Background: Substance use-related morbidity and mortality is a major population health problem. However, there is currently no consensus definition of a ‘public health approach to substance use’ and the term is applied inconsistently in research and practice. A comprehensive framework is urgently needed to guide public health action.
Objectives: This review synthesizes academic and practice literature to outline the core values, concepts, activities, and goals underlying a public health approach to legal and illegal substance use.
Methods: We conducted a systematic scoping review of both grey and peer-reviewed literature focused on conceptualizing, defining, or describing a public health approach to substance use. A total of 244 articles covering international literature from 1950 to 2023 are included in this review.
Results: The key values of the framework include equity, person-centered care, cultural safety, social justice, human rights, decolonization, and evidence-based practice and policy. Several frameworks are emphasized, including sex/gender-specific approaches and social determinants of health. Key goals of the framework include harm reduction, benefit maximization, prevention, and improvement of health and wellbeing. Key activities include decriminalization; regulation (of access, distribution, supply, promotion and production); improvement of environmental and social conditions; provision of supports; health promotion and public education; and research and evaluation. The importance of multi-pronged interdisciplinary approaches at all socioecological levels is emphasized.
Implications: This research provides a comprehensive and evidence-based path for policymakers, practitioners, researchers, and community members looking to design and implement public-health-based approaches to substance use.