Opioid harm reduction: A scoping review of physician and system-level gaps in knowledge, education, and practice

Subst Abus. 2022;43(1):972-987. doi: 10.1080/08897077.2022.2060423.


Background: Harm reduction includes treatment and prevention approaches rather than abstinence, as a public health strategy for mitigating the opioid epidemic. Harm reduction is a new strategy for many healthcare professionals, and gaps in knowledge and practices may lead to barriers to optimal treatment. Our objective was to identify and describe gaps in physicians' knowledge, education, and practice in harm reduction strategies related to opioid overdose. Methods: We searched the PubMed, CINAHL, and Web of Science databases for articles published between 2015 and 2021, published in English, containing empirical evidence, addressing opioid harm reduction, and identifying gaps in physicians' knowledge, education, or practice. Results: Thirty-seven studies were included. Studies examined how physicians' perceptions or stigma influenced harm reduction efforts and addressed clinical knowledge gaps in overdose treatment and prevention and OUD treatment. Less than half of the studies addressed access issues at the system level, above the individual healthcare professional. Conclusion: Individual-level interventions should be addressed with professional continuing education and curricular-based changes through experiential and interprofessional education. System-level gaps can be remedied by increasing patient access to care, creating policies favorable to harm reduction, and extending resources to provide harm reduction strategies.

Keywords: Opioid; buprenorphine; harm reduction; knowledge; methadone; naloxone; opioid use disorder; physician; scoping review.

Publication types

  • Review
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Drug Overdose* / drug therapy
  • Harm Reduction
  • Humans
  • Naloxone / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Opiate Overdose*
  • Opioid-Related Disorders* / drug therapy
  • Physicians*


  • Analgesics, Opioid
  • Narcotic Antagonists
  • Naloxone