Defining a public health approach to substance use: insights from a systematic scoping review and conceptual...

Psychoactive substance use represents a significant global public health challenge, leading to diverse health, social, and environmental harms. Traditional punitive and commercial approaches have faced criticism for potentially worsening these harms and overlooking potential benefits. Consequently, there is an increasing global call for a comprehensive public health approach to address psychoactive substances, focusing on both supply and demand reduction. However, the core components of a public health approach remain unclear. We aimed to conceptualize a public health approach to psychoactive substances and describe its core values, goals, and activities.

We used a two-step process to develop a coherent and comprehensive conceptual framework. First we conducted a scoping review of academic and practice literature on a public health approach to psychoactive substances published between 1950 and 2023 (n = 230 English language records). We then conducted an iterative team-based synthesis of the review findings and expert public health knowledge to address gaps in extant literature using a structured conceptual framework development approach.

This conceptual framework includes core values (i.e. social justice, health equity, evidence-informed), activities (i.e. legal and regulatory action, supports and services, prevention and education, advocacy, and research, monitoring, and evaluation), and goals (e.g. improving population health; addressing determinants of substance use, substance harms and substance policy related harms; countering carceral logics) that are central to a public health approach to psychoactive substances.

Our coherent and comprehensive framework incorporates international literature and is informed by contemporary values and goals with the aim of promoting a consensus understanding of this critical practice area. This framework can guide efforts to design, implement, and evaluate public health interventions that maximize benefits and mitigate harm associated with psychoactive substances.