Management Of Substance Use Disorders Research Articles

‘Please Don’t Do This to Us’: TV Show Illustrates Importance of Families in SUD Care of Youth

‘Please Don’t Do This to Us’: TV Show Illustrates Importance of Families in SUD Care of Youth

Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention.

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals' health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental lifestages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilienceagainst developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions. Involvement of health care providers in detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Despite advances in our understanding and management of SUDs, individuals with these conditions continue to be stigmatized and, in some countries, incarcerated, highlighting the need to dismantle policies that perpetuate their criminalization and instead develop policies to ensure support and access to prevention and treatment.

ERAS Protocol Options for Perioperative Pain Management of Substance Use Disorder in the Ambulatory Surgical Setting.

Even prior to the COVID-19 pandemic, rates of ambulatory surgeries and ambulatory patients presenting with substance use disorder were increasing, and the end of lockdown has further catalyzed the increasing rates of ambulatory patients presenting for surgery with substance use disorder (SUD). Certain subspecialty groups of ambulatory procedures have already established protocols to optimize early recovery after surgery (ERAS), and these groups have subsequently enjoyed improved efficiency and reduced adverse outcomes as a result. In this present investigation, we review the literature as it relates to substance use disorder patients, with a particular focus on pharmacokinetic and pharmacodynamic profiles, and their resulting impact on the acute- or chronic user ambulatory patient. The systematic literature review findings are organized and summarized. We conclude by identifying areas of opportunity for further study, specifically with the aim of developing a dedicated ERAS protocol for substance use disorder patients in the ambulatory surgery setting. - Healthcare in the USA has seen an increase in rates of both substance use disorder patients and separately in ambulatory surgery cases. - Specific perioperative protocols to optimize outcomes for patients who suffer from substance use disorder have been described in recent years. - Agents of interest like opioids, cannabis, and amphetamines are the top three most abused substances in North America. - A protocol and recommend further work should be done to integrate with concrete clinical data, in which strategies should be employed to confer benefits to patient outcomes and hospital quality metrics like those enjoyed by ERAS protocol in other settings.

Validation of the UPPS-P Impulsive Behavior Scale and Clinical Correlates of its Scores in French-Speaking Patients Starting a Residential Detoxification Program.

Impulsivity is a multifaceted construct that plays a prominent role in substance use disorder (SUD). The UPPS-P model distinguishes five impulsivity components (positive urgency, negative urgency, lack of perseverance, lack of premeditation, and sensation seeking). This study aimed to explore the structure of the UPPS-P in patients hospitalized for SUDs and to investigate the relationship between the dimensions of impulsivity and clinical variables. Inpatients of a residential detoxification service (n = 125) were recruited. A confirmatory factor analysis was performed, and associations were assessed between the components of impulsivity and clinical indexes. The factor analysis supported a model of impulsivity with five interrelated latent variables. Good internal consistency was found. External validity was supported by relationships with psychological difficulties. Multiple correlations (Kendall) suggested that, except for its sensation-seeking component, impulsivity is a significant risk factor for both the severity of addictive problems and their comorbidities. This study provides further evidence in favor of the 5-dimensional model of impulsivity. It highlights impulsivity as a transdiagnostic risk factor that should be considered in the management of SUD.

Development, validation, and feasibility testing of a yoga module for substance use disorder

ABSTRACT Introduction: Research evidence and theoretical models point to the need to implement yoga and mindfulness interventions as they impact different physiological and psychological functioning associated with addiction and relapse. To ensure the safe application of yoga, a standardized yoga module that can be practiced across any drug type of substance addiction is required. This study focuses on developing, validating, and testing a yoga module’s feasibility for the management of substance use disorder (SUD). Materials and Methods: The yoga module was developed for SUD by including specific yogic practices derived from research evidence from Google Scholar, PubMed, and traditional literature targeting symptoms related to SUD. Yoga experts validated the module using a 3-point Likert scale. Practices which scored a content validity ratio (CVR) score ≥0.33 were retained in the yoga module for SUD. A pilot assessment was done online to test the module’s feasibility. Participants in a 9-week residential rehabilitation center participated in the study. The module was taught as an add-on to their existing treatment. The motivation for seeking treatment was assessed at baseline, and quality of life was assessed at pre- and post-intervention using the questionnaire de motivation au traitement des toxicomanies and the World Health Organization Quality of Life BREF (WHOQOL BREF), respectively. Results: Thirty experts validated the developed module. Based on the CVR scoring, 37 yoga practices were retained. The final list of practices included breathing exercises, sukshmāvyāyāma (loosening exercise), āsana (postures), prāṇāyāma (breathing exercise), and dhyāna (meditation). In the feasibility study, all participants (n = 12) reported satisfaction and mentioned no adverse effects of the yoga intervention. The participants’ mean ± standard deviation (SD) of identified motivation was 26.6 ± 1.9, introjected amotivation 22.7 ± 5.1, external motivation 16.4 ± 6.2, and a motivation 15.1 ± 5.7. The Global score or Internalization coefficient mean ± SD was 29.1 ± 18.1. The participant’s total score on the WHOQOL-BREF was significant post intervention (P = 0.004). With the practice of the module, there was a significant change in the participant’s psychological (P = 0.008), social (P = 0.002), and environmental domains (P < 0.001) but not in physical health (P = 0.17). At 1 month follow-up, 11 participants (n = 12) maintained abstinence. Conclusion: The designed yoga module for SUD was validated by yoga experts and was considered safe and feasible by patients with SUD. In addition, patients reported an increase in their quality of life. This can be further studied in randomized controlled trials.

Telehealth interventions for substance use disorders in low- and- middle income countries: A scoping review.

The increasing prevalence and magnitude of harmful effects of substance use disorders (SUDs) in low- and middle-income countries (LMICs) make it imperative to embrace interventions which are acceptable, feasible, and effective in reducing this burden. Globally, the use of telehealth interventions is increasingly being explored as possible effective approaches in the management of SUDs. Using a scoping review of literature, this article summarizes and evaluates evidence for the acceptability, feasibility, and effectiveness of telehealth interventions for SUDs in LMICs. Searches were conducted in five bibliographic databases: PubMed, Psych INFO, Web of Science, Cumulative Index of Nursing and Allied Professionals and the Cochrane database of systematic review. Studies from LMICs which described a telehealth modality, identified at least one psychoactive substance use among participants, and methods that either compared outcomes using pre- and post-intervention data, treatment versus comparison groups, post-intervention data, behavioral or health outcome, and outcome of either acceptability, feasibility, and/or effectiveness were included. Data is presented in a narrative summary using charts, graphs, and tables. The search produced 39 articles across 14 countries which fulfilled our eligibility criteria over a period of 10 years (2010 to 2020). Research on this topic increased remarkably in the latter five years with the highest number of studies in 2019. The identified studies were heterogeneous in their methods and various telecommunication modalities were used to evaluate substance use disorder, with cigarette smoking as the most assessed. Most studies used quantitative methods. The highest number of included studies were from China and Brazil, and only two studies from Africa assessed telehealth interventions for SUDs. There has been an increasingly significant body of literature which evaluates telehealth interventions for SUDs in LMICs. Overall, telehealth interventions showed promising acceptability, feasibility, and effectiveness for SUDs. This article identifies gaps and strengths and suggests directions for future research.

Title of the study: Practice and attitude of doctors towards patients with substance use: A study from south India.

To evaluate the practice and attitude of doctors towards substance use disorders (SUD) and their management. Following stratified proportionate random sampling, selected doctors in the south zone of Bengaluru, India, were interviewed face-to-face using a structured questionnaire. 150 doctors were interviewed. In their practice, a quarter of patients (median of 27.5 (IQR: 11.45-45) use one or other form of Alcohol, Tobacco or Other Drugs of abuse (ATOD). Doctors, in general, enquire about substance use but do not actively intervene. They have mixed attitudes (both positive and negative) towards persons with SUD. A significant positive correlation was noted between the number of years of experience (post-MBBS) with practices related to "brief-intervention" (p=0.014) and "concerned and sympathetic" attitudes (p<0.001). However, a significant negative correlation was observed between the number of years of experience and "substance-specific management" practices (p<0.001). Further, there was a positive correlation between "brief-interventions" practices with the attitude of being "concerned and sympathetic" (p<0.001). A mediation analysis revealed that nearly a third of the overall effect of the number of years of experience on brief-interventions practices was mediated by a concerned and sympathetic attitude. Serious efforts must be made to train doctors in the effective management of SUD. Attitudes of the doctors influence practices such as brief interventions. Programs directed towards changing the attitudes of doctors can bring changes in their practices.

Prescribing buprenorphine for opioid use disorder in primary care: A survey of French general practitioners in the Sentinelles network

IntroductionAlthough opioid substitution coverage in France is high and patient care with buprenorphine is mainly managed by general practitioners (GPs), buprenorphine sales have been decreasing since 2011, suggesting that French GPs are prescribing less buprenorphine. Yet this possible change in GP practices has not yet been investigated. This study aimed to examine primary care GPs' opinions about buprenorphine and habits related to prescribing buprenorphine. MethodsThe study team conducted a cross-sectional survey from March 2021 to July 2021 among a sample of GPs in the Sentinelles network, a French epidemiologic surveillance system based on primary care practitioners. The study collected information about substance use disorder (SUD) training, opinions on buprenorphine, and habits related to buprenorphine prescription were collected (initiation and renewal within the past two years). FindingsAmong the 237 participants (34 % response rate), 15.2 % reported having had specific training for SUD management. A majority reported a very positive (16 %) or positive (63.7 %) opinion of buprenorphine. Most participants agreed (61.2 %) or strongly agreed (31.2 %) that buprenorphine was efficacious in the treatment of illicit opioid use disorder. Of the 206 GPs who reported having treated patients with opioid use disorder in the past two years, 47 (22.8 %) had initiated a buprenorphine prescription, whereas 177 (85.9 %) had renewed a buprenorphine prescription. Previous SUD training was associated with initiating buprenorphine (OR 4.66; 95 % CI [2.15–10.08]), while female gender was associated with not initiating buprenorphine prescribing (OR 0.46; 95 % CI [0.22–0.98]). ConclusionA sample of French GPs who work in primary care has a positive view of buprenorphine, but the absence of SUD training among this population may be a barrier to their prescribing buprenorphine.

Beyond opioid prescribing: Evaluation of a substance use disorder curriculum for OBGYN residents.

Amidst the current opioid crisis, there is a need for better integration of substance use disorder screening and treatment across specialties. However, there is no consensus regarding how to best instruct OBGYN trainees in the clinical skills related to opioid and other substance use disorders (SUD). Study objectives were (1) to assess the effectiveness a SUD curriculum to improve self-reported competence among OBGYN residents and (2) to explore its effectiveness to improve attending evaluations of residents' clinical skills as well as its feasibility and acceptability from the resident perspective. A pilot 3-session curriculum was developed and adapted to SUD screening and treatment which included readings, didactics, and supervised outpatient clinical experiences for OBGYN post-graduate year 1 (PGY-1) residents rotating through an integrated OBGYN-SUD clinic. Eighteen residents completed pre and post clinical skills self-assessments (SUD screening, counseling, referring, Motivational Interviewing) using an adapted Zwisch Rating Scale (range 1-5). Scores were compared between time points using paired t-tests. Sub-samples also (a) were evaluated by the attending on three relevant Accreditation Council for Graduate Medical Education Milestones (ACGME) milestone sets using the web-based feedback program, myTIPreport (n = 10) and (b) completed a qualitative interview (n = 4). All PGY-1s (18/18) across three academic years completed the 3-session SUD curriculum. Clinical skill self-assessments improved significantly in all areas [SUD Screening (2.44 (0.98) vs 3.56 (0.62), p = <0.01); Counseling (1.81 (0.71) vs 3.56 (0.51), p = < .01; Referring (2.03 (0.74) vs 3.17 (0.71), p = < .01; Motivational Interviewing (1.94 (1.06) vs 3.33 (0.69), p = < .01)]. Milestone set levels assigned by attending evaluations (n = 10) also improved. Qualitative data (n = 4) revealed high acceptability; all curriculum components were viewed positively, and feedback was provided (e.g., desire for more patient exposures). A pilot SUD curriculum tailored for OBGYN PGY-1 residents that goes beyond opioid prescribing to encompass SUD management is feasible, acceptable and likely effective at improving SUD core clinical skills.

Lifestyle interventions in the management of substance use disorder.

Substance use disorder (SUD) is a persistent problem within society and an issue of increasing community awareness and concern. SUD is often comorbid with significant mental health challenges, trauma and negative social determinants of health. SUDs contribute to increased burden of chronic disease and can lead to increased mortality and shorter life expectancy, not just through overdose but also through increased rates of mental and physical chronic disease. The aim of this article is to explore the evidence regarding lifestyle interventions as either primary interventions or adjuncts to existing treatments for individuals with SUD. Lifestyle interventions can play a significant part in the management of people with SUD. These interventions play a part in SUD treatment and relapse prevention as well as improving physical and mental health and quality of life. These interventions ideally can be instituted and managed through community services and primary care.

Selection of Optimal Physiological Features for Accurate Detection of Stress.

Stress is an established risk factor in the development of addiction and in reinstating drug seeking. Substance use disorder (SUD) is a dangerous epidemic that affects the brain and behavior. Despite this growing epidemic and its subsequent consequences, there are limited management and treatment options, pharmacotherapies and psychosocial treatments available. To this end, there is a need for new and improved personalized devices and treatments for the detection and management of SUD. Based on documented negative effects of stress in SUD, in this paper, our objective was to select a few significant physiological features from a set of 8 features collected by a chest-worn RespiBAN Professional in 15 individuals. We used three machine learning classifiers on these optimal physiological features to detect stress. Our results indicate that best accuracies were achieved when electrodermal activity (EDA), body temperature and chest-worn accelerometer were considered as features for the classification. Challenges, implications and applications were discussed. In the near future, the proposed methods will be replicated in individuals with SUD.

Evaluating the Impact of Substance Use Disorder Resources on Outcomes of Persons Who Inject Drugs with Infections.

The aim of the study is to evaluate the impact of inpatient substance use disorder (SUD) resources on outcomes of persons who inject stimulants and/or opioids (PWIDs) with infections. This retrospective cohort evaluated PWIDs hospitalized from July 1, 2020, to May 31, 2021, and prescribed an antimicrobial course. The patients were compared based on inpatient implementation of SUD resources, including consultation of addiction medicine/behavioral health, implementation of an opioid withdrawal treatment protocol, or continuation/initiation of medications for opioid use disorder. The primary outcome was a composite of antibiotic completion, no unplanned discharge, and no 30-day readmission. Notable secondary outcomes included length of stay and presence of stigmatizing language in the electronic medical record. A total of 119 patients were analyzed-74 (62.2%) received SUD resources. The primary outcome was met by 43 patients with SUD resources implemented (58.1%) and 19 patients without resources (42.2%, P = 0.093). After adjustment for infection type, implementation of SUD resources (adjusted odds ratio, 2.593; 95% confidence interval, 1.162-5.789) was independently associated with primary outcome success. The patients who received SUD resources had a median length of stay of 7 days (4-13.3) compared with 4 days (2-6.5) in those without resources ( P < 0.001). Stigmatizing language was present in 98% of patient electronic medical records. Patient care provided to PWIDs with infections is optimized when SUD resources are implemented. This study further supports the necessity of improving SUD management when PWIDs are admitted to healthcare facilities.

Transitional-Age Youth With Substance Use Disorders

Young adulthood is a time of rapid biological, psychological, and social development. This complex mix of internal and external forces presents opportunities for incredible growth and for risky choices with long-term implications. Perhaps nowhere are the developmental conflicts of autonomy, identity, and risk-taking more salient for transitional-age youth (youth between the ages of 16 and 25 years) than in the area of substance use and misuse. This article aims to provide a clinically relevant review of the epidemiology, unique features, screening, assessment, and treatment of substance use disorders among transitional-age youth, with the goal of informing both the overall spirit of and specific approaches to the management of substance use disorders in this complex population. [ Psychiatric Annals , 52(6), 222–226.]

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

BackgroundCommunity-based harm reduction programs reduce morbidity and mortality associated with drug use. While hospital-based inpatient addiction consult services can also improve outcomes for patients using drugs, inpatient clinical care is often focused on acute withdrawal and the medical management of substance use disorders. There has been limited exploration of the integration of community-based harm reduction programs into the hospital setting. We conducted a qualitative study to describe provider perspectives on the implementation of a harm reduction in-reach program.MethodsWe conducted 24 semi-structured interviews with providers from three different primary work sites within a safety net hospital in Boston, MA, in 2021. Interviews explored perceived facilitators and barriers to the implementation of the harm reduction in-reach program in the hospital setting and solicited recommendations for potential improvements to the harm reduction in-reach program. Interviews were analyzed using an inductive approach that incorporated principles of grounded theory methodology to identify prevailing themes.ResultsTwenty-four participants were interviewed from the harm reduction in-reach program, inpatient addiction consult service, and the hospital observation unit. Thematic analysis revealed seven major themes and multiple facilitators and barriers to the implementation of the harm reduction in-reach program. Participants highlighted the impact of power differences within the medical hierarchy on inter-team communication and clinical care, the persistence of addiction-related stigma, the importance of coordination and role delineation between care team members, and the benefits of a streamlined referral process.ConclusionsHarm reduction programs offer accessible, patient-centered, low-barrier care to patients using drugs. The integration of community-based harm reduction programs into the inpatient setting is a unique opportunity to bridge inpatient and outpatient care and expand the provision of harm reduction services.Trial registration: Not applicable.

Attention Deficit Hyperactivity Disorder and Substance Use Disorder: A Narrative Review.

Attention deficit hyperactivity disorder (ADHD) has a growing incidence and prevalence in the United States and throughout the world, much of which is contributed to increased awareness of the condition and solidified diagnostic criteria. Substance use disorder (SUD) similarly has seen a sharp increase, particularly with the rising cases of opioid abuse. Management of ADHD is done primarily with pharmacologic therapy, often stimulants and with psychosocial interventions (i.e., exercise, meditation, peer-to-peer intervention, etc.) for adjunctive management. Management of SUD involves cessation and treatment based on the underlying drug of abuse. Many clinicians are uncomfortable treating ADHD in patients with SUD based on concerns the intervention may lead to an adverse event, including drug relapse, and the development of other psychiatric comorbidities. Concerns also arise about stimulants acting as a gateway drug in adolescents leading to the onset of SUD.Thus, in this narrative review, we aim to shed light on ADHD in relation to SUD and to provide clinical insight based on the current scientific literature on the topic. ADHD causes lesions in subcortical structures in the basal ganglia and limbic system. Treatment of ADHD with stimulants has been shown to normalize malformed neuroanatomical variations and lead to improved long-term outcomes compared to non-treatment of ADHD. Based on current scientific literature, it is recommended to treat ADHD with guideline-directed pharmacologic agents including stimulants along with non-pharmacologic interventions primarily exercise. There may be some improvement in reducing risky behavior, such as substance abuse, and may even help prevent the development of SUD.

Substance Use Disorders in Children and Adolescents

Background: Exposure to addictive substances commonly occurs during childhood and adolescence and it adds more adverse consequences in life course. However, evidence is scarce for management of substance use disorders in this population. Methods: We searched for published literature of previous 10 years on PubMed, Cochrane database, and Google Scholar until June 2021. The literature found relevant was organized into various subheadings like epidemiology, etiology, screening, and prevention and treatment. Results: Alcohol and tobacco remain the most commonly used substances amongst children and adolescents the world over, closely followed by cannabis. High-risk populations including street children are most severely afflicted. There are a multitude of risk factors ranging from biological to psychosocial, most importantly parental drug use and adverse experience in childhood. Public health initiatives including school, family, and community interventions have shown promising results. Early screening for substance use is beneficial with special attention on externalizing disorders. Studies on pharmacological treatment remain sparse while psychosocial interventions employing different modalities such as behavioural- and contingency-related techniques have shown initial promise. Conclusions: Adolescents and children are more prone to substance use and associated risk-taking behavior. There is a vital need for well-designed studies for assessing risk and protective factors, comprehensive screening, prevention, and intervention modalities in children and adolescents including street children and other high-risk population.

The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

The Management of Substance Use Disorders: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.

In August 2021, leadership within the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved a joint clinical practice guideline (CPG) for the management of substance use disorders (SUDs). This synopsis summarizes key recommendations. In March 2020, the VA/DoD Evidence-Based Practice Work Group assembled a team to update the 2015 VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The guideline panel developed key questions, systematically searched and evaluated the literature, created two 1-page algorithms, and distilled 35 recommendations for care using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. This synopsis presents the recommendations that were believed to be the most clinically impactful. The scope of the CPG is broad; however, this synopsis focuses on key recommendations for the management of alcohol use disorder, use of buprenorphine in opioid use disorder, contingency management, and use of technology and telehealth to manage patients remotely.

Telehealth for Substance Use Disorders: A Rapid Review for the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Substance Use Disorders.

Approximately 20.4 million Americans met criteria for a substance use disorder (SUD) in 2019; however, only about 12.2% of persons with an SUD receive specialty care. Telehealth offers alternatives to traditional forms of substance use treatment. To synthesize recent findings on the efficacy of telehealth for SUDs. MEDLINE, Embase, PubMed, and the Cochrane Library from January 2015 through August 2021 (English language only). Randomized controlled trials (RCTs) of adults with a diagnosis of SUD based on the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases. One investigator abstracted data and assessed study quality, and a second checked for accuracy. This rapid review synthesized evidence from 17 RCTs. Evidence is very uncertain that telehealth provided as videoconference therapy (1 RCT) or web-based cognitive behavioral therapy (CBT) (3 RCTs) has similar effects to in-person therapy for improving abstinence from alcohol or cannabis. Low-strength evidence suggests that web-based CBT has similar effects for improving abstinence in multiple SUDs (2 RCTs). Low-strength evidence suggests that adding supportive text messaging to follow-up care improves abstinence and amount of alcohol per day (2 RCTs) but does not improve emergency department visits or frequency of consumption (2 RCTs). Enhanced telephone monitoring likely reduces readmissions for SUD detoxification compared with usual follow-up alone (1 RCT) but does not reduce days of substance use (low-strength evidence). Narrative synthesis, heterogeneity of telehealth interventions, no assessment of publication bias, and study methodology. Evidence is very uncertain that telehealth is similar to in-person care for SUD outcomes. Limited evidence suggests some benefit of adding telehealth to usual SUD care. U.S. Department of Veterans Affairs Veterans Health Administration.

Harm reduction and abstinence-based models for treatment of substance use disorders during the COVID-19 pandemic: a global perspective.

The COVID-19 pandemic has significantly affected treatment services for people with substance use disorders (SUDs). Based on the perspectives of service providers from eight countries, we discuss the impact of the pandemic on SUD treatment services. Although many countries quickly adapted in provision of harm reduction services by changes in policy and service delivery, some went into a forced abstinence-based strategy. Similarly, disruption of abstinence-based approaches such as therapeutic communities has been reported. Global awareness is crucial for responsible management of SUDs during the pandemic, and the development of international health policy guidelines is an urgent need in this area.