A review of the complex intersection between religion, spirituality, and harm reduction.

Background and objectives: Within substance use research, religion and spirituality (r/s) have been understudied in relation to harm reduction approaches. We perform a literature review to characterize various intersections between r/s and harm reduction.

Methods: We searched major databases, Google Scholar, and other sources for academic articles and gray literature on the intersection between r/s and harm reduction. We describe areas of overlap and tension as well as analyze the results using three tiers of proximity to lived/living experience.

Results: Of the 457 papers identified, 169 met final inclusion. Of these, 100 papers contained discussion of alignment between religious or spiritual values and harm reduction values, 39 discussed strategic uses of religious or spiritual resources, 22 discussed harm reduction practices in relation to substances with religious/spiritual relevance, such as psychedelics, and 8 discussed religious/spiritual support for harm reduction workers. Eighteen noted that content was coproduced with persons with lived/living experience, 75 of them noted content was informed by relationship with persons with lived/living experience, and in 76 no such engagement was mentioned.

Discussion and conclusions: The relevance of r/s is not limited to abstinence-based models and has significance in the harm reduction literature.

Scientific significance: This is the first systematic study of the complex intersection between r/s and harm reduction. The results point to opportunities to further understand r/s as both barrier to and resource for harm reduction efforts, as well as how proximity to those with lived/living experience may influence alignment with harm reduction values.