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.
Holly Mathias, MA, is a PhD student, Vanier Scholar and 2023 Pierre Elliott Trudeau Scholar in the School of Public Health at the University of Alberta. She is also a trainee with the Inner City Health and Wellness Program (Royal Alexandra Hospital, Edmonton, AB).
Holly's research interests span the intersects of drug policy, health services, gender and place. Holly’s doctoral research examines the experiences of family caregivers of people who use drugs in rural and remote Canada.
Outside of her research, Holly is an active community member. She serves as the Field Officer for the Canadian Students for Sensible Drug Policy (CSSDP) - Edmonton and as a member of the national CSSDP board.
Dr. Elaine Hyshka is an Associate Professor and Canada Research Chair in Health Systems Innovation at the University of Alberta’s School of Public Health.
Her program of health systems and services research is focused on advancing a public health approach to substance use in Canada. She works closely with service providers, health authorities, people with lived experience of substance use, and all levels of government to identify, evaluate, and scale systems innovations for improving health outcomes and advancing health equity.