Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Background: Mortality due to overdose is still increasing in the United States (US), and has impacted rural and underserved communities exceptionally. Harm-reduction measures (naloxone distribution and syringe-service programs) have been approved by the country, but in practice, the two spheres are still lagging behind. Purpose: The aim of this scoping review is to summarize the evidence regarding obstacles and opportunities affecting the implementation of harm-reduction programs in communities of the United States with rural and under-served populations. Methods: With the PRISMA-ScR 2020 framework and methodology of Arksey and O'Malley in ground, six databases and grey-literature sources were searched to locate research focusing on the implementation of harm-reduction policies, measures, or access. Information was developed in charts and themed. Results: There were 52 studies that met the inclusion criteria. It was found that there are 5 themes namely: (1) structural and resource barriers; (2) stigma, policy resistance and cultural mistrust; (3) community engagement and peer facilitation; (4) equity and cultural responsiveness; and (5) intersectoral collaboration and innovation. Conclusions: Sustainable funding, policy coherency, design responsive to culture, cross-sector partnerships are all related to the success of its implementation. The incorporation of harm reduction in rural health infrastructure is the ultimate key to equitable overdose-prevention results.