Equity and Evidence Gaps in Pharmacy Harm Reduction

No peer-reviewed implementation literature exists on some potentially relevant pharmacy-led harm reduction services, including safer supply and off-label androgen use support. Reporting of sex, gender, race, and ethnicity across included studies was inconsistent. Only two included studies explicitly targeted equity-deserving populations: pregnant and postpartum people with opioid use disorder, and Indigenous communities. The literature focused heavily on opioid-related harms, while harms related to amphetamines, cocaine, benzodiazepines, and polysubstance use were underrepresented. Validated implementation and evaluation frameworks were rarely used in included studies, limiting comparability across the evidence base. Without meaningful involvement of affected communities, pharmacy harm reduction services may reproduce power imbalances and fail to reflect the needs of those they aim to support.