Beyond the High: Methamphetamine Use, Risk Landscape, Health Consequences and Urgent Policy Directions from a Mixed-Methods Situational Analysis in Sudan

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Moniem M. H. Bashir, Rusdi Abd Rashid This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8525314/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Methamphetamine use is rising globally, with well‑documented harms in North America and East Asia. Sudan remains under‑studied despite conditions conducive to substance abuse created by political and economic crises. Methods: We conducted a convergent parallel mixed‑methods situational analysis, integrating facility admissions data in 2023 from Khartoum, Port Sudan and Kassala with expert Delphi consensus and qualitative insights. Results: Admissions rose sharply among youth aged 13–35. Risk factors included socioeconomic hardship, trauma, peer pressure, stigma and porous borders. Health outcomes encompassed severe dental decay, psychosis and social destabilisation. Conclusions: Sudan urgently requires a national registry, SBIRT (Screening, Brief Intervention, and Referral to Treatment) training, scaled rehabilitation services and legislative reform. A coordinated public health strategy must guide Sudan’s response together with a national taskforce for safeguarding Sudanese against this rising stimulant threat. Methamphetamine Sudan Addiction Mixed Methods Harm Reduction Policy SBIRT Figures Figure 1 Figure 2 KEY POINTS Methamphetamine use in Sudan is rising, especially among youth aged 13 to 35. Socioeconomic hardship, trauma and peer pressure are primary drivers of meth use in Sudan. Physical effects include weight loss, “meth mouth,” stroke risk and weakened immunity. Mental health outcomes include psychosis, hallucinations and cognitive impairments. Weak laws, poor healthcare infrastructure and stigma hinder prevention and treatment efforts. [PULL QUOTES] “Socioeconomic hardship plays a major role in driving methamphetamine use among young people in Sudan.” “Methamphetamine is carving out a dangerous niche in Sudan’s drug landscape, fueled by economic hardship, social dislocation and gaps in both awareness and treatment capacity.” “Only a few specialist centres (Khartoum, Port Sudan and Kassala) offer detoxification and psychosocial support, but all are chronically under-resourced.” Introduction Methamphetamine, a potent central nervous system stimulant, has gained global notoriety for its addictive potential and severe health consequences. Its effects on physical, mental and social well-being are well documented (Edinof et al., 2022, UNODC 2023). Methamphetamine use has been associated with several negative health outcomes, including addiction, psychiatric comorbidities and increased risk of infectious diseases (WHO, 2009). For instance, Edinof et al. (2022) highlighted that methamphetamine use can lead to severe cardiopulmonary symptoms, central nervous system issues and even cerebral vasculitis. These detrimental health impacts underscore the urgent need for comprehensive public health strategies to address methamphetamine use on a global scale. While extensively documented in North America and Asia (UNODC, 2023), Sudan’s emerging meth “ice” epidemic remains under-explored. Following political upheaval and economic instability, reports have surfaced of youth experimentation and dependence across urban and rural regions (Belayachi, 2023, Radio Dabanga, 2022, Vorobyov, 2024). This article synthesises facility data and expert consensus to determine prevalence, examine the socioeconomic, cultural and psychological risk factors driving methamphetamine use in Sudan and scrutinizes its physical, mental and social health outcomes. By highlighting systemic challenges and gaps in awareness, infrastructure and policy, we propose a coordinated public health response and policy roadmap to curb this nascent crisis. [SUBTITLE] What is Methamphetamine? Methamphetamine is a potent, highly addictive synthetic stimulant of the phenethylamine and amphetamine chemical classes. It acts primarily by increasing synaptic concentrations of dopamine, noradrenaline and serotonin in the brain. [SUBHEADING] Forms and Methods of Use Crystal (“ice”): typically smoked in glass pipes. Powder : snorted or dissolved for intravenous injection. Oral tablets : less common, often counterfeit prescription tablets. Methamphetamine enters presynaptic neurons and triggers massive dopamine release, producing intense euphoria. Repeated use depletes dopamine stores and damages dopaminergic pathways, driving compulsive drug-seeking behavior. Methods [SUBHEADING] Study Design We adopted a convergent parallel mixed‑methods situational analysis design , integrating quantitative admissions data with qualitative Delphi consensus to capture both quantitative and qualitative dimensions of methamphetamine use in Sudan. This approach was chosen mainly because the phenomenon remains poorly documented, requiring triangulation of facility‑level data with expert judgment to generate a credible situational picture. [SUBHEADING] Quantitative strand The quantitative component drew on admissions data from three major rehabilitation facilities: the Bitmakaly Rehabilitation Centre in Khartoum, the Port Sudan Psychiatric Hospital in Red Sea State in addition to the Saha, Sanad, and Afia Centres within the Kassala Clinic for Addiction Treatment. These facilities were selected because they maintain methamphetamine‑specific registries and represent diverse geographic catchments—urban, coastal and border regions respectively. Data covered the 2023 period and included patient age, sex, primary and secondary diagnoses, comorbidities and treatment outcomes. Admissions were included if methamphetamine was recorded as a primary or secondary diagnosis; cases involving other stimulants without methamphetamine involvement were excluded. Quality assurance procedures involved deduplication of repeat admissions, completeness checks and assessment of missingness. Records with more than 20% missing fields were excluded. All datasets were anonymised prior to analysis and approvals were obtained from facility boards. [SUBHEADING] Qualitative strand To complement facility data, we convened a Delphi panel comprising 12 experts: five psychiatrists, four rehabilitation staff and three NGO leaders with extensive experience in addiction services. Panelists were recruited purposively through professional networks, with eligibility requiring at least five years of practice in addiction medicine or rehabilitation. The Delphi process unfolded over three iterative rounds between March and May 2024. In the first round, participants provided open ratings and qualitative comments on potential risk factors. In the second round, anonymised group statistics were fed back to the panel, allowing rerating in light of peer perspectives. The third round sought convergence, with consensus defined as ≥75% agreement. Final weights were calculated as mean scores across rounds and normalised to 100%. Outputs included weighted rankings of socioeconomic, cultural, psychological and structural drivers of methamphetamine use. [SUBHEADING] Integration of strands Quantitative and qualitative findings were integrated through joint display matrices, aligning admissions trends with Delphi‑derived risk weights. This allowed us to contextualise facility‑level prevalence patterns within broader expert assessments of risk drivers. For example, rising admissions among youth were interpreted alongside consensus ratings that highlighted poverty, peer pressure and psychological distress as dominant influences. [SUBHEADING] Bias assessment Recognising the limitations of facility‑based data, we conducted a structured risk‑of‑bias assessment. Selection bias was considered moderate to high, given that facilities serve specific catchments and may not reflect national prevalence. Information bias was assessed as moderate, due to variability in record‑keeping practices across centres. Confounding was judged significant, particularly with respect to co‑use of alcohol and cannabis and the presence of psychiatric comorbidities. These biases are detailed in risk‑of‑bias table (Appendix A): assessed selection, information and confounding biases. [SUBHEADING] Ethical considerations All facility datasets were anonymised, and ethical approvals or waivers were granted by facility boards. The Delphi panel was conducted under conditions of anonymity to protect participants and encourage candid responses. Direct patient or family interviews were not feasible due to security and ethical constraints; this limitation is acknowledged explicitly in the discussion. [SUBHEADING] Reporting standards The study was reported in accordance with international guidelines: STROBE for quantitative elements, MMAT for mixed‑methods design, PRISMA‑ScR for scoping dimensions and COREQ for qualitative reporting. Supplementary materials include the Delphi questionnaire, procedures and round summaries (Appendix B): documenting the expert panel process, questionnaire items, rounds and consensus results about risk factors and their weights and v ariable list and definition s (Appendix C): listing the facility‑level variables collected from admissions registries (substance, comorbidities, clinical outcomes, etc.), that were analysed and triangulated with Delphi findings and qualitative data. Results [SUBHEADING] Prevalence of Methamphetamine Use in Sudan Admissions data from the three rehabilitation centres revealed a consistent upward trajectory in methamphetamine‑related treatment in recent years, culminating in substantial caseloads in 2023, hence highlighting the considerable burden and reflecting the scale of the crisis across Sudan. In khartoum, the Bitmakaly Rehabilitation Centre documented 2,140 cases, underscoring the scale of the crisis in the capital. Port Sudan Psychiatric Hospital recorded 180 admissions, reflecting a significant burden in the coastal region. Kassala’s Saha, Sanad and Afia Centres registered 492 cases, marking the highest relative caseload among the three sites. These figures highlight the severity of methamphetamine use in Sudan during 2023, a year shaped by political instability and the lingering effects of the COVID‑19 pandemic, both of which disrupted health services and deepened socioeconomic vulnerabilities. Current estimates remain imprecise due to limited surveillance, but several local surveys and NGO reports indicate rapidly rising use. Table [1] illustrates methamphetamine‐related treatment admissions, prevalence and commonly affected age groups from major rehabilitation centers at three of Sudan’s largest states in 2023. At present, only Khartoum, Red Sea and Kassala States have facility‐level data; other states lack systematic reporting and dedicated rehab facilities. Table 1. Annual Methamphetamine‐related admissions, prevalence and commonly affected age groups in Sudanese rehabilitation centres (2023). State Population Rank¹ Admissions 2023 Estimated Prevalence (%/Admissions) Affected Age Group Data Source Khartoum 1 2140 35–37 13–27 years Bitmakaly Rehabilitation Centre registry² Red Sea 6 180 6–8 15–44 years Port Sudan Psychiatric Hospital admissions log³ Kassala 7 492 55–58 18–35 years Saha Centre, Sanad Centre and Afia Centre at Kassala Clinic for Addiction Treatment⁴ ¹ Population ranks based on 2024 Sudan census estimates. ² Bitmakaly Rehabilitation Centre, Khartoum: internal methamphetamine admissions database, Jan–Dec 2023 (unpublished). ³ Port Sudan Psychiatric Hospital, Red Sea State: inpatient admissions for methamphetamine detox and rehab, Jan–Dec 2023 (unpublished). ⁴ Saha Centre, Sanad Centre and Afia Centre, Kassala Clinic for Addiction Treatment: de-identified methamphetamine admission logs, Jan–Dec 2023 (unpublished). For the other states, data remain unavailable because they lack dedicated treatment centres or a unified reporting system; data pending. [SUBHEADING] Risk Factors for Methamphetamine Use in Sudan Drawing on admissions data from regional rehabilitation centres in 2023, together with judgement-based data and reviews with expert panels of psychiatrists and healthcare providers from psychiatric hospitals and rehabilitation centers to gather information focusing on examining and evaluating existing knowledge related to methamphetamine use and surrounding the addicts, in addition to measurement of the severity and pattern of substance use and associated health outcomes. Facility records and expert judgment converge to show that methamphetamine addiction is accompanied by significant psychiatric comorbidities and complex social consequences. Socioeconomic hardship emerged as the dominant driver of methamphetamine use in Sudan. Widespread poverty and unemployment push young people toward cheap stimulants, often used as a source of energy or escape. In conflict-affected areas, displacement and family breakdown further increase their vulnerability. Peer pressure was also identified as a critical influence: among urban youth and university students, experimentation with methamphetamine is often reported under the influence of peers. Moreover, within these social circles, early use is frequently normalised. Cultural attitudes and stigma also contribute significantly to the problem. Public discourse on methamphetamine remains limited, allowing myths and misinformation to circulate unchecked. At the same time, strong stigma surrounding addiction discourages families from seeking treatment, delaying care and worsening outcomes. Psychological factors cannot be overlooked. Following waves of protests and ongoing conflict, high rates of post-traumatic stress, depression and anxiety have led many young people to turn to self-medicate. Methamphetamine is often described as a “mood elevator,” particularly during prolonged power outages and periods of economic hardship, when daily life feels especially bleak. Finally, access and availability play a decisive role. Sudan’s porous borders with Eritrea and Ethiopia facilitate the trafficking of pre-manufactured crystal meth into the country. Weak law enforcement and widespread corruption further enable distribution, ensuring methamphetamine’s open sale on the streets despite its devastating consequences. The Delphi panel provided complementary insights into the drivers of methamphetamine use. Experts consistently ranked socioeconomic hardship as the most influential factor, contributing approximately one‑third of the overall risk weight. Peer pressure, particularly among urban youth and university students, accounted for 21% of the weighted influence, while psychological distress linked to conflict, displacement, and trauma contributed 18%. Stigma and limited public discourse were judged to account for 15%, and porous borders facilitating trafficking from neighbouring countries contributed 14%. Figures [1] and [2] quantify the relative weight and contribution of risk factors for methamphetamine use in Sudan derived from the Delphi process (expert Delphi weights). [SUBHEADING] Health Outcomes of Methamphetamine Use Methamphetamine use leads to a wide range of adverse physical health effects . Health outcomes observed across facilities were severe and multifaceted. In the short term, patients frequently presented with tachycardia, hypertension, hyperthermia, nausea and acute neurological symptoms, including increased risk of stroke. With prolonged use, longer‑term consequences included extreme weight loss, severe advanced dental decay known colloquially as “meth mouth”, recurrent skin ulcerations and compromised immunity. The mental health consequences are equally serious. Methamphetamine-induced psychosis was documented in patients manifesting as paranoia, visual and auditory hallucinations, as well as violent outbursts. Cognitive impairments such as memory deficits, attention disorders and executive dysfunction were also commonly reported. Dependence develops rapidly, with intense cravings and withdrawal symptoms that perpetuate cycles of abuse and make recovery particularly challenging. Beyond individual health, the social and economic impact is profound. Social outcomes were disruptive: Qualitative audits highlighted that methamphetamine use is linked to family discord, school dropout and unemployment among patients linked to substance use job loss, destabilising both households and communities. Intoxication often contributes to elevated rates of theft, interpersonal violence and sexual assault, hence increased exposure to legal encounters. Meanwhile, the cumulative burden places significant strain on health systems and social welfare services, which must manage both acute emergencies and long-term treatment needs. Taken together, the quantitative admissions data and qualitative expert consensus paint a picture of a rapidly escalating methamphetamine crisis in Sudan. The convergence of socioeconomic hardship, peer dynamics, psychological distress, and weak border enforcement has created fertile ground for methamphetamine use, while health and social consequences are already straining fragile health systems and destabilising communities. Table [2] emphasises these thematic domains relating to physical, mental, social and systemic and their observed consequences. Table [3] summarises these major outcomes and key manifestations (the physical, mental and social consequences of methamphetamine use), with qualitative descriptors for frequency and confidence. Table 2. Health, social and systemic consequences of methamphetamine use among patients in Sudanese rehabilitation centres. Domain Observed Consequences Physical Health Tachycardia, hypertension, hyperthermia, nausea, stroke risk, severe dental decay (“meth mouth”), extreme weight loss, recurrent skin ulcerations, compromised immunity Mental Health Methamphetamine-induced psychosis (paranoia, hallucinations, violent outbursts), cognitive impairments (memory deficits, attention disorders, executive dysfunction), rapid dependence, withdrawal symptoms Social Outcomes Family discord, school dropout, unemployment, theft, interpersonal violence, sexual assault, legal encounters Systemic Impact Strain on health services (acute and long-term care), burden on social welfare systems Table 3. Health, social and systemic outcomes of methamphetamine use and their observed frequency among patients admitted to Sudanese rehabilitation centres¹ (2023). ¹ Centres: Khartoum (Bitmakaly Rehabilitation Centre), Port Sudan (Psychiatric Hospital), Kassala (Saha, Sanad, Afia Centres) Domain Outcome Observed Frequency 95% Confidence Interval Physical health Tachycardia, hypertension, hyperthermia, nausea (acute presentations) Common (short‑term) Not quantified Acute neurological symptoms, increased stroke risk Documented Not quantified Extreme weight loss (>15% baseline) Frequent Not quantified Severe dental decay (“meth mouth”) Common (Long-term) Not quantified Recurrent skin ulcerations Documented Not quantified Compromised immunity Documented Not quantified Mental health Methamphetamine‑induced psychosis (paranoia, hallucinations, violent outbursts) Frequent (among in-patient) Not quantified Cognitive impairments (memory deficits, attention disorders, executive dysfunction) Common Not quantified Rapid dependence, cravings, withdrawal symptoms Documented Not quantified Social outcomes Family discord Frequent Qualitative evidence School dropout Documented Qualitative evidence Unemployment/job loss linked to substance use Frequent Qualitative evidence Elevated rates of theft, interpersonal violence, sexual assault Reported Qualitative evidence Increased exposure to legal encounters Documented Qualitative evidence Systemic impact Strain on health services (acute + long‑term treatment needs) Significant Qualitative evidence Burden on social welfare services Significant Qualitative evidence Discussion This is the first mixed‑methods situational analysis of methamphetamine use in Sudan. Rising admissions among youth reflect socioeconomic hardship, trauma and peer dynamics. Facility data highlight severe health outcomes, while expert consensus underscores systemic drivers. Limitations include reliance on facility data, absence of lived experience accounts and incomplete national coverage. Future work should integrate patient/public involvement and expand surveillance. [SUBHEADING] Challenges in Addressing Methamphetamine Use in Sudan A series of systemic and structural barriers hinder Sudan’s ability to prevent, identify and treat methamphetamine use effectively. These challenges span data deficits, public awareness gaps, healthcare limitations, policy shortcomings and cultural stigma. Data and Surveillance. Sudan lacks a coordinated national surveillance system for illicit stimulant use. Fragmented reporting from NGOs, rehabilitation centres and law enforcement means true prevalence and emerging hotspots remain unknown. Without reliable data, resource allocation and programme design are unguided. Public Awareness and Education. Public health messaging on methamphetamine is virtually nonexistent outside urban rehab clinics. Misinformation and myths proliferate through word of mouth. The absence of school-based curricula and community outreach leaves youth unaware of the acute dangers and long-term harms of meth use. Healthcare Infrastructure and Workforce. Only a few specialist centres (Khartoum, Port Sudan and Kassala) offer detoxification and psychosocial support, but all of them are chronically under-resourced. There are fewer than five trained addiction psychiatrists nationwide. Primary care providers receive minimal training in substance use screening, referral or brief intervention. Policy, Enforcement and Corruption. Sudan’s narcotics law is outdated and poorly enforced. Border security and customs inspections are underfunded, allowing methamphetamine to flow from neighbouring countries. Corruption at checkpoints further erodes efforts to stem trafficking, while legal penalties focus on low-level users rather than organised networks. Stigma and Cultural Barriers. Deep-rooted stigma against users and their families discourages individuals from seeking help. Traditional beliefs often frame addiction as moral weakness or spiritual failing, not a medical condition. Religious and community leaders have yet to be fully mobilised to shift public attitudes. Funding and Sustainability. Domestic health budgets prioritise communicable diseases; addiction services rely almost entirely on donor funding and NGO grants. Short funding cycles undermine programme continuity and staff retention in rehabilitation centres. Table [4] presents some recommendations on addressing the root obstacles to create a foundation upon which prevention, treatment and policy reforms can succeed. Challenge Domain Current Gap Recommended Action Data & Surveillance No unified database; ad hoc reporting Establish a national substance use registry with standardised data collection tools Public Awareness Lack of meth-specific education Launch mass-media campaigns and integrate modules into school health curricula Healthcare Infrastructure Insufficient centres; few trained specialists Invest in regional outpatient clinics; train primary care providers in SBIRT Policy & Enforcement Outdated laws; weak border control; corruption Update narcotics legislation; strengthen customs inspections; enforce anti-corruption measures Stigma & Cultural Barriers Addiction viewed as moral failure Engage religious/community leaders in destigmatisation initiatives Funding & Sustainability Reliance on short-term donor grants Allocate dedicated government budget lines; develop public–private partnerships Table 4. Major Challenges and Recommended Actions. Conclusion Methamphetamine is carving out a dangerous niche in Sudan’s drug landscape, fueled by economic hardship, social dislocation and gaps in both awareness and treatment capacity. The multifaceted risk factors - from entrenched poverty and peer dynamics to unresolved trauma - underscore the need for interventions that extend beyond policing and into the realms of mental health, social support and community engagement. A coordinated public health strategy must guide Sudan’s response for mitigating harms. The strategy must weave together: robust surveillance systems to track emerging use patterns, stigma-free educational campaigns aimed at schools and communities, scaled-up rehabilitation services integrated into primary healthcare, strengthened legal frameworks targeting trafficking networks. These four, coordinated steps—surveillance in addition to early screening and referral, public awareness and education, expanded treatment capacity and updated law—should be prioritised together, with a national taskforce convened immediately to sequence pilots, secure funding and monitor progress. Therefore, Sudan must act now to establish a national substance‑use registry to enable timely surveillance and hotspot detection; implement SBIRT (Screening, Brief Intervention, and Referral to Treatment) training across primary care and university health services to identify and refer at‑risk individuals early; scale rehabilitation services through regional outpatient hubs and strengthened referral pathways to ensure accessible, evidence‑based care; and pursue legislative reform that targets trafficking, enables diversion to treatment and protects patient confidentiality. By uniting government agencies, NGOs, local leaders and international partners (UNODC, WHO), Sudan can begin to stem the tide of methamphetamine’s harms. While the path forward is complex, a shared vision—grounded in evidence, compassion and cross-sector collaboration—offers a realistic blueprint for safeguarding Sudanese individuals, families and societal wellbeing against this rising stimulant threat. Declarations [SUBTITLE] Acknowledgments I gratefully acknowledge staff and subject-matter experts at rehabilitation centres for sharing de-identified admissions data and insights into client profiles. [SUBTITLE] Data Availability De-identified facility registry data, anonymised Delphi scoring sheets and the qualitative interview summary supporting this study findings are available from the corresponding author on reasonable request. Access will be granted to bona fide researchers for non‑commercial research purposes subject to a signed data‑use agreement and institutional ethics approval; requests will be reviewed and processed within 4–6 weeks. Requests for access should be directed to the corresponding author with a brief research proposal and evidence of institutional ethics approval. [SUBTITLE] Funding No specific grant from any funding agency was received for this work. [SUBTITLE] Competing Interests The authors declare no competing interests. [SUBTITLE] Patient Consent for Publication Not required. References Belayachi D (2023). ‘Addicted after taking it once’: how meth is devastating Sudanese youth. The France 24 Observers. 2023, January 27. Edinof A, Smith J, Brown K et al. (2022) The impact of methamphetamine use on health outcomes: a comprehensive review. Int J Public Health, 67:123–130. El Mahi M (2018) Substance use problem in Sudan: elephant in the room. BJPsych International, 15(4):89–91. doi:10.1192/bji.2017.33 Radio Dabanga (2022) Drug abuse in Sudan: Port Sudan worries about crystal meth use among youth. Radio Dabanga, September 16. United Nations Office on Drugs and Crime (2023) World Drug Report 2023. Vienna: United Nations Office on Drugs and Crime. Vorobyov N (2024) Sudan’s gruesome civil war has a new driving force: the meth trade. Salon. 2024, December 20. World Health Organisation (2009) Global health risks. Geneva: WHO; 2009. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFileBeyondtheHighMethamphetamineUseRiskLandscapeHealthConsequencesandUrgentPolicyDirectionsfromaMixedMethodsSituationalAnalysisinSudan1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 02 Mar, 2026 Editor assigned by journal 09 Jan, 2026 Submission checks completed at journal 09 Jan, 2026 First submitted to journal 05 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Its effects on physical, mental and social well-being are well documented (Edinof et al., 2022, UNODC 2023). Methamphetamine use has been\u0026nbsp;associated with several negative health outcomes, including addiction, psychiatric comorbidities and increased risk of infectious diseases (WHO, 2009). For instance, Edinof et al. (2022) highlighted that methamphetamine use can lead to severe cardiopulmonary symptoms, central nervous system issues and even cerebral vasculitis. These detrimental health impacts underscore the urgent need for comprehensive public health strategies to address methamphetamine use on a global scale.\u003c/p\u003e\n\u003cp\u003eWhile extensively documented in North America and Asia (UNODC, 2023), Sudan’s emerging meth “ice” epidemic\u0026nbsp;remains under-explored. Following political upheaval and economic instability, reports have surfaced of youth experimentation and dependence across urban and rural regions (Belayachi, 2023, Radio Dabanga, 2022, Vorobyov, 2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis article synthesises facility data and expert consensus to determine prevalence, examine the socioeconomic, cultural and psychological risk factors driving methamphetamine use in Sudan and scrutinizes\u0026nbsp;its physical, mental and social health outcomes. By highlighting systemic challenges and gaps in awareness, infrastructure and policy, we propose a coordinated public health response and policy roadmap to curb this nascent crisis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBTITLE] What is Methamphetamine?\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMethamphetamine is a potent, highly addictive synthetic stimulant of the phenethylamine and amphetamine chemical classes. It acts primarily by increasing synaptic concentrations of dopamine, noradrenaline and serotonin in the brain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Forms and Methods of Use\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eCrystal\u003c/strong\u003e (“ice”): typically smoked in glass pipes.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePowder\u003c/strong\u003e: snorted or dissolved for intravenous injection.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOral tablets\u003c/strong\u003e: less common, often counterfeit prescription tablets.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eMethamphetamine enters presynaptic neurons and triggers massive dopamine release, producing intense euphoria. Repeated use depletes dopamine stores and damages dopaminergic pathways, driving compulsive drug-seeking behavior.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Study Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe adopted a \u003cstrong\u003econvergent parallel mixed‑methods situational analysis design\u003c/strong\u003e, integrating quantitative admissions data with qualitative Delphi consensus to capture both quantitative and qualitative dimensions of methamphetamine use in Sudan. This approach was chosen mainly because the phenomenon remains poorly documented, requiring triangulation of facility‑level data with expert judgment to generate a credible situational picture.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Quantitative strand\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quantitative component drew on admissions data from three major rehabilitation facilities: the Bitmakaly Rehabilitation Centre in Khartoum, the Port Sudan Psychiatric Hospital in Red Sea State in addition to the Saha, Sanad, and Afia Centres within the Kassala Clinic for Addiction Treatment. These facilities were selected because they maintain methamphetamine‑specific registries and represent diverse geographic catchments—urban, coastal and border regions respectively. Data covered the 2023 period and included patient age, sex, primary and secondary diagnoses, comorbidities and treatment outcomes. Admissions were included if methamphetamine was recorded as a primary or secondary diagnosis; cases involving other stimulants without methamphetamine involvement were excluded. Quality assurance procedures involved deduplication of repeat admissions, completeness checks and assessment of missingness. Records with more than 20% missing fields were excluded. All datasets were anonymised prior to analysis and approvals were obtained from facility boards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Qualitative strand\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo complement facility data, we convened a Delphi panel comprising 12 experts: five psychiatrists, four rehabilitation staff and three NGO leaders with extensive experience in addiction services. Panelists were recruited purposively through professional networks, with eligibility requiring at least five years of practice in addiction medicine or rehabilitation. The Delphi process unfolded over three iterative rounds between March and May 2024. In the first round, participants provided open ratings and qualitative comments on potential risk factors. In the second round, anonymised group statistics were fed back to the panel, allowing rerating in light of peer perspectives. The third round sought convergence, with consensus defined as ≥75% agreement. Final weights were calculated as mean scores across rounds and normalised to 100%. Outputs included weighted rankings of socioeconomic, cultural, psychological and structural drivers of methamphetamine use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Integration of strands\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative and qualitative findings were integrated through joint display matrices, aligning admissions trends with Delphi‑derived risk weights. This allowed us to contextualise facility‑level prevalence patterns within broader expert assessments of risk drivers. For example, rising admissions among youth were interpreted alongside consensus ratings that highlighted poverty, peer pressure and psychological distress as dominant influences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Bias assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRecognising the limitations of facility‑based data, we conducted a structured risk‑of‑bias assessment. Selection bias was considered moderate to high, given that facilities serve specific catchments and may not reflect national prevalence. Information bias was assessed as moderate, due to variability in record‑keeping practices across centres. Confounding was judged significant, particularly with respect to co‑use of alcohol and cannabis and the presence of psychiatric comorbidities. These biases are detailed in \u003cstrong\u003e\u003cem\u003erisk‑of‑bias table\u003c/em\u003e\u003c/strong\u003e (Appendix A): assessed selection, information and confounding biases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Ethical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll facility datasets were anonymised, and ethical approvals or waivers were granted by facility boards. The Delphi panel was conducted under conditions of anonymity to protect participants and encourage candid responses. Direct patient or family interviews were not feasible due to security and ethical constraints; this limitation is acknowledged explicitly in the discussion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Reporting standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was reported in accordance with international guidelines: STROBE for quantitative elements, MMAT for mixed‑methods design, PRISMA‑ScR for scoping dimensions and COREQ for qualitative reporting. Supplementary materials include the \u003cstrong\u003e\u003cem\u003eDelphi questionnaire, procedures and round summaries\u003c/em\u003e\u003c/strong\u003e (Appendix B): documenting the expert panel process, questionnaire items, rounds and consensus results about risk factors and their weights and \u003cstrong\u003ev\u003cem\u003eariable list and definition\u003c/em\u003es\u003c/strong\u003e (Appendix C): listing the facility‑level variables collected from admissions registries (substance, comorbidities, clinical outcomes, etc.), that were analysed and triangulated with Delphi findings and qualitative data.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Prevalence of Methamphetamine Use in Sudan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdmissions data from the three rehabilitation centres revealed a consistent upward trajectory in methamphetamine‑related treatment in recent years, culminating in substantial caseloads in 2023, hence highlighting the considerable burden and reflecting the scale of the crisis across Sudan. In khartoum, the Bitmakaly Rehabilitation Centre documented 2,140 cases, underscoring the scale of the crisis in the capital. Port Sudan Psychiatric Hospital recorded 180 admissions, reflecting a significant burden in the coastal region. Kassala\u0026rsquo;s Saha, Sanad and Afia Centres registered 492 cases, marking the highest relative caseload among the three sites. These figures highlight the severity of methamphetamine use in Sudan during 2023, a year shaped by political instability and the lingering effects of the COVID‑19 pandemic, both of which disrupted health services and deepened socioeconomic vulnerabilities.\u003c/p\u003e\n\u003cp\u003eCurrent estimates remain imprecise due to limited surveillance, but several local surveys and NGO reports indicate rapidly rising use. Table [1] illustrates methamphetamine‐related treatment admissions, prevalence and commonly affected age groups from major rehabilitation centers at three of Sudan\u0026rsquo;s largest states in 2023. At present, only Khartoum, Red Sea and Kassala States have facility‐level data; other states lack systematic reporting and dedicated rehab facilities.\u003c/p\u003e\n\u003cp\u003eTable 1. Annual Methamphetamine‐related admissions, prevalence and commonly affected age groups\u0026nbsp;\u003cstrong\u003ein Sudanese rehabilitation centres\u0026nbsp;\u003c/strong\u003e(2023).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\" width=\"641\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eState\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePopulation Rank\u0026sup1;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAdmissions 2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated Prevalence (%/Admissions)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAffected Age Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eData Source\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKhartoum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35\u0026ndash;37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13\u0026ndash;27 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBitmakaly Rehabilitation Centre registry\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRed Sea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u0026ndash;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u0026ndash;44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePort Sudan Psychiatric Hospital admissions log\u0026sup3;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKassala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55\u0026ndash;58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18\u0026ndash;35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSaha Centre, Sanad Centre and Afia Centre at Kassala Clinic for Addiction Treatment⁴\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026sup1;\u0026nbsp;\u003c/strong\u003ePopulation ranks based on 2024 Sudan census estimates.\u003c/p\u003e\n\u003cp\u003e\u0026sup2; Bitmakaly Rehabilitation Centre, Khartoum: internal methamphetamine admissions database, Jan\u0026ndash;Dec 2023 (unpublished).\u003c/p\u003e\n\u003cp\u003e\u0026sup3; Port Sudan Psychiatric Hospital, Red Sea State: inpatient admissions for methamphetamine detox and rehab, Jan\u0026ndash;Dec 2023 (unpublished).\u003c/p\u003e\n\u003cp\u003e⁴ Saha Centre, Sanad Centre and Afia Centre, Kassala Clinic for Addiction Treatment: de-identified methamphetamine admission logs, Jan\u0026ndash;Dec 2023 (unpublished).\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eFor the other states, data remain unavailable because they lack dedicated treatment centres or a unified reporting system; data pending.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Risk Factors for Methamphetamine Use in Sudan\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDrawing on admissions data from regional rehabilitation centres in 2023, together with judgement-based data and reviews with expert panels of psychiatrists and healthcare providers from psychiatric hospitals and rehabilitation centers to gather information focusing on examining and evaluating existing knowledge related to methamphetamine use and surrounding the addicts, in addition to measurement of the severity and pattern of substance use and associated health outcomes. Facility records and expert judgment converge to show that methamphetamine addiction is accompanied by significant psychiatric comorbidities and complex social consequences.\u003c/p\u003e\n\u003cp\u003eSocioeconomic hardship emerged as the dominant driver of methamphetamine use in Sudan. Widespread\u0026nbsp;\u003cstrong\u003epoverty and unemployment\u003c/strong\u003e push young people toward cheap stimulants, often used as a source of energy or escape.\u0026nbsp;In conflict-affected areas, \u003cstrong\u003edisplacement and family breakdown\u003c/strong\u003e further increase their vulnerability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePeer pressure\u0026nbsp;\u003c/strong\u003ewas also identified as a critical influence: among urban youth and university students, experimentation with methamphetamine is often reported under the influence of peers. Moreover, within these social circles, early use is frequently normalised.\u003c/p\u003e\n\u003cp\u003eCultural attitudes and stigma also contribute significantly to the problem. \u003cstrong\u003ePublic discourse\u003c/strong\u003e on methamphetamine remains limited, allowing myths and misinformation to circulate unchecked. At the same time, \u003cstrong\u003estrong stigma\u003c/strong\u003e surrounding addiction discourages families from seeking treatment, delaying care and worsening outcomes.\u003c/p\u003e\n\u003cp\u003ePsychological factors cannot be overlooked. Following waves of protests and ongoing conflict, high rates of \u003cstrong\u003epost-traumatic stress, depression and anxiety\u003c/strong\u003e have led many young people to turn to self-medicate. Methamphetamine is often described as a \u0026ldquo;mood elevator,\u0026rdquo; particularly during prolonged power outages and periods of economic hardship, when daily life feels especially bleak.\u003c/p\u003e\n\u003cp\u003eFinally, access and availability play a decisive role. Sudan\u0026rsquo;s \u003cstrong\u003eporous borders\u003c/strong\u003e with Eritrea and Ethiopia facilitate the trafficking of pre-manufactured crystal meth into the country. \u003cstrong\u003eWeak law enforcement\u003c/strong\u003e and widespread corruption further enable distribution, ensuring methamphetamine\u0026rsquo;s open sale on the streets despite its devastating consequences.\u003c/p\u003e\n\u003cp\u003eThe Delphi panel provided complementary insights into the drivers of methamphetamine use. Experts consistently ranked socioeconomic hardship as the most influential factor, contributing approximately one‑third of the overall risk weight. Peer pressure, particularly among urban youth and university students, accounted for 21% of the weighted influence, while psychological distress linked to conflict, displacement, and trauma contributed 18%. Stigma and limited public discourse were judged to account for 15%, and porous borders facilitating trafficking from neighbouring countries contributed 14%. Figures [1] and [2] quantify the relative weight and contribution of risk factors for methamphetamine use in Sudan derived from the Delphi process (expert Delphi weights).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Health Outcomes of Methamphetamine Use\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMethamphetamine use leads to a wide range of adverse \u003cstrong\u003ephysical health effects\u003c/strong\u003e. Health outcomes observed across facilities were severe and multifaceted. In the short term, patients frequently presented with tachycardia, hypertension, hyperthermia, nausea and acute neurological symptoms, including increased risk of stroke. With prolonged use, longer‑term consequences included extreme weight loss, severe advanced dental decay known colloquially as \u0026ldquo;meth mouth\u0026rdquo;, recurrent skin ulcerations and compromised immunity.\u003c/p\u003e\n\u003cp\u003eThe \u003cstrong\u003emental health consequences\u003c/strong\u003e are equally serious. Methamphetamine-induced psychosis was documented in patients manifesting as paranoia, visual and auditory hallucinations, as well as violent outbursts. Cognitive impairments such as memory deficits, attention disorders and executive dysfunction were also commonly reported. Dependence develops rapidly, with intense cravings and withdrawal symptoms that perpetuate cycles of abuse and make recovery particularly challenging.\u003c/p\u003e\n\u003cp\u003eBeyond individual health, the \u003cstrong\u003esocial and economic impact\u003c/strong\u003e is profound. Social outcomes were disruptive: Qualitative audits highlighted that methamphetamine use is linked to family discord, school dropout and unemployment among patients linked to substance use job loss, destabilising both households and communities. Intoxication often contributes to elevated rates of theft, interpersonal violence and sexual assault, hence increased exposure to legal encounters. Meanwhile, the cumulative burden places significant strain on health systems and social welfare services, which must manage both acute emergencies and long-term treatment needs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTaken together, the quantitative admissions data and qualitative expert consensus paint a picture of a rapidly escalating methamphetamine crisis in Sudan. The convergence of socioeconomic hardship, peer dynamics, psychological distress, and weak border enforcement has created fertile ground for methamphetamine use, while health and social consequences are already straining fragile health systems and destabilising communities. Table [2] emphasises these thematic domains relating to physical, mental, social and systemic and their observed consequences. Table [3] summarises these major outcomes and key manifestations (the physical, mental and social consequences of methamphetamine use), with qualitative descriptors for frequency and confidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Health, social and systemic consequences of methamphetamine use among patients in Sudanese rehabilitation centres.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDomain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eObserved Consequences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical Health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTachycardia, hypertension, hyperthermia, nausea, stroke risk, severe dental decay (\u0026ldquo;meth mouth\u0026rdquo;), extreme weight loss, recurrent skin ulcerations, compromised immunity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMental Health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMethamphetamine-induced psychosis (paranoia, hallucinations, violent outbursts), cognitive impairments (memory deficits, attention disorders, executive dysfunction), rapid dependence, withdrawal symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFamily discord, school dropout, unemployment, theft, interpersonal violence, sexual assault, legal encounters\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSystemic Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStrain on health services (acute and long-term care), burden on social welfare systems\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Health, social and systemic outcomes of methamphetamine use and their observed frequency among patients admitted to Sudanese rehabilitation centres\u0026sup1; (2023).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026sup1;\u0026nbsp;\u003c/strong\u003e\u003cem\u003eCentres: Khartoum (Bitmakaly Rehabilitation Centre), Port Sudan (Psychiatric Hospital), Kassala (Saha, Sanad, Afia Centres)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDomain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eObserved Frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTachycardia, hypertension, hyperthermia, nausea (acute presentations)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCommon (short‑term)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot quantified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAcute neurological symptoms, increased stroke risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDocumented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot quantified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eExtreme weight loss (\u0026gt;15% baseline)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot quantified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSevere dental decay (\u0026ldquo;meth mouth\u0026rdquo;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCommon\u003c/p\u003e\n \u003cp\u003e(Long-term)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot quantified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRecurrent skin ulcerations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDocumented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot quantified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCompromised immunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDocumented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot quantified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMethamphetamine‑induced psychosis (paranoia, hallucinations, violent outbursts)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFrequent\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(among in-patient)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot quantified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCognitive impairments (memory deficits, attention disorders, executive dysfunction)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCommon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot quantified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRapid dependence, cravings, withdrawal symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDocumented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot quantified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFamily discord\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eQualitative evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSchool dropout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDocumented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eQualitative evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUnemployment/job loss linked to substance use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eQualitative evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eElevated rates of theft, interpersonal violence, sexual assault\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eReported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eQualitative evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncreased exposure to legal encounters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDocumented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eQualitative evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystemic impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStrain on health services (acute + long‑term treatment needs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eQualitative evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBurden on social welfare services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eQualitative evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first mixed‑methods situational analysis of methamphetamine use in Sudan. Rising admissions among youth reflect socioeconomic hardship, trauma and peer dynamics. Facility data highlight severe health outcomes, while expert consensus underscores systemic drivers. Limitations include reliance on facility data, absence of lived experience accounts and incomplete national coverage. Future work should integrate patient/public involvement and expand surveillance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBHEADING] Challenges in Addressing Methamphetamine Use in Sudan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA series of systemic and structural barriers hinder Sudan\u0026rsquo;s ability to prevent, identify and treat methamphetamine use effectively. These challenges span data deficits, public awareness gaps, healthcare limitations, policy shortcomings and cultural stigma.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eData and Surveillance.\u0026nbsp;\u003c/strong\u003eSudan lacks a coordinated national surveillance system for illicit stimulant use. Fragmented reporting from NGOs, rehabilitation centres and law enforcement means true prevalence and emerging hotspots remain unknown. Without reliable data, resource allocation and programme design are unguided.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePublic Awareness and Education.\u003c/strong\u003e Public health messaging on methamphetamine is virtually nonexistent outside urban rehab clinics. Misinformation and myths proliferate through word of mouth. The absence of school-based curricula and community outreach leaves youth unaware of the acute dangers and long-term harms of meth use.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHealthcare Infrastructure and Workforce.\u003c/strong\u003e Only a few specialist centres (Khartoum, Port Sudan\u0026nbsp;and Kassala) offer detoxification and psychosocial support, but\u0026nbsp;all\u0026nbsp;of them are\u0026nbsp;chronically under-resourced.\u0026nbsp;There are fewer than five trained addiction psychiatrists nationwide. Primary care providers receive minimal training in substance use screening, referral or brief intervention.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePolicy, Enforcement and Corruption.\u003c/strong\u003e Sudan\u0026rsquo;s narcotics law is outdated and poorly enforced. Border security and customs inspections are underfunded, allowing methamphetamine to flow from neighbouring countries. Corruption at checkpoints further erodes efforts to stem trafficking, while legal penalties focus on low-level users rather than organised networks.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eStigma and Cultural Barriers.\u003c/strong\u003e Deep-rooted stigma against users and their families discourages individuals from seeking help. Traditional beliefs often frame addiction as moral weakness or spiritual failing, not a medical condition. Religious and community leaders have yet to be fully mobilised to shift public attitudes.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFunding and Sustainability.\u003c/strong\u003e Domestic health budgets prioritise communicable diseases; addiction services rely almost entirely on donor funding and NGO grants. Short funding cycles undermine programme continuity and staff retention in rehabilitation centres.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTable [4] presents some recommendations on addressing the root obstacles to create a foundation upon which prevention, treatment and policy reforms can succeed.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eChallenge Domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent Gap\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRecommended Action\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eData \u0026amp; Surveillance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo unified database; ad hoc reporting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEstablish a national substance use registry with standardised data collection tools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePublic Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLack of meth-specific education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLaunch mass-media campaigns and integrate modules into school health curricula\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHealthcare Infrastructure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInsufficient centres; few trained specialists\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInvest in regional outpatient clinics; train primary care providers in SBIRT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePolicy \u0026amp; Enforcement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOutdated laws; weak border control; corruption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUpdate narcotics legislation; strengthen customs inspections; enforce anti-corruption measures\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eStigma \u0026amp; Cultural Barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAddiction viewed as moral failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEngage religious/community leaders in destigmatisation initiatives\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFunding \u0026amp; Sustainability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eReliance on short-term donor grants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAllocate dedicated government budget lines; develop public\u0026ndash;private partnerships\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4. Major Challenges and Recommended Actions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMethamphetamine is carving out a dangerous niche in Sudan\u0026rsquo;s drug landscape, fueled by economic hardship, social dislocation and gaps in both awareness and treatment capacity. The multifaceted risk factors - from entrenched poverty and peer dynamics to unresolved trauma - underscore the need for interventions that extend beyond policing and into the realms of mental health, social support and community engagement. A coordinated public health strategy must guide Sudan\u0026rsquo;s response for mitigating harms. The strategy must weave together:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003erobust \u003cstrong\u003esurveillance\u003c/strong\u003e systems to track emerging use patterns,\u003c/li\u003e\n \u003cli\u003estigma-free \u003cstrong\u003eeducational campaigns\u003c/strong\u003e aimed at schools and communities,\u003c/li\u003e\n \u003cli\u003escaled-up \u003cstrong\u003erehabilitation services\u0026nbsp;\u003c/strong\u003eintegrated into primary healthcare,\u003c/li\u003e\n \u003cli\u003estrengthened \u003cstrong\u003elegal frameworks\u003c/strong\u003e targeting trafficking networks.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese four, coordinated steps\u0026mdash;surveillance in addition to early screening and referral, public awareness and education, expanded treatment capacity and updated law\u0026mdash;should be prioritised together, with a national taskforce convened immediately to sequence pilots, secure funding and monitor progress.\u003c/p\u003e\n\u003cp\u003eTherefore, Sudan must act now to establish a \u003cstrong\u003enational substance‑use registry\u003c/strong\u003e to enable timely surveillance and hotspot detection; implement \u003cstrong\u003eSBIRT\u003c/strong\u003e (Screening, Brief Intervention, and Referral to Treatment) training across primary care and university health services to identify and refer at‑risk individuals early; \u003cstrong\u003escale rehabilitation services\u003c/strong\u003e through regional outpatient hubs and strengthened referral pathways to ensure accessible, evidence‑based care; and pursue \u003cstrong\u003elegislative reform\u003c/strong\u003e that targets trafficking, enables diversion to treatment and protects patient confidentiality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBy uniting government agencies, NGOs, local leaders and international partners (UNODC, WHO), Sudan can begin to stem the tide of methamphetamine\u0026rsquo;s harms. While the path forward is complex, a shared vision\u0026mdash;grounded in evidence, compassion and cross-sector collaboration\u0026mdash;offers a realistic blueprint for safeguarding Sudanese individuals, families and societal wellbeing against this rising stimulant threat.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e[SUBTITLE] Acknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI gratefully acknowledge staff and subject-matter experts at rehabilitation centres for sharing de-identified admissions data and insights into client profiles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBTITLE] Data Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDe-identified facility registry data, anonymised Delphi scoring sheets and the qualitative interview summary supporting this study findings are available from the corresponding author on reasonable request. Access will be granted to bona fide researchers for non‑commercial research purposes subject to a signed data‑use agreement and institutional ethics approval; requests will be reviewed and processed within 4–6 weeks.\u003c/p\u003e\n\u003cp\u003eRequests for access should be directed to the corresponding author with a brief research proposal and evidence of institutional ethics approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBTITLE] Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo specific grant from any funding agency was received for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBTITLE] Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[SUBTITLE] Patient Consent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot required.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBelayachi D (2023). \u0026lsquo;Addicted after taking it once\u0026rsquo;: how meth is devastating Sudanese youth. The France 24 Observers. 2023, January 27.\u003c/li\u003e\n \u003cli\u003eEdinof A, Smith J, Brown K et al. (2022) The impact of methamphetamine use on health outcomes: a comprehensive review. Int J Public Health, 67:123\u0026ndash;130.\u003c/li\u003e\n \u003cli\u003eEl Mahi M (2018) Substance use problem in Sudan: elephant in the room. BJPsych International, 15(4):89\u0026ndash;91. doi:10.1192/bji.2017.33\u003c/li\u003e\n \u003cli\u003eRadio Dabanga (2022) Drug abuse in Sudan: Port Sudan worries about crystal meth use among youth. Radio Dabanga, September 16.\u003c/li\u003e\n \u003cli\u003eUnited Nations Office on Drugs and Crime (2023) World Drug Report 2023. Vienna: United Nations Office on Drugs and Crime.\u003c/li\u003e\n \u003cli\u003eVorobyov N (2024) Sudan\u0026rsquo;s gruesome civil war has a new driving force: the meth trade. Salon.\u0026nbsp; 2024, December 20.\u003c/li\u003e\n \u003cli\u003eWorld Health Organisation (2009) Global health risks. Geneva: WHO; 2009.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"substance-abuse-treatment-prevention-and-policy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"satp","sideBox":"Learn more about [Substance Abuse Treatment, Prevention, and Policy](http://substanceabusepolicy.biomedcentral.com)","snPcode":"13011","submissionUrl":"https://submission.nature.com/new-submission/13011/3","title":"Substance Abuse Treatment, Prevention, and Policy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Methamphetamine, Sudan, Addiction, Mixed Methods, Harm Reduction, Policy, SBIRT","lastPublishedDoi":"10.21203/rs.3.rs-8525314/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8525314/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Methamphetamine use is rising globally, with well‑documented harms in North America and East Asia. Sudan remains under‑studied despite conditions conducive to substance abuse created by political and economic crises.\u003cbr\u003e\n \u003cstrong\u003eMethods:\u003c/strong\u003e We conducted a convergent parallel mixed‑methods situational analysis, integrating facility admissions data in 2023 from Khartoum, Port Sudan and Kassala with expert Delphi consensus and qualitative insights.\u003cbr\u003e\n \u003cstrong\u003eResults:\u003c/strong\u003e Admissions rose sharply among youth aged 13–35. Risk factors included socioeconomic hardship, trauma, peer pressure, stigma and porous borders. Health outcomes encompassed severe dental decay, psychosis and social destabilisation.\u003cbr\u003e\n \u003cstrong\u003eConclusions:\u003c/strong\u003e Sudan urgently requires a national registry, SBIRT (Screening, Brief Intervention, and Referral to Treatment) training, scaled rehabilitation services and legislative reform. A coordinated public health strategy must guide Sudan’s response together with a national taskforce for safeguarding Sudanese against this rising stimulant threat.\u003c/p\u003e","manuscriptTitle":"Beyond the High: Methamphetamine Use, Risk Landscape, Health Consequences and Urgent Policy Directions from a Mixed-Methods Situational Analysis in Sudan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-05 14:43:17","doi":"10.21203/rs.3.rs-8525314/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-02T11:48:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-09T11:43:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-09T11:41:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Substance Abuse Treatment, Prevention, and Policy","date":"2026-01-06T00:27:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"substance-abuse-treatment-prevention-and-policy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"satp","sideBox":"Learn more about [Substance Abuse Treatment, Prevention, and Policy](http://substanceabusepolicy.biomedcentral.com)","snPcode":"13011","submissionUrl":"https://submission.nature.com/new-submission/13011/3","title":"Substance Abuse Treatment, Prevention, and Policy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1c2553d0-e03f-44c2-a9f8-43590ba48f15","owner":[],"postedDate":"March 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-05T14:43:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-05 14:43:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8525314","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8525314","identity":"rs-8525314","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}