Fighting drug addiction: Individual interventions, community strategies, and the balance between abstinence and harm reduction

Background:

Drug addiction is a chronic global crisis, affecting an estimated 3–4% of the population in Canada and the United States, contributing to over 100,000 drug-related deaths annually in the United States alone. Opioid overdoses are now the leading cause of accidental death in adults under 50, surpassing motor vehicle accidents. Beyond mortality, substance use disorders impose a heavy burden through lost productivity, comorbid psychiatric illness, infectious disease transmission, and an estimated economic cost exceeding USD 35 billion annually in Canada and over USD 700 billion in the United States. Despite this, access to evidence-based treatment remains limited, and stigma continues to undermine public health responses. We reviewed the evidence on effective individual- and community-level interventions. We examined the evidence regarding best public health policies.

Methods:

We conducted a narrative review of data from national surveys, public health agencies (e.g., Canadian Public Health Association (CPHA), and peer-reviewed literature. Individual-level (rehabilitation, medication-assisted therapy [MAT], counseling) and community-level interventions (harm reduction, safe consumption sites, decriminalization) were evaluated.

Results:

At the individual level, rehabilitation and counseling remain central, though more than 50% of patients discontinue treatment before completion, and most require multiple attempts (median: 2). MAT with methadone, buprenorphine, or naltrexone reduces mortality by up to 59%, yet remains underutilized: in 2021, only 22% of Americans with opioid use disorder received MAT. Integrated programs outperform abstinence-only models, though relapse rates remain 40–50%.

At the community level, harm reduction has demonstrated substantial benefits. Canada distributed over 590,000 naloxone kits by 2019, preventing thousands of overdoses. Supervised consumption sites (SCS) reversed nearly 29,000 overdoses in British Columbia (2017–2024) and reduced neighbourhood deaths in Toronto by 67%. Saskatchewan reported a 28% decline in drug-toxicity deaths following SCS implementation. Portugal’s decriminalization model reduced drug-related deaths by 75% over two decades. Prohibitionist policies have consistently failed. Despite strong evidence, stigma and community resistance remain barriers to SCS adoption. While integrated and harm reduction approaches demonstrate superior outcomes, abstinence-only models remain widely promoted, fueling ongoing controversy in both policy and practice.

Conclusion:

Drug addiction imposes a staggering burden of mortality, morbidity, and economic loss. Evidence supports integrated approaches that combine individual-level MAT and social support with community-based harm reduction. Successful implementation requires raising awareness about the harms of addiction and reducing the stigma that hinders effective policy adoption.

Dr. Mohammed Dibas is a recent graduate of Al-Najah University Medical School in Palestine with a strong interest in oncology and medical research. His passion for oncology began early in his medical training and continues to grow as he pursues opportunities to bridge clinical practice with scientific inquiry. He is dedicated to advancing medical knowledge through research, particularly in oncology, and aims to contribute to improving patient outcomes by integrating evidence-based approaches into clinical care.