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Substance use and substance use disorder, in relation to COVID-19: protocol for a scoping review

This is a published protocol, not a completed study, describing a planned JBI-methodology scoping review that will search ten databases and grey literature for English-language research on how substance use and substance use disorder relate to COVID-19 infection risk and rates.

By the NurseTrainer Evidence Studio

Systematic Reviews Published 2021 3 min read DOI 10.1186/s13643-021-01605-9
United KingdomdoajSubstance Use DisorderOpen AccessNursing Research

In brief

This is a published protocol, not a completed study, describing a planned JBI-methodology scoping review that will search ten databases and grey literature for English-language research on how substance use and substance use disorder relate to COVID-19 infection risk and rates.

What this article is about

Quick Answer

This is a published protocol, not a completed study, describing a planned JBI-methodology scoping review that will search ten databases and grey literature for English-language research on how substance use and substance use disorder relate to COVID-19 infection risk and rates.

Student takeaways

Key Takeaways

  • The protocol establishes two guiding research questions: the impact of substance use and SUD on COVID-19 infection and progression, and the impact of COVID-19 on rates of substance use and SUD.
  • The review will search ten academic databases (including CINAHL, Embase, PubMed, PsycINFO, and Web of Science) plus multiple grey-literature sources such as Google Scholar, Disaster Lit, and clinical trial registries.
  • Only English-language original research published from January 2020 onward will be eligible, spanning all populations, settings, and substance/SUD types, while case reports, opinion pieces, and other reviews are excluded.
  • The review will follow the Joanna Briggs Institute Reviewers' Manual (2015) scoping review methodology, including two reviewers independently screening citations and full-text articles.
  • Planned data analysis combines quantitative methods (frequencies) with qualitative methods (content and thematic analysis), reported as a narrative summary, and the review is pre-registered on the Open Science Framework.

Student summary

Why This Research Matters

This article is a study protocol, not a finished study. It was published in the journal Systematic Reviews in 2021 by Navin Kumar and ten co-authors from institutions including Yale, Columbia, NYU, the University of Bath, the University of Worcester, the American University of Beirut, and the University of Jordan. A protocol is a detailed plan that researchers publish before they carry out a review, so that other scientists know exactly what methods will be used and can check later whether the review followed its own plan. In this case, the plan is for a scoping review, a type of review that maps out what is already known about a topic and identifies gaps in the evidence, rather than trying to answer one narrow question the way a systematic review does.

The topic is substance use and substance use disorder (SUD) during the COVID-19 pandemic. The authors explain why this matters: people who smoke, vape, or use opioids, cannabis, alcohol, or psychoactive prescription drugs, and people who have a SUD, were considered to be at greater risk from COVID-19. At the same time, the economic and social disruption caused by the pandemic (job loss, isolation, closed treatment services) was expected to make substance use and SUD worse for many people. The authors point out that earlier reviews on this subject usually looked at only one or two substances at a time, so there was no single review that pulled together evidence across the full range of substances and SUD types. This scoping review protocol was designed to fill that gap.

The protocol lays out two guiding questions: what does current research say about how substance use and SUD affect COVID-19 infection and its course, and what impact has COVID-19 had on rates of substance use and SUD. To answer these, the team planned a wide search of both academic databases and grey literature (material not published in peer-reviewed journals). The academic databases include CINAHL, Embase, PubMed, PsycINFO, Web of Science, WHO's coronavirus literature database, Sociological Abstracts, Africa-Wide Information, Global Health, and Middle Eastern Central Asian Studies. The grey-literature sources include Google Scholar, Disaster Lit, HSRProj, government websites, and clinical trial registries such as ClinicalTrials.gov and the WHO registry. Searches would cover material published from January 2020 onward, since that is roughly when COVID-19 emerged. Only English-language, original research would be included; case reports, opinion pieces, editorials, commentaries, and other reviews would be excluded.

The review would follow the Joanna Briggs Institute (JBI) methodology, a widely used, structured approach for scoping reviews. Two reviewers would independently screen titles, abstracts, and full texts, and independently extract data, which helps reduce bias and error. The findings would then be summarized narratively, using both quantitative methods (such as counting how many studies covered each substance or population) and qualitative methods (such as thematic analysis of common patterns across studies). The whole project was registered in advance on the Open Science Framework, which is a form of transparency that lets other researchers see the plan before results come out and reduces the temptation to change methods partway through to get more favorable findings.

For nursing students, this article is a good example of how rigorous evidence reviews are actually built. Because it is only a protocol, it does not yet contain results about how substance use and COVID-19 are connected; it only describes how a future review will try to find that out. Reading it helps you understand what a well-designed scoping review looks like before any data is analyzed, including why dual screening, pre-registration, and a broad multi-database search matter for trustworthy evidence. It is also a reminder that people who use substances or live with SUD are a vulnerable population whose health needs deserve careful, systematic attention during public health emergencies like a pandemic.

Source abstract

Study Overview

Abstract Background The COVID-19 pandemic is creating severe issues for healthcare and broad social structures, exposing societal vulnerabilities. Among the populations affected by COVID-19 are people engaged in substance use, such as people who smoke; vape (e-cigarette use); use opioids, cannabis, alcohol, or psychoactive prescription drugs; or have a substance use disorder (SUD). Monitoring substance use and SUD during the pandemic is essential, as people who engage in substance use or present with SUD are at greater risk for COVID-19, and the economic and social changes resulting from the pandemic may aggravate SUD. There have been several reviews focused on COVID-19 in relation to substance use and SUD. Reviews generally did not consider on a large range of substance use variants or SUDs. We plan a scoping review that seeks to fill gaps in our current understanding of substance use and SUD, in the COVID-19 era. Methods A scoping review focused on substance use and SUD, in relation to COVID-19, will be conducted. We will search (from January 2020 onwards) Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Web of Science Core Collection, Embase, Global Health, WHO Global Literature on Coronavirus Disease Database, WHO Global Index Medicus, PsycINFO, PubMed, Middle Eastern Central Asian Studies, CINAHL Complete, and Sociological Abstracts. Grey literature will be identified using Disaster Lit, Google Scholar, HSRProj, governmental websites, and clinical trials registries (e.g., ClinicalTrial.gov , World Health Organization, International Clinical Trials Registry Platform and International Standard Randomized Con-trolled Trial Number registry). Study selection will conform to Joanna Briggs Institute Reviewers’ Manual 2015 Methodology for JBI Scoping Reviews. Only English language, original studies investigating substance use and SUD, in relation to COVID-19 in all populations and settings, will be considered for inclusion. Two reviewers will independently screen all citations, full-text articles, and abstract data. A narrative summary of findings will be conducted. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods. Discussion Original research is urgently needed to mitigate the risks of COVID-19 on substance use and SUD. The planned scoping review will help to address this gap. Systematic review registration Open Science Framework (osf/io/tzgm5).

Study type: Open access journal article

Evidence appraisal

Main Findings

  • The protocol establishes two guiding research questions: the impact of substance use and SUD on COVID-19 infection and progression, and the impact of COVID-19 on rates of substance use and SUD.
  • The review will search ten academic databases (including CINAHL, Embase, PubMed, PsycINFO, and Web of Science) plus multiple grey-literature sources such as Google Scholar, Disaster Lit, and clinical trial registries.
  • Only English-language original research published from January 2020 onward will be eligible, spanning all populations, settings, and substance/SUD types, while case reports, opinion pieces, and other reviews are excluded.
  • The review will follow the Joanna Briggs Institute Reviewers' Manual (2015) scoping review methodology, including two reviewers independently screening citations and full-text articles.
  • Planned data analysis combines quantitative methods (frequencies) with qualitative methods (content and thematic analysis), reported as a narrative summary, and the review is pre-registered on the Open Science Framework.

Practice transfer

Clinical Relevance

  • Nurses caring for patients with substance use or SUD during public health emergencies should recognize this population as being flagged in the literature as potentially higher-risk for COVID-19-related complications, pending the completed review's findings.
  • Because pandemic-related disruption (job loss, isolation, reduced access to treatment services) is hypothesized to worsen substance use and SUD, nurses should be alert to relapse or escalation risk in patients with a substance use history during periods of social or economic disruption.
  • The protocol's inclusion of a wide range of substances (tobacco, alcohol, cannabis, opioids, prescription psychoactive drugs) is a reminder that substance use assessment in clinical practice should not focus on a single substance in isolation.
  • Once completed, the review is intended to identify evidence gaps; nurses and researchers can use these gaps to prioritize future clinical research or quality-improvement questions relevant to substance use care during infectious disease outbreaks.
  • Because this is a protocol rather than a completed review, no practice-changing clinical conclusions can yet be drawn; clinicians should look for the completed scoping review before applying any specific findings to care.

Faculty notes

Educational Relevance

This is a protocol paper published in Systematic Reviews (2021) by Kumar, Janmohamed, Nyhan, Martins, Cerda, Hasin, Scott, Pates, Ghandour, Wazaify, and Khoshnood, describing a planned scoping review on substance use and substance use disorder (SUD) in relation to COVID-19. As a protocol, it reports methodological design rather than empirical findings, and instructors should frame classroom discussion around appraisal of the review methodology itself, not around clinical results.

The stated rationale is that COVID-19 disproportionately threatens people who use substances or have a SUD, both because of elevated infection/complication risk and because pandemic-driven social and economic disruption plausibly worsens substance use patterns. The authors note that existing reviews on this intersection tended to focus narrowly on single substances, creating a fragmented evidence base; this scoping review aims to consolidate evidence across the full range of substances (tobacco, alcohol, cannabis, opioids, prescription psychoactive drugs, and others) and SUD presentations.

Two research questions anchor the protocol: (1) what does current research indicate about the impact of substance use and SUD on COVID-19 infection and progression, and (2) what impact has COVID-19 had on rates of substance use and SUD. The eligibility criteria admit English-language original research (quantitative and qualitative studies, including small-sample designs) across all populations and settings, while excluding commentaries, correspondence, case reports, case series, editorials, and opinion pieces.

The search strategy is notably comprehensive: ten academic databases (CINAHL Complete, Embase, PubMed, PsycINFO, Web of Science Core Collection, WHO's coronavirus-specific database, Sociological Abstracts, Africa-Wide Information, Global Health, and Middle Eastern Central Asian Studies) plus grey-literature sources (medRxiv, PsyArXiv, Disaster Lit, Google Scholar, HSRProj, government websites, and trial registries including ClinicalTrials.gov and WHO/ICTRP registers), covering material from January 2020 onward. A medical-library informationist helped design the multi-database search strategy, which is good practice worth highlighting to students learning literature-search rigor.

Methodologically, the review follows the Joanna Briggs Institute (JBI) Reviewers' Manual (2015) scoping review methodology, with dual independent screening and data extraction to reduce selection and extraction bias. Data charting would capture core study characteristics such as design, population, substance/SUD measures, and setting, with preprints flagged as non-peer-reviewed. Planned synthesis combines quantitative description (frequencies of study characteristics) with qualitative content/thematic analysis, reported narratively alongside tables and figures; the completed review reports results per the PRISMA extension for Scoping Reviews (PRISMA-ScR). The protocol is pre-registered on the Open Science Framework (osf.io/tzgm5), which supports transparency and guards against post hoc changes to scope or analysis.

For teaching purposes, this protocol is a strong exemplar for discussing scoping-review design with Canadian nursing students learning evidence appraisal: pre-registration, a librarian-designed multi-database and grey-literature search strategy, explicit eligibility criteria, dual independent review, and mixed quantitative/qualitative synthesis. Limitations for classroom discussion include the English-language restriction (likely excluding relevant non-English evidence, especially given the international, multi-country scope implied by the author team), the inherent lag between protocol and completed review, and the fact that a scoping review maps breadth of evidence rather than assessing methodological quality or answering a single, focused clinical question the way a systematic review with meta-analysis would.

Critical appraisal

Limitations

  • This is a study protocol only; it reports planned methods, not results, so no clinical findings about COVID-19 and substance use/SUD can be drawn from it yet.
  • The eligibility criteria restrict inclusion to English-language studies, which may exclude relevant research published in other languages despite the review's international, multi-country author team.
  • As a scoping review, the planned methodology maps the breadth of available evidence and identifies gaps, but does not include formal quality or risk-of-bias appraisal of individual studies, unlike a systematic review.

Classroom use

Discussion Questions

  • Why do researchers publish a protocol before conducting a scoping review, and what benefits does pre-registration on a platform like the Open Science Framework provide?
  • How does a scoping review differ from a systematic review in terms of purpose, scope, and methodology, based on what this protocol describes?
  • Why might people who use substances or have a substance use disorder be considered at greater risk during a pandemic like COVID-19?
  • What are the potential strengths of searching ten academic databases plus multiple grey-literature sources, and what challenges might such a broad search create for the review team?
  • Why did the authors choose to include only English-language studies, and what evidence might this decision exclude given the review's multinational author team?
  • How might dual independent screening and data extraction by two reviewers reduce bias compared to a single-reviewer approach?
  • What is the difference between quantitative (frequency-based) and qualitative (thematic) analysis, and why might a review use both approaches together?
  • As a nursing student, how would you use the completed version of this scoping review (once published) differently from how you would use this protocol?
  • What ethical or practical reasons might explain why pandemic-related economic and social disruption could worsen substance use disorder in some populations?
  • If you were designing a scoping review on a related nursing topic, what elements of this protocol (search strategy, eligibility criteria, JBI framework, pre-registration) would you adopt, and why?

Knowledge check

Quiz

1. What type of publication is this article?

  1. A completed systematic review with meta-analysis
  2. A protocol for a scoping review
  3. A randomized controlled trial
  4. A case report
Answer: A protocol for a scoping review
Rationale: The title and abstract identify this as 'protocol for a scoping review,' meaning it describes planned methods rather than completed results.

2. According to the abstract, why are people who engage in substance use or have a SUD a population of concern during COVID-19?

  1. They are at greater risk for COVID-19, and pandemic-related economic and social changes may aggravate SUD
  2. They are immune to COVID-19 infection
  3. They have unlimited access to healthcare during the pandemic
  4. There is no known relationship between substance use and COVID-19
Answer: They are at greater risk for COVID-19, and pandemic-related economic and social changes may aggravate SUD
Rationale: The abstract states people who engage in substance use or present with SUD 'are at greater risk for COVID-19, and the economic and social changes resulting from the pandemic may aggravate SUD.'

3. What methodology framework will the review follow for study selection?

  1. PRISMA for randomized controlled trials only
  2. Joanna Briggs Institute Reviewers' Manual 2015 Methodology for JBI Scoping Reviews
  3. Cochrane Handbook for systematic reviews of interventions
  4. GRADE evidence rating system
Answer: Joanna Briggs Institute Reviewers' Manual 2015 Methodology for JBI Scoping Reviews
Rationale: The abstract states: 'Study selection will conform to Joanna Briggs Institute Reviewers' Manual 2015 Methodology for JBI Scoping Reviews.'

4. Which of the following databases is explicitly named in the search strategy?

  1. CINAHL Complete
  2. LexisNexis
  3. IEEE Xplore
  4. JSTOR
Answer: CINAHL Complete
Rationale: The abstract lists CINAHL Complete among the databases to be searched, alongside PubMed, Embase, PsycINFO, and others.

5. What language and study type restrictions apply to studies eligible for inclusion?

  1. Only French-language systematic reviews
  2. Only English language, original studies investigating substance use and SUD in relation to COVID-19
  3. Only studies published before 2020
  4. Only qualitative studies from North America
Answer: Only English language, original studies investigating substance use and SUD in relation to COVID-19
Rationale: The abstract specifies: 'Only English language, original studies investigating substance use and SUD, in relation to COVID-19 in all populations and settings, will be considered for inclusion.'

6. How many reviewers will independently screen citations and full-text articles, according to the protocol?

  1. One
  2. Two
  3. Four
  4. Ten
Answer: Two
Rationale: The abstract states: 'Two reviewers will independently screen all citations, full-text articles, and abstract data.'

7. What types of data analysis are planned for this scoping review?

  1. Quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods
  2. Only meta-analytic pooling of effect sizes
  3. Only cost-effectiveness analysis
  4. Only network analysis
Answer: Quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods
Rationale: The abstract states: 'Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods.'

8. Where is this systematic review protocol registered?

  1. Open Science Framework (osf/io/tzgm5)
  2. ClinicalTrials.gov as a trial
  3. PROSPERO
  4. It is not registered
Answer: Open Science Framework (osf/io/tzgm5)
Rationale: The abstract states: 'Systematic review registration Open Science Framework (osf/io/tzgm5).'

9. Based on the supplementary full-text review, which of these is an example of a grey-literature source used in the search strategy?

  1. Disaster Lit
  2. Encyclopaedia Britannica
  3. A single hospital's internal newsletter
  4. A textbook publisher's catalog
Answer: Disaster Lit
Rationale: The full text describes grey literature sources including Disaster Lit, Google Scholar, HSRProj, governmental websites, and clinical trial registries.

10. Why did the authors decide to conduct this scoping review, according to the abstract's stated rationale?

  1. Existing reviews generally did not consider a large range of substance use variants or SUDs, leaving gaps in understanding
  2. No prior reviews on COVID-19 and substance use existed at all
  3. The authors wanted to replace all prior systematic reviews on the topic
  4. Government funding required a new review regardless of existing evidence
Answer: Existing reviews generally did not consider a large range of substance use variants or SUDs, leaving gaps in understanding
Rationale: The abstract notes: 'Reviews generally did not consider on a large range of substance use variants or SUDs. We plan a scoping review that seeks to fill gaps in our current understanding.'

Study cards

Flashcards

What kind of document is 'Substance use and substance use disorder, in relation to COVID-19: protocol for a scoping review'?

It is a study protocol describing the planned methods for a future scoping review, not a completed review with results.

In what journal and year was this protocol published?

It was published in Systematic Reviews in 2021.

What is a scoping review, in contrast to a systematic review?

A scoping review maps the breadth of existing evidence on a topic and identifies gaps, rather than answering one narrow clinical question with formal quality appraisal like a systematic review does.

What are the two research questions guiding this scoping review?

(1) What does research suggest about the impact of substance use and SUD on COVID-19 infection and progression? (2) What impact has COVID-19 had on substance use and SUD rates?

Why are people with substance use or SUD considered a population of concern during COVID-19?

They are considered at greater risk for COVID-19, and pandemic-related economic and social disruption may aggravate SUD.

What methodological framework guides the review's conduct?

The Joanna Briggs Institute (JBI) Reviewers' Manual 2015 methodology for scoping reviews.

Name three academic databases the review will search.

Examples include CINAHL Complete, PubMed, Embase, PsycINFO, and Web of Science Core Collection.

Name two grey-literature sources included in the search strategy.

Examples include Google Scholar, Disaster Lit, HSRProj, governmental websites, and clinical trial registries such as ClinicalTrials.gov.

What time period does the literature search cover?

The search covers material published from January 2020 onward, roughly coinciding with the emergence of COVID-19.

What language restriction applies to eligible studies?

Only English-language original studies are eligible for inclusion.

How many reviewers screen citations and extract data, and why does this matter?

Two reviewers screen and extract data independently, which helps reduce selection and extraction bias.

What two types of data analysis are planned?

Quantitative analysis (e.g., frequencies) and qualitative analysis (e.g., content and thematic analysis), summarized narratively.

Where is this review pre-registered, and why does pre-registration matter?

It is registered on the Open Science Framework (osf.io/tzgm5); pre-registration increases transparency and reduces the risk of changing methods after seeing results.

What study types are excluded from this scoping review?

Only original studies are included, so commentaries, correspondence, case reports, case series, editorials, and opinion pieces are excluded.

What range of substances does the review consider?

Tobacco/smoking, vaping (e-cigarettes), opioids, cannabis, alcohol, and psychoactive prescription drugs, along with substance use disorder broadly.

What institutions are represented among the protocol's authors?

Yale University, Columbia University, NYU Grossman School of Medicine, the University of Bath, the University of Worcester, the American University of Beirut, and the University of Jordan.

Who helped design the literature search strategy?

A medical-library informationist (research librarian) helped design the multi-database search strategy, supporting a rigorous, reproducible search.

What reporting standards does the protocol reference?

The scoping review is reported using the PRISMA extension for Scoping Reviews (PRISMA-ScR); protocol papers like this one typically follow PRISMA-P protocol-reporting conventions.

What is one key limitation of relying on this protocol alone for clinical decision-making?

It contains no completed findings or results yet; it only describes planned methods, so no clinical conclusions should be drawn from it directly.

Why is a study protocol like this useful for nursing students to read?

It demonstrates the rigor of well-designed evidence reviews, showing how pre-registration, broad multi-database searching, dual independent screening, and mixed-methods analysis support trustworthy evidence before any results are produced.

Search-ready answers

Frequently asked questions

What is this article about?

It is a published protocol describing the planned methods for a scoping review examining the relationship between substance use, substance use disorder (SUD), and COVID-19.

Does this article contain results about substance use and COVID-19?

No. This is a protocol, published before the review was conducted, so it describes planned methods rather than findings.

What is the difference between a scoping review and a systematic review?

A scoping review maps the breadth of existing evidence and identifies research gaps on a broad topic, while a systematic review typically answers a narrower question and includes formal quality/risk-of-bias appraisal of included studies.

Why are people who use substances considered at higher risk during COVID-19?

The protocol states that people who engage in substance use or have SUD are considered at greater risk for COVID-19, and that pandemic-related economic and social disruption may worsen SUD.

What databases will be searched for this scoping review?

Ten academic databases, including CINAHL Complete, Embase, PubMed, PsycINFO, Web of Science Core Collection, WHO's coronavirus literature database, Sociological Abstracts, Africa-Wide Information, Global Health, and Middle Eastern Central Asian Studies, plus grey-literature sources like Google Scholar and clinical trial registries.

What types of studies will be included or excluded?

Included: English-language original research (quantitative and qualitative, including small-sample studies) on substance use/SUD in relation to COVID-19. Excluded: commentaries, correspondence, case reports and case series, editorials, and opinion pieces.

How will the researchers reduce bias in study selection?

Two reviewers will independently screen all citations and full-text articles and independently extract data, which helps catch errors and reduce individual bias.

Where is this scoping review registered?

It is registered on the Open Science Framework at osf.io/tzgm5, ahead of the review being carried out.

Who wrote this protocol and where are they based?

Navin Kumar and ten co-authors from institutions including Yale University, Columbia University, NYU Grossman School of Medicine, the University of Bath, the University of Worcester, the American University of Beirut, and the University of Jordan.

Why should nursing students care about a protocol paper rather than a completed study?

Protocols show how rigorous evidence reviews are designed before data collection begins, illustrating best practices like pre-registration, broad database searching, and dual independent screening that support trustworthy, unbiased findings.