This review is a rapid synthesis focussed on the range of harm reduction and treatment models intended to meet the unique needs of women and gender-diverse persons who use opioids. Harm reduction services include drug-checking, safer supply, supervised consumption services/overdose prevention sites, distribution of harm reduction equipment (e.g. needles), outreach and education Harm Reduction and Treatment Models for Women and Gender-Diverse Persons who use Opioids programs and services. Treatment services include opioid-agonist treatment (OAT), as well as other outpatient or residential services. The review was limited to people who use opioids given the increasing burden of opioid-related harms in Ontario.

Key findings:

1. Harm reduction and treatment programs designed for women and gender-diverse people who use drugs described in the peer-reviewed literature varied in design and scope.(Note: ‘Gender diverse’ is a general term referring to gender identifies that do not fall within the woman/man gender binary and can include gender queer, non-binary, trans).
2. A number of studies focussed on pregnant and parenting (assumed cis-) women while very few studies were explicitly designed for gender-diverse persons. Programs mainly provided psychosocial support and access to health services. There was little focus on structural elements such as policy change, creating supportive environments, and strengthening community actions.
3. Structural and contextual factors influencing program development and implementation (e.g., criminalization of substance use, community engagement) were often not explicitly reported.
4. For included studies, program goals were largely met and used a wide range of outcome measures.
5. This review identifies current gaps and missed opportunities within harm reduction and treatment models designed for women and gender-diverse persons who opioids, and highlights the need to: Expand the scope of program beyond the individual level to address the complex interaction of structural and social/societal factors in the context of gendered disparities; Identify and remove barriers to the leadership of women and gender-diverse persons with living and lived expertise of drug use, specifically in the development and implementation of harm reduction and treatment programs