Harm-Reduction Programs and Interventions for Equity-Deserving Populations Who Use Crack-Cocaine: A Scoping Review.

Area of Science:

• Public Health
• Addiction Medicine
• Social Sciences

Background:

• Crack-cocaine use presents severe health risks, including cardiac, pulmonary, psychiatric issues, and infectious disease transmission.
• Equity-deserving populations face disproportionate impacts due to socio-economic marginalization and systemic inequities.
• Rising crack-cocaine prevalence in Europe necessitates a public health approach and inclusive harm reduction strategies.

Purpose of the Study:

• To conduct a comprehensive review of harm reduction programs and interventions for crack-cocaine use.
• To focus on interventions tailored for equity-deserving groups.
• To identify effective strategies and gaps in current research and practice.

Main Methods:

• A comprehensive literature search was conducted in November 2024 across 9 bibliographic databases.
• Backward citation tracking was used to identify additional relevant publications.
• Data from 24 included publications were extracted, synthesized, and tabulated for narrative analysis.

Main Results:

• Harm reduction programs are tailored for diverse groups including women, hospitalized patients, people with HIV, Indigenous peoples, and marginalized urban populations.
• Interventions aim to decrease mortality and morbidity by promoting safer consumption, improving living conditions, and enhancing community engagement.
• Specific attention is needed for women's experiences with gendered and racial violence, and for underrepresented groups like youth, migrants, and refugees.

Conclusions:

• Harm reduction services must prioritize health equity, addressing stigma, violence, and structural barriers.
• Programs should be inclusive, considering age and migration contexts for vulnerable populations.
• There are significant geographic and contextual gaps in research, with a need for more studies outside North America and in rural settings.