,4-me hylenedioxyme hamphe amine, MDMA), cocaine (COC)
and cannabis), obacco and alcohol in ou Spanish and wo Po uguese lo-
ca ions was in es iga ed by WBE. Was ewa e samples du ing he ini ial
lockdown ( om Ma ch 2020) un il a e he mos s ingen measu es
we e elie ed (July 2020, he ein deno ed “New No mal”, see below) in
o de o ollow he ends in use and compa e i wi h da a om o me
yea s.
2. The COVID-19 lockdown in Spain and Po ugal
Fig. 1 ou lines he imeline o he COVID-19 pandemic, he was ewa e
sampling campaign and he di e en le els o es ic ions in he s udied
a eas o Spain and Po ugal om Janua y o July 2020.
2.1. Spain
The fi s case o SARS-CoV-2 was de ec ed on 31 Janua y 2020 in The
Cana y Islands (Wo ld Heal h O ganiza ion, 2020a). Due o he as expan-
sion on he subsequen weeks, he au ho i ies decla ed he s a eo ala m on
15 Ma ch 2020 and imposed a lockdown, whe e only essen ial ac i i ies
we e pe mi edand mo emen was es ic ed o buy g oce ies and o he es-
sen ial goods, seek medical a endance, e c. Du ing Ma ch, cases con inued
o ise wi h a peak on 31 Ma ch 2020. In he ollowing weeks, cases and
dea hs ollowed a dec easing pa e n un il 11 May 2020, when he qua an-
ine ended. F om ha day on, he measu es we e s a ed o be loosened
(di ided in h ee phases), allowing he g adual opening o ba s, es au an s,
pubs and finally he in e - egional mobili y a he end o June, which was
o ficially called “New No mal”. In Spain, was ewa e sampling was
pe o med in he pe iod be ween 10 Ma ch 2020 o 14 July 2020, depend-
ing on he pa icula loca ion sampled. Fu he de ails a e p o ided in
Sec ion 3.2 and Table S1.
2.2. Po ugal
The fi s case o SARS-Co -2 was de ec ed on 2 Ma ch 2020 in Po o
(Wo ld Heal h O ganiza ion, 2020b). On 16 Ma ch 2020, schools we e
closed and wo days la e , on 18 Ma ch 2020, he Eme gency S a e was de-
cla ed, and Po ugal was placed unde a s ic lockdown. Du ing he consec-
u i e weeks, new cases and dea hs dec eased un il 2 May 2020, when he
qua an ine ended. The so-called s a e o calami y (Es ado de Calamidade),
di ided in h ee phases s a ed he same day, whe e g adually, ec ea i e
cen e s, ac i i ies e c. we e opened un il ea ly June. F om hen, es ic ions
we e wi hd awn and his s age is also e med he e “New No mal”,asan
analogy o he Spanish defini ion, and since such e m ha has been widely
used o desc ibe pas se ling a e a c isis, including COVID-19 c isis
(Ahls om e al., 2020;Be wick, 2020). Was ewa e samples we e collec ed
A. Es é ez-Dan a e al. Science o he To al En i onmen 836 (2022) 155697
2
om 19 Ap il 2020 o 24 July 2020 in Po ugal. Fu he de ails a e p o-
ided in Sec ion 3.2 and Table S1.
3. Ma e ial and me hods
3.1. Chemicals and eagen s
Indi idual solu ions o 1 mg mL
−1
o AMP, MAMP, MDMA, COC,
benzoylecgonine (BE), 11-no -9-ca boxy- e ahyd ocannabinol (THC-
COOH), co inine (COT) and ans-3′-hyd oxyco inine (OH-COT), and
0.1 mg mL
−1
o hei deu e a ed analogues (AMP-D
6
,MAMP-D
5
, MDMA-
D
5
, COC-D
3
,BE-D
3
, THC-COOH-D
9
,COT-D
3
and OH-COT-D
3
)usedas
su oga e in e nal s anda ds (ISs), we e supplied by Ce illian (Round
Rock, TX, USA). Sodium sal s o E hyl-Sul a e (E S) and i s deu e a ed
analogue (E S-D
5
) we e supplied by San a C uz Bio echnology (San a
C uz, CA, USA). Indi idual solu ions o 1 mg mL
−1
o he S-(+) enan iome
o AMP, MAMP and MDMA we e supplied by Me ck (Da ms ad ,
Ge many).
LC-MS g ade me hanol (MeOH), LC-MS g ade ace ic acid, LC-MS g ade
o micacid, ammonia (NH
3
) solu ion in wa e (25%), e abu ylammonium
b omide (TBA, 99%) and β-Glucu onidase ( om Helix poma ia, ype H2)
we e supplied by Me ck. Sodium ace a e and sodium chlo ide we e ob-
ained om Fluka (S einheim, Ge many). Ul apu e wa e was ob ained
wi h a Genie Wa e Sys em om RephiLe Bioscience (Bos on, MA, USA).
3.2. Was ewa e samples collec ion
Composi e24-h awinfluen was ewa e was sampled a he en anceo
six was ewa e ea men plan s (WWTPs) co e ing ou Spanish loca ions
(San iago de Compos ela, Bilbao and i swhole me opoli an a ea, Cas ellón
and Vi o ia-Gas eiz) and wo Po uguese ci ies (Po o and Vila do Conde)
om Ma ch o July 2020. In addi ion, samples om one week in 2019
we e also analyzed o San iago de Compos ela, Bilbao and i s me opoli an
a ea and Cas ellón.
Table S1 compiles sampling da es and flow a es o each indi idual
sample, he cha ac e is ics o he WWTPs and sampling mode. A ime-
p opo ional sampling mode was employed in all ci ies. Fu he da a om
2017 and 2018 (and 2019 in he case o Po o) we e ob ained om he li -
e a u e (Bijlsma e al., 2021;Eu opean Moni o ing Cen e o D ugs and
D ug Addic ion, 2021;González-Ma iño e al., 2020;López-Ga cía e al.,
2020;Mon es e al., 2020).
3.3. Sample ea men and LC-MS/MS me hod
Analyses o illici d ugs we e pe o med a Uni e si y Jaume I
(Cas ellón samples) o a he Uni e si y o San iago de Compos ela (all e-
maining samples), a e solid-phase ex ac ion and LC-MS/MS analysis as
desc ibed elsewhe e (Bijlsma e al., 2014;González-Ma iño e al., 2018).
These wo me hods a o d me hod limi s o quan ifica ion (MQL) in he
2 (BE) –100 (AMP) and 1.2 (MDMA) –64 (AMP) ng L
−1
ange, espec-
i ely, and sa is ac o y eco e ies in spiked was ewa e (77–124% and
95–121%, espec i ely, RSD alues ≤16% in bo h cases). Besides, bo h lab-
o a o iespa icipa ed and sa is ac o ily passed he in e lab s udy o ganized
by he SCORE Ne wo k in 2020, which wa an s good pe o mance and
compa abili y o he esul s ( an Nuijs e al., 2018).
Some selec ed samples we e also submi ed o an enan iome ic analysis
as desc ibed in Es é ez-Dan a e al. (2021a). This me hodology ende s
MQLs in he 2–5o 4–8ngL
−1
(please no e ha hey e e o pu e enan io-
me s) and eco e ies in was ewa e in he 82–116% ange (RSD ≤15%) o
66–125% ange (RSD ≤17%), depending on whe he he SPE being used
was he one om he Uni e si y o San iago de Compos ela o Uni e si y
Jaume I, espec i ely, see Es é ez-Dan a e al. (2021a) o u he de ails.
Analyses o E S (e hanol bioma ke ) and COT and OH-COT (nico ine
bioma ke s) we e all pe o med a he Uni e si y o San iago de
Compos ela by di ec injec ion-LC-MS/MS, a e enzyma ic deconjuga ion
o nico ine me aboli es, as de ailed in Rod íguez-Ál a ez e al. (2014a,
2014b). These wo me hods p o ide eco e ies wi h spiked sewage in he
92–112% ange (RSD ≤7%) and MQLs in he 200–600 ng L
−1
ange.
3.4. Es ima ion o loads and human use
Concen a ions o each pa icula bioma ke (compiled in Table S2)
we e used o de e mine popula ion-no malized daily loads (compiled in
Table S3) o each compound in he 24 h composi e was ewa e samples,
(Eq. (1)). Human consump ion a es (p esen ed in Table S4) we e hen
es ima ed (Eq. (2)) by using he co ec ion ac o (CF) alues: 2.77
(AMP), 2.3 (MAMP), 4.4 (MDMA), 3.59 (COC consump ion om BE) as
p oposed in G acia-Lo e al. (2016), 3.41 (nico ine consump ion om
COT) and 1.90 (nico ine consump ion om OH-COT), whose alues
whe e hen a e aged o each sample as p oposed in Mon es e al. (2020);
Rod íguez-Ál a ez e al. (2014b) and 3047 (E S) as p oposed in
Rod íguez-Ál a ez e al. (2015). Al hough a ecen s udy in Aus alia
(Thai e al., 2021) p oposed a highe CF (4000) o E S, based on sale
Fig. 1. Timeline summa y o he COVID-19 pandemic es ic ions in he pe iod Janua y–July 2020 in he s udied a eas. Da es p esen ed as mon h/day/yea .
A. Es é ez-Dan a e al. Science o he To al En i onmen 836 (2022) 155697
3
s a is ics, ha would accoun o in-sewe deg ada ion, ou o me na ion-
wide s udy (López-Ga cía e al., 2020) in Spain showed a good ma ch o
WBE da a ob ained wi h he CF 3047, compa ed o su eys on use o
sales. Besides, he useo he same CF as p e iously applied in o me s udies
in Spain wa an s a be e compa abili y o da a. Fo THC (cannabis) calcu-
la ions om THC-COOH, wo CF alues we e used: 182 which de i es only
om THC-COOH and 36.4, which de i es om he po en ial con e sion o
hyd oxy-THC o THC-COOH, as discussed in de ail in Bijlsma e al., (2021).
In he case o e hanol, use was ansla ed o L day
−1
1000 inhabi an
−1
by
conside ing i s densi y.
Daily loads ¼Concen a ion Flow a e 1000=Popula ion ð1Þ
Human use ¼Daily loads CF ð2Þ
3.5. De e mina ion o enan iome ic ac ion
Enan iome ic analysis was ca ied ou o AMP and MDMA enabling he
measu emen o he concen a ion o enan iome s (C
R
o he R(−)-enan-
iome and C
S
o S(+)-enan iome ) in andomly selec ed samples and
hose showing anomalous ( oo high) loads o MDMA (see Sec ion 4.1.2).
These we e used o de i e he enan iome ic ac ion (EF), which was hen
employed o en a i ely di e en ia e be ween lici (p esc ip ion) o illici
(abuse) consump ion and di ec dumping in he sewage ne wo k. In his
wo k, EF is p esen ed as EF
R
, i.e. he a io be ween he concen a ions o
he R(−)-enan iome and he sum o bo h enan iome s (Eq. (3)).
EFR¼CR=CRþCS
ðÞ (3)
The ob ained EF
R
alues a e p esen ed in Table S5.
3.6. S a is ical analysis
Da a we e plo ed wi h Mic oso Excel 365 and R ggplo 2 package.
S a is ical di e ences (α= 0.05) in he empo al pa e n wi hin each loca-
ion and conside ing all he di e en yea s and lockdown phases un il New
No mal we e assessed by a K uskal-Wallis es , wi h a pos -hoc Bon e oni
co ec ion, by using he so wa e S a g aphics Cen u ion 18.
4. Resul s and discussion
Figs. 2–7show he e olu ion o he subs ance di ided in ou phases:
WBE da a om p e ious yea s, lockdown pe iod, less s ingen measu es
(compiling all h ee phases) and New No mal. Mo eo e , a mo e de ailed
di ision acco ding o he di e en de-escala ion phases, as de ailed in
Sec ion 2 and Fig. 1, and o me yea s is shown in he Supplemen a y In o -
ma ion (Figs. S1–S6).
Table 1 compiles he mos ele an WBE s udies on he impac o
COVID-19 on he use o d ugs (Alygizakis e al., 2021;Bade e al., 2020,
2021;Been e al., 2021;Di Ma can onio e al., 2022;Eu opean Moni o ing
Cen e o D ugs and D ug Addic ion, 2020a;Reins adle e al., 2021),
whe eas he mos ele an in e na ional, o ela ed o Spain and/o
Po ugal, epo s elying on (web) su eys, and, o a mino ex en , o he in-
dica o s a e p esen ed in Table 2 (Eu opean Moni o ing Cen e o D ugs
and D ug Addic ion, 2020c;Global D ug Su ey, 2021;Obse a o io
Español de las D ogas y las Adicciones, 2020a, 2020b).
4.1. Illici d ugs use
4.1.1. Amphe amine and me hamphe amine
MAMP emained below he de ec ion limi s in all samples. This is
consis en wi h o me s udies in Eu ope and Spain (Bijlsma e al., 2021;
González-Ma iño e al., 2020), whe e he WBE-de i ed consump ion es i-
ma es we e ypically e y low wi h ew excep ions. In ac , in a o me
s udy whe e samples om 13 Spanish ci ies we e collec ed du ing a week
in Sp ing 2018 (Bijlsma e al., 2021), a e age MAMP loads we e below
5 mg day
−1
1000 inhabi an
−1
excep in Mad id (ca. 13 mg day
−1
1000
inhabi an
−1
)andBa celona(ca.48mgday
−1
1000 inhabi an
−1
).
Du ing 2020, AMP was de ec ed in his s udy, bu only in Bilbao and i s
me opoli an a ea and Vi o ia-Gas eiz (es ima ed a e age consump ion:
703 and 928 mg day
−1
1000 inhabi an
−1
, espec i ely, Table S4), bo h lo-
ca ions belong o he Spanish egion o he Basque Coun y, being below
me hod de ec ion limi s in he emaining loca ions (Table S2). These find-
ings confi m ou o me s udies in he a ea o Bilbao, whe e a high con-
sump ion o AMP was obse ed (mean ca. 700–800 mg day
−1
1000
inhabi an
−1
,in2018–2019 (Bijlsmae al.,2021;Es é ez-Dan a e al.,
2021a)), and illus a e no di e en end due o COVID-19 measu es
(Figs. 2 and S1). The s a is ical analysis confi med ha he e was no
s a is ical di e ence (Table S6) be ween he di e en pe iods o he
s udy, including o me yea s in he case o Bilbao and i s me opoli an
a ea. Fu he mo e, hese findings also poin o he ac ha AMP use is
Fig. 2. Violin plo s summa izing he WBE-de i ed consump ion o AMP in Bilbao and i s me opoli an a ea(BIL), Vi o ia-Gas eiz(VIT) andbo h loca ions (all). The ho izon al
line andbluedo s and smalle black do s ep esen hemedian, mean and indi idual da apoin s, espec i ely. Coding: PY(p e ious yea s, in g een), LD(lockdown, in pu ple),
RLD ( elaxed phase I-III lockdown, in o ange), NN(newno mal,in yellow). N.B.: loga i hmic scale; AMP was belowMDL in he emaining loca ions. Fu he de ailed plo s a e
p esen ed in Fig. S1.
A. Es é ez-Dan a e al. Science o he To al En i onmen 836 (2022) 155697
4
no a local issue in Bilbao and i s me opoli an a ea, bu a egional beha -
iou , which will posi ion he consump ion o AMP in he Basque Coun y
a le els close o hose ound in cen al Eu ope, e.g. Belgium, The
Ne he lands and some pa s o Ge many (González-Ma iño e al., 2020).
Da a om his egion ag ee wi h gene al-popula ion su eys (GPS), as
ega ds he ac ha AMP consump ion is highe in his egion as compa ed
o he es o Spain, bu WBE es ima ions indica e ha such di e ence is
la ge o wha GPS epo , as al eady discussed in o me s udies (Bijlsma
e al., 2021;Es é ez-Dan a e al., 2021a). Besides, he enan iome ic analysis
confi med a sligh en ichmen o R(−)-AMP in he was ewa e o bo h lo-
ca ions, wi h EF
R
alues highe han 0.5 (Table S5). This is cohe en wi h
da a om o me yea s in he a ea o Bilbao and poin ing o illici consump-
ion, aking in o accoun also p esc ip ion figu es o ela ed pha maceu i-
cals, which in hese wo loca ions would ep esen less han 1% o AMP
loads in was ewa e (Es é ez-Dan a e al., 2021a). On he o he hand, his
enan iome ic me hod is mo e sensi i e (MQL o AMP isome s is 5–8ng
L
−1
) ha he egula one. Thus, EF
R
alues could be calcula ed o all sam-
ples subjec o his me hod excep hose om Cas ellón and one o he
samples om San iago de Compos ela. Fu he mo e, EF
R
alues we e
mo e a iable, pa icula ly in San iago de Compos ela, which may indi-
ca e ha p esc ip ion o pha maceu icals may be a sou ce o amphe -
amine in his loca ion (Es é ez-Dan a e al., 2021a), al hough
concen a ions emain low (ca. 5–10 ng L
−1
).
O he WBE s udies (Alygizakis e al., 2021;Been e al., 2021;Eu opean
Moni o ing Cen e o D ugs and D ug Addic ion, 2020a;Reins adle e al.,
2021)compiledinTable 1 show a mixed pic u e, wi h ci ies exhibi ing di-
e gen ends as compa ed o he p e-COVID-19 e a. Besides, he EMCDDA
epo on he impac o COVID-19 (Eu opean Moni o ing Cen e o D ugs
and D ug Addic ion, 2020a) which includes WBE da a om 29 loca ions
in Eu ope indica es ha AMP consump ion was eco e ed (o e en in-
c eased) when he lockdown measu es we e eased. All hese WBE da a do
no ag ee, howe e , wi h web-su eys (Table 2), pa icula ly o Spain
(Obse a o io Español de las D ogas y las Adicciones, 2020a), which
seem o poin owa ds a dec ease in AMP use. Ye , he Global D ug Su ey
(which does no include Spanish no Po uguese da a (Global D ug Su ey,
2021)), poin ed owa ds a ce ain le el o subs i u ion o AMP by MAMP
Fig. 3. Violin plo s summa izing he WBE-de i ed consump ion o MDMA in Cas ellón (CAS), San iago de Compos ela (SAN), Bilbao and i s me opoli an a ea (BIL), Vi o ia-
Gas eiz (VIT), Po o (POR) and Vila do Conde (VDC) and all loca ions (all). The ho izon al line and blue do s and smalle black do s ep esen he median, mean and
indi idual da apoin s, espec i ely. Coding: PY (p e ious yea s, in g een), LD (lockdown, in pu ple), RLD ( elaxed phase I-III lockdown, in o ange), NN (new no mal, in
yellow). N.B.: loga i hmic scale. Fu he de ailed plo s a e p esen ed in Fig. S2.
Fig. 4. Violin plo s summa izing he WBE-de i ed consump ion o Cocaine in Cas ellón (CAS), San iago de Compos ela (SAN), Bilbao and i s me opoli ana ea(BIL), Vi o ia-
Gas eiz (VIT), Po o (POR) and Vila do Conde (VDC) and all loca ions (all). The ho izon al line and blue do s and smalle black do s ep esen he median, mean and
indi idual da apoin s, espec i ely. Coding: PY (p e ious yea s, in g een), LD (lockdown, in pu ple), RLD ( elaxed phase I-III lockdown, in o ange), NN (new no mal, in
yellow). N.B.: loga i hmic scale. Fu he de ailed plo s a e p esen ed in Fig. S3.
A. Es é ez-Dan a e al. Science o he To al En i onmen 836 (2022) 155697
5
du ing lockdown, which was also obse ed in a WBE s udy in Innsb uck
(Aus ia) (Reins adle e al., 2021). Howe e , his end was no obse ed
in his s udy.
4.1.2. MDMA
MDMA was de ec ed in he six s udied ci ies. The exc e ion loads o
MDMA in 2020 anged om 0.8 o 60 mg day
−1
1000 inhabi an
−1
(Table S3), wi h wo no able excep ions: San iago de Compos ela on
Ma ch 12 (i.e. 3 days p io he lockdown) and Bilbao and i s me opoli an
a ea on July 9 (i.e. New No mal), which esul ed in o calcula ed loads o
309 and 306 mg day
−1
1000 inhabi an
−1
, espec i ely. Hence, hese
wo ( oge he wi h o he andomly selec ed) samples we e subjec ed o en-
an iome ic analysis. A sligh en ichmen o R(−)-MDMA was ound in he
was ewa e , wi h EF
R
in he 0.54–0.72 ange, excep hese wo samples,
whose EF
R
was 0.48 (San iago de Compos ela) and 0.51 (Bilbao)
(Table S5). This shi in o EF
R
owa ds a acemic mix u e combined wi h
highe loads sugges a disposal o MDMA in he sewe ne wo k (Es é ez-
Dan a e al., 2021a;Vazquez-Roig e al., 2014), simila ly o ha epo ed
by Emke e al. in The Ne he lands (Emke e al., 2014). Gi en his obse a-
ion, hese wo e en s we e no conside ed o calcula ing a e age loads
(Table S3) no o consump ion back-calcula ion (Table S4). In he case o
he me opoli an a ea o Bilbao he finding was also consis en wi h
media epo s (e.g. (EITB.EUS, 2020;El Dia io Vasco, 2020)) om July
2020 epo ing a police ac ion aking place on he p e ious day whe e a
d ug a ficking o ganiza ion was disman led. No media news we e ound
ela ed o he case o San iago de Compos ela, bu i happened a ew days
be o e he lockdown was in place, when many people we e mo ing o
hei home owns/weekend se les and police was expec ed o con ol
mobili y.
Conside ing he loads on hose wo days ela ed o disposal e en s and
a e age loads in was ewa e in San iago de Compos ela and Bilbao and
i s me opoli an a ea unde no mal ci cums ances (Table S3), we could cal-
cula e he disposed amoun , which would ansla e in o 39 and 247 g o
pu e MDMA in he e en in San iago de Compos ela and Bilbao and i s me -
opoli an a ea, espec i ely. This would co espond o ei he 204 able s o
47.6 g o MDMA c ys al (San iago de Compos ela) and ei he 1372 able s
Fig. 5. Violin plo s summa izing he WBE-de i ed consump ion o THC ( ecalcula ed om TH-COOH wi h a CF o 182) in Cas ellón (CAS), San iago de Compos ela (SAN),
Bilbao and i s me opoli an a ea (BIL), Vi o ia-Gas eiz (VIT), Po o (POR) and Vila do Conde (VDC) and all loca ions (all). The ho izon alline and blue do s and smalle black
do s ep esen he median, mean and indi idual da apoin s, espec i ely. Coding: PY (p e ious yea s, in g een), LD (lockdown, in pu ple), RLD ( elaxed phase I-III lockdown,
in o ange), NN (new no mal, in yellow). N.B.: loga i hmic scale. Fu he de ailed plo s a e p esen ed in Fig. S4.
Fig. 6. Violin plo s summa izing he WBE-de i ed consump ion o nico ine in Cas ellón (CAS), San iago de Compos ela (SAN),Bilbao and i s me opoli an a ea(BIL),Vi o ia-
Gas eiz (VIT), Po o (POR) and Vila do Conde (VDC) and all loca ions (all). The ho izon al line and blue do s and smalle black do s ep esen he median, mean and
indi idual da apoin s, espec i ely. Coding: PY (p e ious yea s, in g een), LD (lockdown, in pu ple), RLD ( elaxed phase I-III lockdown, in o ange), NN (new no mal, in
yellow). N.B.: loga i hmic scale. Fu he de ailed plo s a e p esen ed in Fig. S5.
A. Es é ez-Dan a e al. Science o he To al En i onmen 836 (2022) 155697
6
o 305 g o MDMA c ys al (Bilbao and i s me opoli an a ea), conside ing
an a e age con en o 180 mg able
−1
o MDMA and 81% pu i y o
MDMA c ys al (Bijlsma e al., 2021). These figu es could be, howe e ,
unde es ima ed, since hey assume ha all MDMA was dissol ed in he
ansi om he disposal si e o he WWTP whe e wa e was collec ed,
bu hismayno be ue.
The ex apola ed MDMA consump ion (a e excluding he wo di ec
disposal e en s) is summa ized in Fig. 3 ( u he de ails in o Fig. S2 and
Table S4). The highes consump ion le els we e ound in Po o (mean:
105 mg day
−1
1000 inhabi an
−1
) while he lowes consump ion was de-
e mined in Cas ellón (mean: 15 mg day
−1
1000 inhabi an
−1
), less han
a hi d o 2019 use in his ci y (mean: 54 mg day
−1
1000 inhabi an
−1
)
Fig. 7. Violin plo s summa izing he WBE-de i ed consump ion o e hanol in Cas ellón (CAS), San iago de Compos ela (SAN), Bilbao and i s me opoli an a ea(BIL), Vi o ia-
Gas eiz (VIT), Po o (POR) and Vila do Conde (VDC) and all loca ions (all). The ho izon al line and blue do s and smalle black do s ep esen he median, mean and
indi idual da apoin s, espec i ely. Coding: PY (p e ious yea s, in g een), LD (lockdown, in pu ple), RLD ( elaxed phase I-III lockdown, in o ange), NN (new no mal, in
yellow). N.B.: loga i hmic scale. Fu he de ailed plo s a e p esen ed in Fig. S6.
Table 1
Compila ion o WBE s udies on he impac o COVID-19 on subs ances o abuse, which include da a om be o e COVID-19.
Re e ence (Reins adle
e al., 2021)
(Been e al.,
2021)
(Alygizakis
e al., 2021)
(Di Ma can onio e al.,
2022)
(Eu opean Moni o ing
Cen e o D ugs and D ug
Addic ion, 2020a)
(Bade e al., 2021)(Bade e al., 2020)
Geog aphical
scope
Aus ia
(Innsb uck, ca.
175,000 inhabi-
an s)
Eu ope (7 ci ies
om 4 coun-
ies)
G eece (A hens,
ca. 4 million
inhabi an s)
I aly (2 WWTPs om he
cen e o he coun y, ca.
800,000 inhabi an s)
EMCDDA epo ,
including WBE om
se e al Eu opean ci ies
Aus alia (20 loca ions, ca.
47% Aus alian popula ion)
Aus alia (Adelaide
a ea, ca. 1.1 million
inhabi an s)
Tempo al
scope
Lockdown
(Ma ch–Ap il
2020)
Lockdown
(1 week in
Ma ch–Ap il
2020)
Lockdown
(2 weeks in
Ma ch–Ap il
2020)
Lockdown-“New No mal”
(23 samples in o al in
Ma ch–Decembe 2020)
Lockdown (LD) and “New
no mal”(NN)
Lockdown (1 week in Ap il
2020) and “New No mal”
(1 week in June 2020)
Lockdown (1 week
in Ap il 2020)
Amphe amine Sligh dec ease Did no change
(3 loca ions)
Dec ease
(1 loca ion)
Inc ease –Did no change (13 ci ies
LD, 11 NN)
Dec ease (11 LD, 5 NN)
Inc ease (5 LD, 13 NN)
––
MDMA Dec ease Did no change
(4 loca ions)
Dec ease
(2 loca ions)
Dec ease –Did no change (9 ci ies
LD, 11 NN)
Dec ease (23 LD, 14 NN)
Inc ease (7 LD, 12 NN)
Did no change (7 s a es)
Dec ease (1 s a es)
–
Cocaine Did no change Did no change
(2 loca ions)
Inc ease
(1 loca ion)
Dec ease
(4 loca ions)
Inc ease Inc ease Did no change (5 ci ies
LD, 13 NN)
Dec ease (18 LD, 1 NN)
Inc ease (7 LD, 14 NN)
Did no change (6 s a es)
Dec ease (2 s a es)
–
Cannabis Did no change Did no change
(4 loca ions)
Did no change –Did no change (8 ci ies
LD, 6 NN)
Dec ease (4 LD, 4 NN)
Inc ease (4 LD, 7 NN)
Did no change (1 s a e)
Inc ease (7 s a es)
–
Tobacco Did no change –Dec ease ––– –
Alcohol Dec ease –– – Did no change (6 NN)
Dec ease (4 NN)
Inc ease (6 NN)
Did no change (5 s a es)
Dec ease (3 s a es)
Dec ease
A. Es é ez-Dan a e al. Science o he To al En i onmen 836 (2022) 155697
7
(Eu opean Moni o ing Cen e o D ugs and D ug Addic ion, 2019)
(Table S4). No s a is ical di e ence was app ecia ed in MDMA consump-
ion in Bilbao and i s me opoli an a ea, San iago de Compos ela, Vi o ia-
Gas eiz and Vila do Conde in he s udied pe iod (Table S6, see also
Fig. S2 and Fig. 3), which includes o me yea s only in he wo fi s loca-
ions. Con e sely, his was no he case o Cas ellón and Po o (Table S6).
Howe e , he pos -hoc es de ec ed only significan di e ences in Cas ellón
be ween 2019 (when consump ion was a i s maximum in his loca ion,
pa icula ly du ing he weekend) and Phase I; and, in Po o, be ween
2017 (lowes measu ed consump ion in ha loca ion, wi hou obse able
weekend peak)and Phase III (Fig. S2). The e o e, and conside ing he o e -
all pic u e p esen ed in Fig. 3, we may conclude ha o e all, MDMA con-
sump ion emained s able in he conside ed pe iod.
In e es ingly, hese findings con as bo h wi h on-line su eys and ex-
pe in o ma ion (Table 2), which indica e an o e all dec ease in MDMA
consump ion du ing he lockdown. Howe e , he conclusions om o he
WBE s udies (Table 1) di e om loca ion o loca ion, bu he o e all
end du ing he lockdown was also owa ds a dec ease o no change in
MDMA consump ion as compa ed o o me yea s in he s udied a eas.
Howe e , consump ion seemed o eco e in hose places a e lockdown
elaxa ion in Eu ope (Eu opean Moni o ing Cen e o D ugs and D ug
Addic ion, 2020a).
4.1.3. Cocaine
Bo h cocaine and i s me aboli e, benzoylecgonine we e de ec ed in all
samples (Table S2). The a io o cocaine o benzoylecgonine was calcula ed
as i may indica e a di ec disposal e en when abo e 1 (Bijlsma e al., 2012;
Pos igo e al., 2010). In his s udy, he a io was ≤0.8 in all samples, wi h
a e ages anging om 0.2 (Vila do Conde) o 0.6 (Bilbao and i s me opol-
i an a ea). Also, in he da es and loca ions o he wo MDMA dumping
e en s (see Sec ion 4.1.2), his a io was calcula ed o be 0.3 (San iago de
Compos ela) and 0.7 (Bilbao and i s me opoli an a ea), wi hou a spike
in cocaine concen a ion no a io being obse ed. Al oge he , his da a
poin s o he ac ha no significan cocaine dumping occu ed in 2020.
The a e age calcula ed consump ion o cocaine om benzoylecgonine,
summa ized in Fig. 4 ( u he de ailed in Fig. S3 and Table S4), was simila
o ha ound in o me yea s (mean be ween 783 and 2503 mg day
−1
1000
inhabi an
−1
)(González-Ma iño e al., 2020), excep o Cas ellón, whe e
he consump ion was lowe (mean: 437 mg day
−1
1000 inhabi an
−1
), as
compa ed o mean alues in 2017–2019 (mean: 1064–2565 mg day
−1
1000 inhabi an
−1
). No s a is ical di e ences among he di e en ime-
pe iods conside ed we e ound in Vi o ia-Gas eiz o Vila do Conde, whe e
da a om o me yea s we e no a ailable, nei he o Bilbao and i s me o-
poli an a ea (Table S6), whe e da a we e a ailable o one week in 2018
and 2019. Howe e , s a is ical di e ences we e obse ed in San iago de
Compos ela, Cas ellón and Po o (Table S6). The pos -hoc es could no de-
ec any s a is ical pai wise di e ences among pe iods in San iago de
Compos ela, howe e , he da a plo ed in Figs. 4 and S3 poin s owa ds a
sus ained end o inc easing use o cocaine, which was no dis up ed by
COVID-19 mobili y es ic ions. As ega ds Cas ellón, di e ences be ween
2017 and he lockdown pe iod and be ween 2019 (when measu ed cocaine
consump ion was a i s highes le el) and all sample subse s om 2020 con-
fi m he obse able decline in cocaine consump ion in his loca ion (Fig. S3,
Fig. 4, Table S6). Con e sely, in Po o, pai wise s a is ical di e ences we e
ob ained among 2017 and he elaxed lockdown pe iod (Phases I–III), and
be ween 2018 and Phase III (Table S6), bu in his case he end obse ed is
comple ely he opposi e o Cas ellón and simila o San iago de
Compos ela, i.e. a end o sus ained inc ease in cocaine consump ion
along he yea s, which could no be impai ed by he COVID-19 es ic ions
(Fig. S3 and Fig. 4).
Al hough su ey da a seem o indica e ha cocaine consump ion de-
c eased du ing he lockdown (Table 2) and e en a e he lockdown
( om a Spanish phone su ey) (Obse a o io Español de las D ogas y las
Adicciones, 2020b), WBE da a om o he publica ions (Table 1) show a
Table 2
Main epo s based on (web) su eys on he impac o COVID-19 on subs ances o abuse.
Re e ence (Global D ug Su ey, 2021)(Eu opean Moni o ing
Cen e o D ugs and D ug
Addic ion, 2020c)
(Obse a o io Español de las D ogas y las
Adicciones, 2020a)
(Obse a o io Español de las D ogas y las
Adicciones, 2020b)
O e all
desc ip ion
Global D ug Su ey Special Edi ion
on COVID-19. Web su ey o ca.
55,000 esponde s being epo ed
EMCDDA Eu opean Web
Su ey on D ugs (EWSD)
wi h 10,600 esponde s
Spanish OEDA epo based on a subse o he
EMCDDA EWSD, by conside ing only he 991
Spanish esponde s, o he web su eys and sou ces
Spanish OEDA elephonic su ey wi h 8780
esponde s. Only he esponde s in he 15–64
yea s ange (7886) a e conside ed he e
b
Geog aphical
scope
11 coun ies wi h o e 1000
esponde s (no including Spain no
Po ugal)
Eu ope (including Spain
and Po ugal)
Spain Spain
Tempo al
scope
May–June 2020 Lockdown- elaxed
lockdown
Lockdown- elaxed lockdown Ma ch–Decembe 2020
Amphe amine Change in equency: 35% dec ease;
45% did no change; 20% inc ease
O e all dec ease
a
Change in amoun : 40% dec ease; 52% did no
change; 8% inc eased
a
–
MDMA Change in equency: 42% dec ease;
46% did no change; 13% inc ease
O e all dec ease Change in amoun : 40% dec ease; 55% did no
change; 5% inc eased
–
Cocaine Change in equency: 39% dec ease;
41% did no change; 21% inc ease
O e all dec ease Change in amoun : 49% dec ease; 46% did no
change; 5% inc eased
0.3% ini ia ed o inc eased consump ion;
0.4% did no change; 0.9% dec eased o
s opped consump ion
Cannabis Change in equency: 22% dec ease;
39% did no change; 39% inc ease
Non-conclusi e (mixed
pic u e)
Change in amoun : 31% dec ease; 43% did no
change; 26% inc eased
2.2% ini ia ed o inc eased consump ion;
2.8% did no change; 3.5% dec eased o
s opped consump ion
Tobacco ––10.8% inc eased; 73.5% did no change; 12.7%
dec eased o s opped consump ion
6.9% ini ia ed o inc eased consump ion;
15.3% did no change; 8.1% dec eased o
s opped consump ion
Alcohol Change in amoun : 21% dec ease;
42% did no change; 36% inc ease
Change in equency: 25% dec ease;
32% did no change; 43% inc ease
O e all inc ease O e all dec ease 5.5% ini ia ed o inc eased consump ion;
30.1% did no change; 28.7% dec eased o
s opped consump ion
a
Amphe amine and me hamphe amine a e g ouped unde he e m “amphe amines”in he EWSD (and Spanish subse ).
b
Please no e ha esponde s no consuming a subs ance ei he be o e no a e COVID-19 a e no included in his summa y, leading o sum o % lowe han 100%.
A. Es é ez-Dan a e al. Science o he To al En i onmen 836 (2022) 155697
8
mixed pic u e, highly dependen on he specific loca ion ha was in es i-
ga ed. Besides, again he EMCDDA s udy poin s owa ds a eco e y o co-
caine consump ion du ing lockdown elaxa ion (Eu opean Moni o ing
Cen e o D ugs and D ug Addic ion, 2020a). As ega ds he findings o
his s udy showing a pa icula ly di e en p ofile (dec ease o cocaine use
in Cas ellón only) may be associa ed o local dis ibu ion o s ock p oblems
due o es ic ion ha whe e mo e easily ci cum en ed in he emaining
loca ions.
4.1.4. Cannabis
Cannabis use was de ec ed in all ci ies in he o m o i s main me abo-
li e, THC-COOH. Consump ion le els we e es ima ed wi h wo di e en
co ec ion ac o s (see Sec ion 3.4), bu o simplici y only he calcula ions
wi h CF 182 a e p esen ed in o Fig. 5 (and Fig. S4), while calcula ions wi h
CF 36.4 a e p esen ed in o Table S4. Gi en ha se e al unce ain ies exi
a ound his compound, as de ailed elsewhe e (Bijlsma e al., 2021;
Causanilles e al., 2017), discussion will ocus on empo al ends a he
han spa ial ends and use es ima es. In his con ex , he s a is ical analysis
confi med he exis ence o empo al s a is ically di e ences in all in es i-
ga ed loca ions, excep Vila do Conde (Table S6). In he case o Bilbao
and i s me opoli an a ea, he s a is ical di e ence is due o he highe
loads o THC measu ed in 2018 espec i e subsequen pe iods (Fig. S4,
Table S6). Simila ly, in Cas ellón and San iago de Compos ela he
di e ences a e due o he ela i ely highe cannabis use es ima ed in
2019, whe eas in Vi o ia-Gas eiz di e ences a e ound be ween lockdown
and New No mal, and in Po o he e is no di e ence being s a is ically sig-
nifican in he pai wise pos -hoc es , bu a so o end owa ds mo e con-
sump ion du ing he pos -lockdown can be obse ed (Table S6, Fig. S4).
Al oge he , he e is no clea end on cannabis consump ion (Fig. 5).
Mo eo e , in his case, findings a e in line wi h o he WBE s udies showing
no change in cannabis consump ion o e en an inc ease (Table 1), which
also ag ee wi h (on-line) su eys (Table 2) whe e a ema kable change in
cannabis consump ion is no e y clea .
4.2. Alcohol and obacco
4.2.1. Nico ine
Nico ine consump ion is p esen ed in Fig. 6 (de ailed in Table S4 and
Fig. S5) as he a e age es ima ion om i s wo me aboli es (Mon es e al.,
2020;Rod íguez-Ál a ez e al., 2014b). In his case, da a om p e ious
yea s we e only a ailable o Cas ellón, San iago de Compos ela and Bilbao
and i s me opoli an a ea and o a limi ed numbe o yea s. Al hough he
p esence o nico ine me aboli es in was ewa e may also be due o smoking
cessa ion p oduc s o e-ciga e es, besides obacco smoking, hese o he
sou ces a e expec ed o be a he small in he case o Spain, as discussed
in Mon es e al. (2020).
Vi o ia-Gas eiz s ands ou wi h 2- old consump ion compa ed o he
o he ci ies sampled in 2020 (mean: 2654 mg day
−1
1000 inhabi an
−1
s. 1391–1674 mg day
−1
1000 inhabi an
−1
in he o he ci ies). The
highe usage a e in his loca ion may pa ially be due o he highe a -
iabili y and should be confi med in u u e s udies. Conside ing 0.8 mg o
nico ine being abso bed pe ciga e e (Mon es e al., 2020;Rod íguez-
Ál a ez e al., 2014b;S . Cha les e al., 2010), ha would ep esen
and a e age o 1.7–3.1 ciga e es day
−1
inhabi an
−1
, depending on
he loca ion sampled.
All loca ions showed s a is ical di e ences among pe iods, wi h he
excep ion o Vila do Conde (Table S6). In Cas ellón and Bilbao and i s me -
opoli an a ea, his was a ibu ed o a highe consump ion in2018 as com-
pa ed o some o he pe iods in 2020 (Table S6), sugges ing a sligh
dec easing end (Figs. 6 and S5). In San iago de Compos ela, he di e -
ences we e due o he low measu ed consump ion du ing he 5 p e-
lockdown days sampled as compa ed o Phases I and II o lockdown elax-
a ion (Table S6, Fig. S5), while in Vi o ia-Gas eiz he e was significan
lowe consump ion in New No mal as compa ed o lockdown, and in
Po o, he end was owa ds an inc ease om Phase I owa ds NewNo mal
(Table S6, Fig. S5).
The only wo WBE s udies conside ing obacco (Table 1) show con a-
dic o y conclusions (Alygizakis e al., 2021;Reins adle e al., 2021).
Thus, o e all, he pic u e is no conclusi e, bu poin s owa ds a mino
impac o COVID-19 on obacco. Al hough he e was a significan dec ease
in obacco sales in Ap il and June 2020 espec ing he same pe iod o he
o me yea (Fig. S7), su eys (Table 2) indica e only a ma ginal impac o-
wa ds a smalldec ease in consump ion o obacco (Obse a o io Español de
las D ogas y las Adicciones, 2020a, 2020b).
4.3. Alcohol
A e age e hanol consump ion in 2020 anged om 20 (Po o) o 28
(Vi o ia-Gas eiz)Lday
−1
1000 inhabi an
−1
(Table S4 and Figs. 7 and
S6), simila ly o a o me s udy which conside ed San iago de
Compos ela, Bilbao and i s me opoli an a ea and Cas ellón, pe o med
in 2018 (López-Ga cía e al., 2020). S a is ical di e ences we e ob-
ained only in Cas ellón and San iago de Compos ela, which in he
pos -hoc es could be a ibu ed o he lowes measu ed consump ion
in 2018 as compa ed o lockdown and New No mal in Cas ellón, and
when compa ing Phase I and New No mal in San iago (Table S6), o e -
all poin ing o a end o inc eased consump ion in he 3 yea s, sus ained
despi e he COVID-19 mobili y es ic ions. In Bilbao and i s me opoli-
an a ea consump ion o e hanol in 2018 and 2020 emained s able
(K uskal-Wallis p- alue: 0.59, no da a a ailable om 2019) and in gen-
e al, he consump ion did no change du ing he lockdown ill he New
No mal was eached (Figs. 7 and S6).
O he WBE s udies (Table 1) ei he poin owa ds a s able alcohol con-
sump ion o dec ease, which may also eco e ed a e he s ic lockdown
pe iod (Eu opean Moni o ing Cen e o D ugs and D ug Addic ion,
2020a). As ega ds o global and Spanish su ey epo s, di e gen esul s
we e shown (Table 2), poin ing owa ds an inc ease o dec ease a Global
o Spanish le el, espec i ely. O he publica ions conside ing su eys a
Spanish le el also poin owa ds an o e all decline in alcohol consump ion
(Kilian e al., 2021;Villanue a-Blasco e al., 2021a, 2021b), bu a he cos
o an inc ease in isky-consump ion (Villanue a-Blasco e al., 2021a). Ye ,
he da a om he panel (su ey) o domes ic consump ion o oods in
Spain (which includes alcoholic d inks) show a d ama ic inc ease o alco-
holic d inks being sold in supe ma ke s and simila shops (Fig. S8). This in-
c ease in alcohol being aken home does, howe e , no necessa y ansla e
in an inc eased consump ion, since alcohol consump ion a ba s, es au-
an s, e c. was se iously impai ed by es ic ions, and WBE s udies in
Aus alia seem o confi m his (Bade e al., 2020, 2021).
5. Concluding ema ks
In his wo k, we ha e s udied he use o illici d ugs, alcohol and o-
bacco by WBE du ing he ini ial mon hs (Ma ch–July 2020) o he pan-
demic in six loca ions in Spain and Po ugal. The o e all pic u e ob ained
poin s owa ds low impac o he COVID-19 mobili y es ic ions, pa icu-
la ly a e elie ing he mo e s ingen measu es. The only ema kable ex-
cep ion was he decline o cocaine consump ion in Cas ellón. O he WBE
published s udies showed e y inconsis en conclusions, highly dependen
on he loca ions unde s udy. Con e sely, web-su eys seem o poin o-
wa ds a clea educ ion o consump ion o AMP, MDMA and COC, bu no
so comp ehensible o he emaining subs ances. Ye , he Spanish s a is ics
on mo ali y ela ed o poisoning due o d ugs o abuse, egis e ed 974 s.
796 dea hs in 2020 and 2019, espec i ely (being 2020 he second highes
egis y in he pe iod be ween 2011 and 2020) (Ins i u o Nacional de
Es adís ica, 2020). This da a may be associa ed wi h an inc ease in p ob-
lema ic use and/o sa u a ion o eme gency se ices bu may also indica e
ha he decline on consump ion did no ake place.
Al hough he esul s o his s udy need o be in e p e ed wi h cau ion,
hey s ess he impo ance and need o a s able WBE ne wo k o d ug
use moni o ing ha can p o ide apid nea eal- ime da a o in o m policy
in e en ions in a pandemic con ex , as i has become a common p ac ice
o COVID-19 moni o ing i sel .
A. Es é ez-Dan a e al. Science o he To al En i onmen 836 (2022) 155697
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