COVID-19 in India: Vulnerable migrant population and an added menace of substance abuse.

COVID-19 pandemic has affected more than 10.9 million and killed more than 1.5 lacs people in India (on February 11, 2021). The country resorted to a nationwide lockdown to prevent the spread of COVID-19. Differential impact of COVID-19 and lockdown resulted in mass unemployment, economic fallout, indebtedness, homelessness, poverty, mental health crisis, and substance abuse. COVID-19 has disproportionally affected the poor as lockdown brought immense economic distress causing many workers to lose livelihood and shelter, ultimately resulting in a mass exodus to their native place.

Findings of recently published articles on the mental health of migrant laborers[1] and the industrial impact of COVID-19[2] are quite significant. Apart from the issues raised in these articles, there is an urgent need to address substance abuse and associated risks among India's migrant population. Daily wage seasonal migrant workers are among the most vulnerable, marginalized, and adversely affected community groups who experience social exclusion, discrimination, inequality, and have poor access to education and public schemes, which render them more prone to stress, strain, and mental disorders leading to increased dependency on psychoactive substances (tobacco – 53.9%, alcohol – 46.5%, and cannabis – 8.9%).[3]

COVID-19 has substantially aggravated preexisting psychological conditions and contributed to increased substance use (cannabis – 63% and alcohol – 71.7%) reported by a global survey.[4] Lockdown affected supply-chain of nonessential items (also liquor and tobacco), which lead to a shortage, high demand, and increased cost, thereby reduced access to chronic abusers. A similar shift in drug abuse behavior was observed during the 2008 global financial crisis, prominently because of the affected delivery of services.[5] There is a risk of a similar drug abuse trend due to COVID-19-induced drug supply changes. A recurring cycle of drug availability and shortage can have a catastrophic impact on the mental health of chronic abusers with possible self-harm behaviors and suicide attempts due to sudden withdrawal.[6] Reports suggest a 50% rise in the number of patients reporting to the emergency department for alcohol and drug withdrawal-related issues.[7] In India, studies found a significant surge in substance abuse cases and registrations in de-addiction centers for treatment since the outbreak.[8] Although there are only a few studies in the Indian context, we are closely monitoring the substance abuse (particularly cannabis abuse) cases postlockdown. Our group contacted the patients and private-run rehabilitation clinics to procure data on cannabis use disorder in the general population under an ongoing project, “To determine the impact of lockdown on patients with cannabis use disorder.” We have recorded an increased number of requests for registration in the rehabilitation program and elevated withdrawal symptoms observed among newly enrolled patients.

Due to the grave impact of pandemic restrictions on migrant workers, they are less likely to comply with public guidelines during future restrictions if any and might be at higher risk to substance abuse. For the management of drug abuse, we suggest strategies such as information collection of existing drug users, monitoring distressing cases and suicide attempts, and providing dedicated telepsychiatry services for migrant workers. In addition, the arrangement of mental health-care centers, transportation facilities, counseling, online training module, and training sessions by psychiatrists and psychologists would be beneficial.

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Conflicts of interest

There are no conflicts of interest.