Zolopa Camille, Clifasefi Seema L, Dobischok Sophia, Gala Natalia, Fraser-Purdy Hannah, Phillips Morgan Kahentonni, Blackmore Sophie, Wendt Dennis C
Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada.
Harm Reduction Research and Treatment Center, University of Washington, Harborview Medical Center, Seattle, WA, USA.
Drug Alcohol Depend. 2025 Apr 1;269:112597. doi: 10.1016/j.drugalcdep.2025.112597. Epub 2025 Feb 12.
There is a great diversity of traditions, practices, and experiences among the Indigenous Peoples of North America and Oceania. However, Indigenous Peoples across these regions are affected by the historical and ongoing violence of settler colonialism, resulting in disproportionately heightened drug-related harms. 'Harm reduction' refers to both an ethos and a set of strategies intended to lessen negative social and/or health effects associated with drug use. While harm reduction could therefore be valuable to Indigenous people who use drugs, important concerns remain regarding the culturally specific implementation and outcomes of such strategies. A clearer picture of research regarding harm reduction in Indigenous communities is needed.
We conducted a scoping review of primary studies regarding drug use harm reduction approaches among Indigenous communities in Australia, Canada, New Zealand, and the United States. We included studies that (1) reported on harm reduction principles or strategies; and (2) either reported disaggregated results for Indigenous participants or were based on a sample in which at least half of the participants identified as Indigenous. Medline and PsycINFO were searched in March 2024; screening by two independent reviewers was completed in April 2024.
Screening 578 references generated a corpus of 28 studies, 16 (57 %) of which were conducted in Canada. Indigenous people who use drugs generally reported favourable attitudes towards harm reduction initiatives; other community members and healthcare providers were more hesitant. A variety of harm reduction strategies were discussed, most commonly needle-syringe programs (n = 8, 29 %). Barriers included the availability and acceptability of harm reduction services. Community members expressed concerns regarding cultural appropriateness, but also offered possibilities for improved integration of harm reduction into Indigenous traditions and practices.
This review indicated an emerging, wide-ranging, and somewhat disparate body of literature. While barriers remain, there are promising possibilities for reconceptualizing harm reduction from an Indigenous ethos.
北美和大洋洲的原住民有着丰富多样的传统、习俗和经历。然而，这些地区的原住民受到定居者殖民主义历史上和持续存在的暴力影响，导致与毒品相关的危害 disproportionately 加剧。“减少危害”既指一种理念，也指一系列旨在减轻与吸毒相关的负面社会和/或健康影响的策略。因此，减少危害对吸毒的原住民可能有价值，但对于此类策略在文化上的具体实施和效果仍存在重要担忧。需要更清楚地了解关于原住民社区减少危害的研究情况。
我们对澳大利亚、加拿大、新西兰和美国原住民社区中关于吸毒减少危害方法的主要研究进行了范围综述。我们纳入了以下研究：（1）报告了减少危害原则或策略；（2）要么报告了原住民参与者的分类结果，要么基于至少一半参与者被认定为原住民的样本。2024年3月检索了Medline和PsycINFO；2024年4月由两名独立评审员完成筛选。
筛选578篇参考文献后得到28项研究的语料库，其中16项（57%）在加拿大进行。吸毒的原住民普遍对减少危害举措持积极态度；其他社区成员和医疗服务提供者则更为犹豫。讨论了多种减少危害策略，最常见的是针头注射器项目（n = 8，29%）。障碍包括减少危害服务的可及性和可接受性。社区成员对文化适宜性表示担忧，但也提出了将减少危害更好地融入原住民传统和习俗的可能性。
本综述表明存在一个新兴的、范围广泛且有些分散的文献体系。虽然障碍仍然存在，但从原住民理念重新构想减少危害有充满希望的可能性。
