Harm reduction approaches within Indigenous communities across Turtle Island: A scoping review of peer-reviewed and grey literature.

Indigenous communities across Turtle Island (North America) have been practicing harm reduction for many decades, though the work is often under documented and underacknowledged. This scoping review serves to explore the current evidence base for opioid-related harm reduction in Indigenous communities, including both academic and grey literature, highlighting the application of harm reduction principles as outlined by the National Harm Reduction Coalition, as well as practices and approaches. Working under the leadership of Indigenous researchers and an Indigenous Advisory Committee, the scoping review included a search of three academic databases, PsycINFO, PubMed/Medline databases, and Ethnic NewsWatch, and three grey literature sources, Google, Harvard Think Tank and Native News databases. A total of sixteen sources met the inclusion criteria in both the academic and grey literature search. Data extraction yielded details surrounding the inclusion of harm reduction principles, the integration of Indigenous epistemologies and worldviews, and implications for harm reduction approaches in Indigenous communities. This scoping review highlights the depth and diversity of community-led, culturally grounded harm reduction practices in Indigenous communities across Turtle Island affirming that they are extensions of longstanding Indigenous ways of knowing, relating, and caring for one another. Advancing Indigenous harm reduction will require sustained investment in Indigenous-led research, programming, and governance and requires a commitment to honoring Indigenous data sovereignty, lived experiences, and the relational knowledge that has long guided this work.