Abstract：
Psychoactive substance use and the regulations that govern it both have the potential to lead to harm. A \'public health approach\' (PHA) is frequently invoked as a means of addressing these harms, but the term is used in inconsistent and contradictory ways. This study systematically reviewed the English-language academic literature to understand how a public health approach to substance use is defined and described.
This review employed thematic synthesis, a methodology designed to rigorously synthesize qualitative evidence. Eligible articles were published in peer-reviewed journals, in the English language, with full text available, and focused primarily on substance use. There were no limits on year of publication. Original research, opinion/commentary, and reviews were included. The searches were conducted in October 2021 in CINAHL, Embase, Medline, PAIS Index, PsycINFO, Scopus, Sociological Abstracts, and Web of Science.
272 articles from 25 countries, published between 1950 and 2021, were synthesized. Definitions of a PHA have changed over time and differ by substance. The most commonly cited characteristics of a PHA were: for alcohol, regulation, e.g. of price and availability (54% of articles); for cannabis: regulation (68%); for illicit drugs: that a PHA is distinct from a criminal justice approach (63%); for opioids: substance use disorder treatment (55%); and for tobacco: regulation (62%).
There is no consensus on the definition of a public health approach to substance use, but there is substantial agreement when it comes to PHAs to specific substances. There are also similarities in how they are described for legal substances versus illicit ones. This review found areas of disagreement regarding the extent to which PHAs should focus on individual-level factors. Policymakers, academics, and others developing or implementing PHAs to substance use should be explicit about their aims and objectives - as well as the premises and assumptions underlying them.
This review employed thematic synthesis, a methodology designed to rigorously synthesize qualitative evidence. Eligible articles were published in peer-reviewed journals, in the English language, with full text available, and focused primarily on substance use. There were no limits on year of publication. Original research, opinion/commentary, and reviews were included. The searches were conducted in October 2021 in CINAHL, Embase, Medline, PAIS Index, PsycINFO, Scopus, Sociological Abstracts, and Web of Science.
272 articles from 25 countries, published between 1950 and 2021, were synthesized. Definitions of a PHA have changed over time and differ by substance. The most commonly cited characteristics of a PHA were: for alcohol, regulation, e.g. of price and availability (54% of articles); for cannabis: regulation (68%); for illicit drugs: that a PHA is distinct from a criminal justice approach (63%); for opioids: substance use disorder treatment (55%); and for tobacco: regulation (62%).
There is no consensus on the definition of a public health approach to substance use, but there is substantial agreement when it comes to PHAs to specific substances. There are also similarities in how they are described for legal substances versus illicit ones. This review found areas of disagreement regarding the extent to which PHAs should focus on individual-level factors. Policymakers, academics, and others developing or implementing PHAs to substance use should be explicit about their aims and objectives - as well as the premises and assumptions underlying them.
摘要：
背景：精神活性物质的使用和管理它的法规都有可能导致伤害。“公共卫生方法”（PHA）经常被用作解决这些危害的手段，但是这个词的使用方式不一致和矛盾。本研究系统地回顾了英语学术文献，以了解如何定义和描述药物使用的公共卫生方法。
方法：这篇综述采用主题综合，一种旨在严格综合定性证据的方法。符合条件的文章发表在同行评审的期刊上，在英语中，全文可用，主要集中在物质使用上。出版年份没有限制。原创研究,意见/评论，和评论都包括在内。搜索于2021年10月在CINAHL进行，Embase,Medline,PAIS指数，PsycINFO,Scopus,社会学文摘,和WebofScience。
结果：来自25个国家的272篇文章，1950年至2021年出版的，是综合的。PHA的定义随着时间而改变,并且在实质上不同。PHA最常引用的特征是：对于酒精，regulation,例如，价格和可用性（54％的文章）；大麻：法规（68％）；非法药物：PHA与刑事司法方法不同（63％）；阿片类药物：物质使用障碍治疗（55％）；烟草：法规（62％）。
结论：关于药物使用的公共卫生方法的定义尚未达成共识，但在涉及特定物质的PHA方面有实质性的一致意见。在如何描述合法物质与非法物质方面也有相似之处。这项审查发现，在PHA应在多大程度上关注个人层面的因素方面存在分歧。政策制定者，学者,和其他开发或实施PHA以实质使用的人应该明确其目的和目标-以及其基础的前提和假设。
方法：这篇综述采用主题综合，一种旨在严格综合定性证据的方法。符合条件的文章发表在同行评审的期刊上，在英语中，全文可用，主要集中在物质使用上。出版年份没有限制。原创研究,意见/评论，和评论都包括在内。搜索于2021年10月在CINAHL进行，Embase,Medline,PAIS指数，PsycINFO,Scopus,社会学文摘,和WebofScience。
结果：来自25个国家的272篇文章，1950年至2021年出版的，是综合的。PHA的定义随着时间而改变,并且在实质上不同。PHA最常引用的特征是：对于酒精，regulation,例如，价格和可用性（54％的文章）；大麻：法规（68％）；非法药物：PHA与刑事司法方法不同（63％）；阿片类药物：物质使用障碍治疗（55％）；烟草：法规（62％）。
结论：关于药物使用的公共卫生方法的定义尚未达成共识，但在涉及特定物质的PHA方面有实质性的一致意见。在如何描述合法物质与非法物质方面也有相似之处。这项审查发现，在PHA应在多大程度上关注个人层面的因素方面存在分歧。政策制定者，学者,和其他开发或实施PHA以实质使用的人应该明确其目的和目标-以及其基础的前提和假设。
