AMS Journal_Fall 2022_Vol 119, Issue 2 | Page 18

PUBLIC HEALTH RESEARCH

BY BALA SIMON , MD , DRPH , ^{1 , 2 , 3} AMIE LEIN , MS , CHES , TTS , ¹ ROBERT DELONGCHAMP , PHD ^{1 , 2}

1 Arkansas Department of Health 2 Department of Epidemiology , University of Arkansas for Medicine for Medical Sciences College of Public Health

3 Department of Family and Preventive Medicine , University of Arkansas for Medical Sciences College of Medicine , Little Rock , Arkansas

Introduction

On March 11 , 2020 , the World Health Organization ( WHO ) declared the COVID-19 a pandemic . On the same day , the first presumptive positive case of COVID-19 was identified in Pine Bluff , Arkansas . This eventually led to the identification of several more cases , numerous school and business closings , and the Governor of Arkansas Asa Hutchinson , declaring a state of emergency for the state . This historic pandemic , and related strategies aimed at stopping its spread caused stress , anxiety , depression , irritability , insomnia , anger , and symptoms of post-traumatic stress disorder . ^{1 , 2} Individuals who initiated substances had the highest levels of worry and fear related to the pandemic . In addition , individuals who had achieved sobriety prior to the beginning of the pandemic relapsed at a much higher rate than if they had never used a substance . ^{3 , 4}

Preclinical studies have established the key role stress plays in perpetuating drug abuse and relapse through a maladaptive response pathway . ⁵ The neurobiological mechanism of stress-related risk of addiction and vulnerability to addiction has been explained through the alterations on the corticostriatal-limbic motivational , learning , and adaptation systems that include mesolimbic dopamine , glutamate , and gammaamino-butyric acid ( GABA ) pathways . ⁶ These pathways explain role of stress in initiation or relapse in use of cigarette smoking , alcohol use , substances such as marijuana , and prescription drug misuse . ^7-10 In our study , we examined the trends in tobacco , alcohol , medical marijuana , and prescription opioid use during the COVID-19 pandemic in Arkansas .

Methods

To determine the extent of substance use , before , during , and after the COVID-19 pandemic , we utilized the monthly tobacco , alcoholic beverage , and medical marijuana sales tax data , and the number of opioid prescriptions by month for the period , January 2019 through January 2021 . Publicly available tobacco , alcoholic beverage , and medical marijuana sales tax data were downloaded from the Arkansas Department of Finance and Administration ’ s website . A descriptive analysis was performed on prescription opioid dispensation data provided by the Arkansas Department of Health ’ s Prescription Drug Monitoring Program . A trend analysis using joinpoint regression was performed on tobacco , alcoholic beverage , and medical marijuana sales tax data , and prescription opioid use data .

Tobacco use

As shown in Figure 1 , cigarette and other tobacco product revenue for the calendar years 2019 and 2020 were $ 216,961,219.77 and $ 232,729,553.76 , respectively ; an increase of 7.3 %. Tobacco sales taxes increased significantly during COVID-19 pandemic ( average change : 0.635 per month , p = 0.0012 ).

TOBACCO TAX

7.5

7.0

6.5

6.0

Figure 1 . Joinpoint regression analysis of tobacco product sales tax . Arkansas , January 2019 to January 2021 .

5.5

Figure 1

50 THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY