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.

BackgroundPeople who inject drugs in North America often continue to inject while hospitalized, and are at increased risk of premature hospital discharge, unplanned readmission, and death. In-hospital access to sterile injection supplies may reduce some harms associated with ongoing injection drug use. However, access to needle and syringe programs in acute care settings is limited. We explored the implementation of a needle and syringe program integrated into a large urban tertiary hospital in Western Canada. The needle and syringe program was administered by an addiction medicine consult team that offers patients access to specialized clinical care and connection to community services.MethodsWe utilized a focused ethnographic design and semi-structured interviews to elicit experiences and potential improvements from 25 hospitalized people who inject drugs who were offered supplies from the needle and syringe program.ResultsParticipants were motivated to accept supplies to prevent injection-related harms and access to supplies was facilitated by trust in consult team staff. However, fears of negative repercussions from non-consult team staff, including premature discharge or undesired changes to medication regimes, caused some participants to hesitate or refuse to accept supplies. Participants described modifications to hospital policies regarding inpatient drug use or access to an inpatient supervised consumption service as potential ways to mitigate patients' fears.ConclusionsAcute care needle and syringe programs may aid hospital providers in reducing harms and improving hospital outcomes for people who inject drugs. However, modifications to hospital policies and settings may be necessary.

Objectives: Many people who use drugs in the United States and Canada continue to access the contaminated unregulated drug supply, resulting in the ever-escalating overdose epidemic. In Canada, even in areas where healthcare providers are authorized to prescribe alternatives to the unregulated supply (e.g., prescribed safer supply), availability and accessibility are low. We sought to characterize the needs of people who use unregulated opioids in Vancouver, Canada by asking them whether access to any pharmaceutical opioids would reduce their use of unregulated opioids, and if so, which pharmaceutical opioids they preferred. Methods: We analyzed data from participants who self-reported using unregulated opioids in three Vancouverbased prospective cohort studies between 2021 and 2022. We employed multivariable logistic regression to identify factors associated with reporting a preferred pharmaceutical opioid to reduce unregulated opioid use. Results: Of 681 eligible participants, 504 (74.0 %) identified a preferred pharmaceutical opioid to reduce unregulated opioid use. The most commonly reported preferred opioids included: diacetylmorphine (42.9 %), fentanyl patches (11.1 %), and fentanyl powder (10.5 %). Overall, 5.6 % of participants who identified diacetylmorphine, 12.5 % of participants who identified fentanyl patches, and no participants who identified fentanyl powder as their preferred opioids reported receiving prescriptions of them. In multivariable analysis, exposure to benzodiazepines through unregulated drug use (adjusted odds ratio [AOR] = 2.57; 95 % confidence interval [CI] = 1.69-3.90), and receipt of prescribed safer supply of opioids without opioid agonist therapy (OAT; AOR = 2.66; 95% CI = 1.12-6.36) within the past six months were significantly associated with reporting a preferred pharmaceutical opioid. Conclusion: Three-quarters of participants reported that receiving prescribed pharmaceutical opioids of their preference could reduce their use of unregulated opioids; however, the proportions of those actually being prescribed their preferred opioids were very low. Further, these participants were also more likely to report exposure to benzodiazepine-adulterated drugs. Our findings provide important implications for future safer supply programs.

SETTING:A temporary emergency shelter was established inside the Commonwealth Stadium in Edmonton, Alberta, to reduce COVID-19 transmission and mitigate health risks among people experiencing homelessness. INTERVENTION:A non-profit organization, Boyle Street Community Services, opened an overdose prevention site (OPS) between February and March 2022 inside the temporary emergency shelter. People accessed the shelter-based OPS to consume unregulated drugs (via injection, intranasally, or orally), receive medical aid, access sterile drug use equipment, and be connected to additional health and social supports, without leaving the shelter. We conducted short interviewer-administered surveys with OPS participants to examine participant views and identify suggested improvements. OUTCOMES:The shelter-based OPS was accessed a total of 1346 times by 174 unique people. Fentanyl was the most common self-reported drug consumed (59%) and most consumption (99% of episodes) was by injection. OPS staff responded to 66 overdoses and reported no deaths. Survey respondents reported that the shelter-based OPS was convenient, with no need to forfeit their shelter spot or find transportation to another OPS. Respondents indicated that the OPS felt safe and accessible and reported that it reduced drug use in other shelter areas. Participants identified the OPS' exclusion of inhalation as a limitation. IMPLICATIONS:People who use unregulated drugs and are experiencing homelessness are at a higher risk of negative health outcomes, which COVID-19 exacerbated. Integrating temporary shelter/housing and harm reduction services may be an innovative way to lower barriers, increase accessibility, and improve well-being for this structurally vulnerable population. Future operators should consider incorporating inhalation services to further reduce service gaps.

Supervised consumption services have been scaled up within Canada and internationally as an ethical imperative in the context of a public health emergency. A large body of peer-reviewed evidence demonstrates that these services prevent poisoning deaths, reduce infectious disease transmission risk behaviour, and facilitate clients' connections to other health and social services. In 2019, the Alberta government commissioned a review of the socioeconomic impacts of seven supervised consumption services in the province. The report is formatted to appear as an objective, scientifically credible evaluation of these services; however, it is fundamentally methodologically flawed, with a high risk of biases that critically undermine its authors' assessment of the scientific evidence. The report's findings have been used to justify decisions that jeopardize the health and well-being of people who use drugs both in Canada and internationally. Governments must ensure that future assessments of supervised consumption services and other public health measures to address drug poisoning deaths are scientifically sound and methodologically rigorous. Health policy must be based on the best available evidence, protect the right of structurally vulnerable populations to access healthcare, and not be contingent on favourable public opinion or prevailing political ideology.

Background: Health risks associated with drug use are concentrated amongst structurally vulnerable people who use illegal drugs (PWUD). We described how Canadian policy actors view structural vulnerability in relation to harm reduction and policymaking for illegal drugs, and what solutions they suggest to reduce structural vulner-ability for PWUD. Methods: The Canadian Harm Reduction Policy Project is a mixed-method, multiple case study. The qualitative component included 73 semi-structured interviews conducted with harm reduction policy actors across Canada's 13 provinces and territories between November 2016 and December 2017. Interviews explored perspectives on harm reduction and illegal drug policies and the conditions that facilitate or constrain policy change. Our sub -analysis utilized a two-step inductive analytic process. First, we identified transcript segments that discussed structural vulnerability or analogous terms. Second, we conducted latent content analysis on the identified ex-cerpts to generate main findings. Results: The central role of structural vulnerability (including poverty, unstable/lack of housing, racialization) in driving harm for PWUD was acknowledged by participants in all provinces and territories. Criminalization, in particular, was seen as a major contributor to structural vulnerability by justifying formal and informal sanctions against drug use and, by extension, PWUD. Many participants expressed that their personal understanding of harm reduction included addressing the structural conditions facing PWUD, yet identified that formal government harm reduction policies focused solely on drug use rather than structural factors. Participants identified several potential policy solutions to intervene on structural vulnerability including decriminalization, safer supply, and enacting policies encompassing all health and social sectors. Conclusions: Structural vulnerability is salient within Canadian policy actors' discourses; however, formal gov-ernment policies are seen as falling short of addressing the structural conditions of PWUD. Decriminalization and safer supply have the potential to mitigate immediate structural vulnerability of PWUD while policies evolve to advance social, economic, and cultural equity.

Objective: The aim of this scoping review is to describe how a public health approach to legal and illegal psychoactive substance use has been previously defined, and to identify its core values, concepts, activities, and goals. Introduction: Jurisdictions globally are increasingly endorsing a public health approach to addressing psychoactive substance use. However, there is currently no agreed definition of this approach, and this term has been applied inconsistently in the literature, policy, and practice. A critical first step toward advancing a public health approach to substance use is identifying and articulating its core components. Inclusion criteria: This review will consider all peer-reviewed and gray literature in English focused on conceptualizing, defining, or describing a public health approach to substance use. Our review does not place limitations on populations, psychoactive substance types, or other contextual factors. Methods: We will search PROSPERO, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and Scopus, as well as health and social science databases; websites of prominent nonprofit, civil society, and government agencies/ organizations in public health and substance use fields; and reference lists of included articles. Two independent reviewers will screen titles/abstracts of peer-reviewed literature, and 1 reviewer will screen titles/abstracts of gray literature. Two independent reviewers will conduct the full-text screening. A data extraction sheet will be pilot tested through double extraction. Findings will be presented as a narrative summary supported by tables and diagrams and, if feasible, a conceptual framework for understanding and applying a public health approach to substance use.

This essay presents three film examples from across the cinemas of Canada which grapple with the politics of sobriety amidst unique cultural contexts: Werewolf (Ashley McKenzie, 2016) broaches the topic of opioid addiction on Cape Breton Island; Love in the Time of Civil War (Rodrigue Jean, 2014) of drug addiction on the streets of Montreal; and The Honour of All (Phil Lucas, 1992), the history of alcoholism on Esk'etemec First Nation in British Columbia. The narratives, aesthetics and modes of production of each film are analysed with an eye towards how they advance a new temperance sensibility that is non-prohibitionist, non-universalist and non-moralist. The three films are positioned within a canon of Canadian films about alcohol and substance misuse, as well as within a broader set of new temperance initiatives found in Canadian society at large. By selecting one film each from an English-Canadian, Acadian-Québécois and First Nations milieu, this paper proposes that their diffuse affinity for surviving addiction offers a means of organizing Canadian cultural studies for reasons other than national belonging, and conceives of temperance as an autonomous movement distinct from state-based public health solutions.

BACKGROUND:Internationally, many supervised consumption services (SCS) include drug inhalation (smoking). However, most research is focused on SCS for people who inject drugs. We aimed to: (1) synthesize the literature on including inhalation or other forms of non-injection drug use (e.g., oral, intranasal) within SCS; (2) describe the state of the science on the feasibility of this practice and its outcomes; and (3) outline an agenda for future evaluation research in this area.METHODS:We searched 9 academic and 13 grey literature databases and ultimately included 40 studies. Thirty-two studies (80%) reported findings from feasibility or needs assessments. From these studies, we extracted information on willingness to use these services, perspectives of people who use drugs and other stakeholders, and recommendations for implementation. Eight studies (20%) evaluated including inhalation in SCS, from which we extracted data on associated outcomes. Data were analysed using narrative synthesis and descriptive statistics.RESULTS:We found high willingness to use SCS including inhalation among people who use drugs, especially those experiencing structural vulnerability. Research emphasized a need for implementation to account for the social nature of drug inhalation, and to limit potential occupational hazards associated with passive inhalation. Positive outcomes associated with inhalation within SCS included improved health and safety of people who use drugs and decreased public drug use. However, this evidence was based primarily on a limited number of studies with designs of mixed quality.CONCLUSION:Our review demonstrates feasibility of, and need for, implementing SCS including inhalation, and some potential positive outcomes associated with this practice. However, more comprehensive and systematic evaluations of including inhalation as well as other forms of non-injection drug use (e.g., oral, intranasal, rectal) within SCS should be conducted.

Background People who use drugs and are structurally vulnerable (e.g., experiencing unstable and/or lack of housing) frequently access acute care. However, acute care systems and providers may not be able to effectively address social needs during hospitalization. Our objectives were to: 1) explore social service providers' perspectives on addressing social needs for this patient population; and 2) identify what possible strategies social service providers suggest for improving patient care. Methods We completed 18 semi-structured interviews with social service providers (e.g., social workers, transition coordinators, peer support workers) at a large, urban acute care hospital in Western Canada between August 8, 2018 and January 24, 2019. Interviews explored staff experiences providing social services to structurally vulnerable patients who use drugs, as well as continuity between hospital and community social services. We conducted latent content analysis and organized our findings in relation to the socioecological model. Results Tensions emerged on how participants viewed patient-level barriers to addressing social needs. Some providers blamed poor outcomes on perceived patient deficits, while others emphasized structural factors that impede patients' ability to secure social services. Within the hospital, some participants felt that acute care was not an appropriate location to address social needs, but most felt that hospitalization affords a unique opportunity to build relationships with structurally vulnerable patients. Participants described how a lack of housing and financial supports for people who use drugs in the community limited successful social service provision in acute care. They identified potential policy solutions, such as establishing housing supports that concurrently address medical, income, and substance use needs. Conclusions Broad policy changes are required to improve care for structurally vulnerable patients who use drugs, including: 1) ending acute care's ambivalence towards social services; 2) addressing multi-level gaps in housing and financial support; 3) implementing hospital-based Housing First teams; and, 4) offering sub-acute care with integrated substance use management.

Food safety and food security are two important public health sectors within Canada, which aim to address foodborne disease and food insecurity, respectively. While these sectors are often siloed within public health organizations, the actions of the two sectors often interact and conflict at the program level despite their common goal of improving population health. The objective of this study was to identify determinants that influenced the success of collaboration between practitioners of the two sectors in British Columbia (BC), to inform Canadian food policy. We inductively analyzed 14 interviews with practitioners working in the two sectors who had experience with successful collaboration. Data were interpreted in consultation with an interprofessional collaboration framework. Participants identified determinants at the systemic level, including the cultural, professional, educational, legislative, and political systems, which were often considered barriers to collaboration. Participants also identified determinants at the organizational level that influenced the success of collaboration between the sectors, including: the organization’s structure and philosophy, leadership, resources, and communication mechanisms. Finally, participants identified interactional determinants as ways to overcome existing barriers, including: willingness to collaborate, trust, communication, mutual respect, and taking a solutions-oriented approach. Practitioners working in food safety and food security can apply the interactional determinants identified in this study to mitigate existing barriers to collaboration and support more synergistic food policies.

Food safety and food security are two important public health sectors within Canada, which aim to address foodborne disease and food insecurity, respectively. While these sectors are often siloed within public health organizations, the actions of the two sectors often interact and conflict at the program level despite their common goal of improving population health. The objective of the present study was to identify determinants that influenced the success of collaboration between practitioners of the two sectors in British Columbia, to inform Canadian food policy. We inductively analyzed 14 interviews with practitioners working in the two sectors who had experience with successful collaboration. Data were interpreted in consultation with an inter-professional collaboration framework. Participants identified determinants at the systemic level, including the cultural, professional, educational, legislative, and political systems, which were often considered barriers to collaboration. Participants also identified determinants at the organizational level that influenced the success of collaboration between the sectors, including: the organization’s structure and philosophy, leadership, resources, and communication mechanisms. Finally, participants identified interactional determinants as ways to overcome existing barriers, including: willingness to collaborate, trust, communication, mutual respect, and taking a solutions-oriented approach. Practitioners working in food safety and food security can apply the interactional determinants identified in this study to mitigate existing barriers to collaboration and support more synergistic food policies.

Food safety and food security are two important public health sectors within Canada, which aim to address foodborne disease and food insecurity, respectively. While these sectors are often siloed within public health organizations, the actions of the two sectors often interact and conflict at the program level despite their common goal of improving population health. The objective of the present study was to identify determinants that influenced the success of collaboration between practitioners of the two sectors in British Columbia, to inform Canadian food policy. We inductively analyzed 14 interviews with practitioners working in the two sectors who had experience with successful collaboration. Data were interpreted in consultation with an inter-professional collaboration framework. Participants identified determinants at the systemic level, including the cultural, professional, educational, legislative, and political systems, which were often considered barriers to collaboration. Participants also identified determinants at the organizational level that influenced the success of collaboration between the sectors, including: the organization’s structure and philosophy, leadership, resources, and communication mechanisms. Finally, participants identified interactional determinants as ways to overcome existing barriers, including: willingness to collaborate, trust, communication, mutual respect, and taking a solutions-oriented approach. Practitioners working in food safety and food security can apply the interactional determinants identified in this study to mitigate existing barriers to collaboration and support more synergistic food policies.

L’insécurité alimentaire et les maladies d’origine alimentaire constituent des enjeux importants au Canada, et on peut considérer les mesures de santé publique prises pour les résoudre comme des facteurs qui façonnent l’environnement alimentaire. De nouvelles données probantes allant dans le sens d'une interrelation entre ces deux domaines, l’objectif de cette étude était d'explorer comment, en Colombie-Britannique (Canada), les efforts en matière de sécurité alimentaire des collectivités et les pratiques de salubrité des aliments (ainsi que les problèmes de santé de la population associés) peuvent se recouper, puis d’interpréter ces résultats pour concevoir et construire un environnement alimentaire plus sain. Nous avons mené 14 entrevues auprès d’informateurs clés (praticiens des secteurs de la sécurité alimentaire des collectivités et de la salubrité des aliments en Colombie-Britannique) et procédé à une analyse descriptive qualitative pour trouver les points d’intersection entre ces deux secteurs. Les participants ont fait état de quatre modalités de convergence entre les deux secteurs. Ils ont signalé comment les pratiques quotidiennes de leur secteur visant à promouvoir des aliments sûrs ou sains pouvaient être favorisées ou entravées par les activités de l’autre secteur, en partie car les politiques passées, disparates, ne tenaient pas compte des nombreux effets sur la santé en lien avec l'alimentation et car certains types de produits alimentaires, comme les fruits et légumes frais, peuvent être considérés à la fois comme risqués et bénéfiques. Enfin, ils ont souligné que les deux secteurs travaillent à l’atteinte d’un même but, soit celui d’améliorer la santé de la population, même si leur optique se révèle légèrement différente. La sécurité alimentaire et la salubrité des aliments sont connectées de plusieurs façons, ce qui a une incidence sur les spécificités de l'environnement alimentaire canadien et sur son amélioration. La collaboration entre les divers secteurs de la santé publique en lien avec l'alimentation est nécessaire pour concevoir de nouveaux programmes ou de nouvelles politiques visant à transformer les habitudes alimentaires des Canadiens.

INTRODUCTION:Food insecurity and foodborne disease are important issues in Canada, and the public health actions taken to address them can be conceptualized as factors shaping the food environment. Given emerging evidence that these two areas may interrelate, the objective of this study was to explore ways in which community food security efforts and food safety practices (and the population health issues they aim to address) may intersect in British Columbia, Canada, and interpret what this might mean for conceptualizing and attaining healthier food environments.METHODS:We conducted 14 key informant interviews with practitioners working in community food security and food safety in British Columbia, and used qualitative descriptive analysis to identify examples of intersections between the sectors.RESULTS:Participants identified four key ways that the two sectors intersect. They identified (1) how their daily practices to promote safe or healthy food could be helped or hindered by the activities of the other sector; (2) that historically disjointed policies that do not consider multiple health outcomes related to food may complicate the interrelationship; (3) that the relationship of these sectors is also affected by the fact that specific types of food products, such as fresh produce, can be considered both risky and beneficial; and (4) that both sectors are working towards the same goal of improved population health, albeit viewing it through slightly different lenses.CONCLUSION:Food security and food safety connect in several ways, with implications for characterizing and improving Canadian food environments. Collaboration across separated public health areas related to food is needed when designing new programs or policies aimed at changing the way Canadians eat.