# Substance Use Health

Substance use health is a term that refers to thinking about people’s relationships with substances as part of their overall health and well-being. A substance use health approach recognizes that substance use occurs across a spectrum that spans non-use, beneficial use, lower-risk use, higher-risk use, and substance use disorder. This spectrum acknowledges that people use (or do not use) substances for a variety of reasons, including health or medicinal reasons, cultural or ceremonial purposes, personal enjoyment, and/or to cope with stress, trauma, or pain. 

Applying a substance use health framework means providers, including clinical and peer support workers, meet people where they are to promote and support their health and well-being across the range of experiences of substance use. A substance use health framework supports the provision of evidence-based health information and services across the continuum of care.

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# Toxic Drug Crisis

Ontario, and Canada, face an ongoing toxic drug crisis driven by an unsafe and unpredictable drug supply among unregulated substances. This means that many unregulated substances people consume are contaminated or of unknown potency. In Ontario, the toxic drug supply continues to cause overdoses, drug poisonings and deaths. A comprehensive, evidence-based response must include monitoring, health promotion, harm reduction, treatment, and wrap-around supports. 

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# Harm Reduction

Harm reduction refers to policies, programs, and practices that seek to reduce the negative health, social, and legal impacts associated with substance use, without requiring an individual to have the goal of abstinence. Harm reduction includes a range of services and supports designed to meet people where they are at and can be a pathway to treatment and recovery services. 

  • Harm reduction supply programs provide a range of equipment and safe disposal methods to support safer practices for people who use drugs. These programs are an evidence-based approach to reduce a range of harms, including preventing the spread of blood-borne illnesses like HIV and hepatitis.
  • Drug monitoring programs are technologies and services that test unregulated substances to identify their contents for contaminants and potency. At the individual level, drug monitoring is a tool to test drugs to provide individuals more information to reduce the risk of drug poisoning before they use. At the system level, drug monitoring is a tool to monitor trends and threats in the drug supply to identify patterns and provide warnings to communities and health professionals.
  • Crisis response is an essential part of harm reduction as the toxic drug supply can cause sudden and life-threatening emergencies. Interventions include naloxone distribution, overdose response training, and emergency intervention.
  • Supervised consumption sites are settings where people can use their own drugs under the supervision of trained health professionals, with overdose prevention and medical intervention available. These services have been shown to save lives, reduce overdose deaths, and connect people who use drugs to health and social supports. 
  • Peer support and outreach are examples of how the range of harm reduction interventions are delivered. Peer-led support can include education, guidance, and navigation support that is relatable, respectful, and trustworthy. Low barrier outreach brings health and harm reduction services directly to people where they are. 

In the face of the toxic drug supply, these harm reduction measures are crucial evidence-supported tools many Alliance members use to save lives, reduce harms, and promote dignity and health for people who use substances. 

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# Treatment

Treatment is an essential part of the continuum of care for substance use health. It is most effective when offered in a way that is voluntary, trauma-informed, and low-barrier. Treatment and recovery support can include: 

  • Prescribed alternatives to manage symptoms and support reduced use or recovery. For example, opioid agonist therapy (OAT) such as Methadone, Suboxone, and slow-release oral morphine (SROM).
  • Withdrawal management programs and treatment programs. For example, Rapid Access Addiction Medicine (RAAM) clinics are a model of low-barrier medical support for people who want help with their substance use.
  • Wrap around care to ensure treatment includes coordinated, ongoing support to address the full range of people’s needs. For example, integrating mental health care with substance use treatment, providing recovery supports such as counselling and peer-support, and connecting people to housing supports. 

The Government of Ontario introduced a new model focused on investments in treatment and recovery with Homelessness and Addiction Recovery Treatment (HART) Hubs.As of January 2025, this includes plans for 28 HART Hubs across Ontario. Many Alliance members are leading or partnered with the HART Hub in their communities. The aim of HART Hubs is to improve access to health care, housing and other social services. In this model, access to health care includes primary health care, addiction recovery and treatment, and mental health supports. 

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# In Summary

Adopting a substance use health approach that is rooted in compassion, human rights, equity, and evidence helps to counter stigma, support people with lived and living experience, and promote safer, healthier communities. A substance use health approach requires a comprehensive continuum of care: respecting the full spectrum of a person’s substance use, supporting harm reduction, offering low-barrier treatment and recovery options, and addressing social determinants of health that are often related to ongoing substance use issues.

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