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

For nursing students

Study summary

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.

For educators

Teaching and appraisal notes

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.