International Overdose Awareness Day: a time to remember, a time to act, a time for evidence

August 31 is International Overdose Awareness Day. This global event, launched in 2001, is held annually to raise awareness of overdose and to grieve with friends and family for those we have lost to overdose. It is much more than a day of remembrance; it is a day to act.1 Drug overdoses are preventable. Current drug prohibition policies and substance use stigma are lethal. In many communities, rates of overdose and overdose deaths have been dramatically increasing, with devastating impacts to those responding to overdose events and those who lose someone they care for or love. These deaths often go unacknowledged due to the silence that continues to surround drug use, the stigma of overdose, and, perhaps most significantly, the ongoing criminalization of people who use drugs. International Overdose Awareness Day challenges this silence and stigma as we gather to raise awareness, publically mourn, and call for action to prevent and reduce drug-related harms, particularly overdose, by insisting on evidence-based policies and practices.1 Articles in this issue of JBI Evidence Synthesis seek to contribute to these efforts and to this movement for change and transformation of approaches to drug-related harms. In the article “Equity-oriented frameworks to inform responses to opioid overdoses,”2 we present a scoping review of literature on equity-oriented approaches to preventing and reducing the harms of overdose and substance use stigma. This review highlights the importance of “the inclusion of people with lived and living experience, multifaceted approaches to reduce stigma and discrimination, recognizing and addressing inequities, drug policy reform and decriminalization, applying harm reduction principles within comprehensive responses, and adopting proportionate universalism.”2(p.1773) Overall, the review illustrates how research is being outpaced by the public health crisis and emphasizes the urgent need for evidence linking health equity concepts such as cultural safety, trauma- and violence-informed care, and harm reduction. Because equity is dependent on decolonization, Indigenous-informed perspectives are essential for informing responses to overdose and substance use stigma. In a second scoping review in this issue, “Interventions and programs that support the health and development of infants with prenatal substance exposure in foster care,”3 we address substance use interventions specifically for infants in foster care who have experienced prenatal substance exposure. This review identifies how interventions require a stronger focus on the root causes or determinants of health, such as poverty, homelessness, stigmatization, and trauma, to more fully support birth families and foster care providers. The review also raises the need for a health-equity approach to interventions with families – approaches that are trauma-informed, are culturally appropriate, and address root causes and stressors that result in the placement of infants in care. Combined, these reviews examine health and social care interventions along the life course from prenatal substance exposure and infancy to potential tragedy of early overdose death. The conclusions are similar and reflect the aims of International Overdose Awareness Day, as the findings of both reviews prioritize concepts of health equity and determinants of health as promising approaches and necessary alternatives to reduce and ameliorate one of the world's worst public health crises. While we publically acknowledge those who have died with a day of mourning on August 31, we also seek action. These reviews should contribute to and inform equity-oriented health care interventions that are responsive to reducing substance use stigma and other harms. Now is a time to remember and to act.

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