A Scoping Review of Community Harm Reduction Strategies for Maternal and Fetal Opioid Impacts: Implications for Policy

Background: Community-based harm reduction for opioid use may be crucial for mitigating maternal and fetal harms by reducing information bias, fostering trust, and connecting individuals to essential treatment and services. This scoping review examines community-based harm reduction strategies and policies addressing maternal opioid use occurring in nonclinical settings, including stigma reduction, public health education, service access, and integration. The objectives of this scoping review are to 1) delineate community-based harm reduction approaches; 2) contextualize findings; 3) identify policy gaps; and 4) synthesize insights for policy.Methods: A systematic selection of articles was conducted using predefined inclusion and exclusion criteria. Three search domains (mother-child dyad, opioid misuse, and harm reduction) were used from PubMed, PsychINFO, and Scopus databases from 2013 onward. Articles were screened using title and abstract review, full-text analysis, and cross-referencing to ensure relevance. Articles focusing on policy related to community-based harm reduction strategies for pregnant individuals experiencing opioid misuse were included in the final review.Results: Initial search yielded 548 articles with 45 articles identified as domain relevant. After full-text review, 26 articles were included in final scoping review. Number of publications increased over time (2013-2017, n = 6; 2018-2021, n = 20). Twenty articles (77%) addressed multisystem level interventions, defined as coordinated strategies across multiple sectors (e.g., healthcare, education, and social services) and favored supportive (over punitive) harm reduction methods. Identified needs included addressing socioeconomic disparities and ensuring equitable access to care. Literature gaps highlight an oversimplification of outcomes such as narrow definitions of neonatal abstinence syndrome that do not account for overall harm reduction.Conclusions: Policy review favored systemic interventions over individual-level criminalization or remediation. Community-based, comprehensive, integrated, and supportive care received less attention than medication-based treatment. These results underscore urgent need for consideration of evidence-based community-level harm reduction strategies to effectively address maternal opioid use and its associated challenges.