The COVID-19 pandemic provoked community anxiety and stress-related disorders and increased drug-related emergency admissions and overdose deaths. The unprecedented disruption in transportation and stay-at-home orders caused a global disruption in the supply and distribution of drugs that impacted both prescription and illicit drug users. In this study, the trend in consuming 10 major illegal drugs and 19 prescription drugs of potential abuse was determined during the early four months of the COVID-19 pandemic in two communities in western Kentucky and northern Tennessee using wastewater-based epidemiology. The hydrocodone consumption rate increased by 72% (up to 430 mg/d/1000 people) in both communities that aligned with convenient opioid access through teleprescription-approved refills. However, a limited supply and a consequent increase in the cost of drugs significantly curtailed the consumption of illicit stimulants (methamphetamine, 16%; cocaine, 42%). Moreover, the increased use of benzodiazepines and antidepressants suggests elevated community anxiety that overall warrants robust neuropsychiatric screening and treatment programs. To the authors' knowledge, this is the first study to determine trends in consumption of diverse illicit and prescription drugs during the stay-at-home early months of the COVID-19 pandemic in United States communities.

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