Use of illicit drugs, alcohol and tobacco in Spain and Portugal during the COVID-19 crisis in 2020 as measured by wastewater-based epidemiology

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 9