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

Background: Crack-cocaine use is associated with severe physical and mental health consequences, including cardiac, pulmonary, and psychiatric conditions. It also heightens the risk of overdose and transmission of infectious diseases such as HIV, tuberculosis, and hepatitis. Equity-deserving populations - more specifically, groups affected by socioeconomic marginalization, discrimination, and systemic inequities - are disproportionately impacted. In recent years, its rising prevalence in European cities has underscored crack-cocaine as a growing social and public health concern. This trend highlights the need to reorient drug policies toward a public health-oriented approach and to implement coherent and inclusive harm-reduction programs and interventions for equity-deserving populations. Summary: We conducted a comprehensive review of harm-reduction programs and interventions for crack-cocaine use, focusing on equity-deserving groups. A literature search was conducted in November 2024, in 9 bibliographic databases. Additional searches were performed using backward citation tracking. A total of 24 publications were included in the final dataset and underwent data extraction, synthesis, and tabulation. Extracted data informed a narrative synthesis by study and population characteristics. Key Messages: Harm-reduction programs and interventions are tailored to women who smoke crack, hospitalized patients, people living with HIV, aboriginal descendants, and marginalized urban populations. They aim to reduce crack-cocaine related mortality and morbidity, by promoting safer consumption practices and healthier lifestyles. They improve living conditions, access to employment, and community engagement. Findings advocate prioritization of harm-reduction services that attend to women's specific experiences of gendered, race-based, social and structural violence, harassment, and discrimination. Besides, despite their vulnerability, street-involved youth, migrants, and refugees are underrepresented in research, underscoring the need for inclusive programs and interventions that consider both age and migration contexts. Most research was conducted in North America, with limited studies from Latin America, Europe, and rural settings, highlighting geographic and contextual gaps. Effective harm reduction must prioritize health equity, addressing stigma, gendered and racial violence, and structural barriers to care.