Substance use is one of the most pressing health crises facing youth in Canada.
Drug poisoning has become a leading cause of death among young people aged 10 to 24 in multiple regions. At the same time, about 40% of young people aged 15 to 24 report experiencing harm from alcohol, while more than 20% are at moderate to high risk of health problems from cannabis use.
Together, these realities highlight the urgent need for services that not only support young people already struggling with substance use, but also work to prevent harms before they happen. That’s the goal of primary prevention—addressing the root causes of harmful substance use to reduce people’s risk factors and increase their safety and wellbeing.
In a newly released discussion paper, Primary Prevention of Harms Related to Substance Use: Promising Practices, CAMH experts call for a shift in our health care system. Instead of reacting only after a diagnosis, they urge a proactive, evidence-based approach that creates healthier, more supportive environments for youth.
“Primary prevention is a public health strategy to get upstream,” says JF Crépault, Senior Policy Advisor at CAMH. “But, more than that, it is a long-term investment in developing health-promoting environments, targeting the social and situational factors linked to substance use challenges.”
Primary prevention does not aim to eliminate all substance use, but to equip young people with the knowledge, skills, and support they need to make healthier choices, manage stressors, and improve quality of life. It also considers how environments influence behaviour, such as through the availability of substances and the regulations that govern them. These efforts improve youth health outcomes, reduce strain on the health care system, and strengthen overall public health.
Central to the paper is an analysis of two types of primary prevention interventions: behavioural and regulatory. Behavioural programs, offered broadly or to targeted groups, help youth delay or avoid substance use by strengthening life skills and providing health education.
A home-grown example is PreVenture, a program founded in Montreal that works with youth who have personality traits linked to higher risk of substance misuse—such as impulsivity, sensation-seeking, or hopelessness—and connects them with healthier coping strategies. A recent study in the Journal of Psychiatry shows the program reduces the risk of substance use disorders by 35 percent year over year.
Regulatory measures, on the other hand, aim to reduce harm by modifying the price, availability, and visibility of legal substances such as alcohol, cannabis, and tobacco/nicotine. These strategies are cost-effective and supported by substantial evidence.
In Lithuania, for example, implementing an alcohol tax is credited with preventing more than 1,000 deaths annually. In Quebec, strict cannabis regulations may have contributed to lower rates of use compared to the rest of Canada, particularly among people aged 18 to 20.
“The crux of preventing substance use-related harms from occurring in the first place is treating society as the patient,” explains Dr. Leslie Buckley, Chief of Addictions at CAMH. “It’s about recognizing that the potential for harm does not discriminate, and implementing prevention tactics can create a safer, more supportive environment for youth. When we look at our current social landscape, we can see that we need to invest upstream to create a healthier society. “
The paper provides guidance for policymakers, service providers, and community leaders seeking to expand their approaches to prevention. At CAMH, we continue to explore how primary prevention can be more widely implemented in Canada, from encouraging practices like the Icelandic Prevention Model—which has been successful at engaging youth in community activities and reducing harmful substance use—to analyzing how substances such as cannabis affect youth mental health. More broadly, the paper emphasizes the need for more information, greater investment in prevention, and regulations that support healthier environments.
While primary prevention looks different across regions—depending on unique needs and available resources—it consistently strengthens youth and family relationships, builds collaborative systems, and promotes safer and healthier communities.
