Substance use prevention in Canadian schools: programs, policies, and barriers to evidence-based practice

Background Despite decades of research on school-based substance use prevention, a persistent gap exists between evidence and practice. Understanding current programs and barriers to evidence-based approaches is essential for systems transformation.Methods A national cross-sectional survey was conducted with 204 Canadian K-12 school administrators (principals, vice-principals) between June and September 2024, recruited through professional associations.Results Schools employed heterogeneous programming; MADD (33.5%), DARE (26.1%), and Safer Schools Together (18.6%) were most common, while 11.7% reported no programs. Many administrators endorsed relationship-building practices alongside zero-tolerance policies. Familiarity with evidence-based approaches was limited; fewer than half reported alignment with equity-oriented approaches, stigma reduction, harm reduction, or upstream prevention. Nearly all identified practice-change barriers, most commonly insufficient professional development resources (50%), lack of a guiding framework (48%), and limited access to trained professionals (44%).Conclusions Canadian schools have inconsistent substance use programming with limited alignment to evidence-based frameworks, though administrators expressed willingness to lead change. Addressing systemic barriers through accessible professional development, national guidance, and policy coherence is essential to bridge the evidence-practice gap and improve student outcomes.