Executive Summary

In recent years—in an effort to stem the rising death toll related to the nationwide opioid epidemic—local, state and federal governments have sought to expand harm reduction services in the United States. These types of services, which implement practical approaches to reduce the negative outcomes associated with potentially risky behaviors such as drug use, began to appear in the 1980s as communities sought to prevent the spread of human immunodeficiency virus (HIV) and hepatitis C virus. Now, as policymakers seek to expand access to harm reduction, health care providers who have not historically worked in the field are being called upon to advocate and implement these strategies.

However, research suggests that the most affected health care providers—physicians, physician assistants (PAs), nurse practitioners (NPs) and pharmacists—sometimes have insufficient knowledge, hold negative beliefs about people who use drugs (PWUD) or have misconceptions about how harm reduction facilitates health improvements. These barriers can hinder providers’ willingness and ability to serve effectively as harm reductionists.

In an effort to overcome such challenges, educational and professional organizations have implemented training on substance use and harm reduction strategies. Many of these programs have been found to increase provider knowledge and self-efficacy. Of note, those that are most effective at improving providers’ willingness to engage in harm reduction and most likely to translate into the provision of harm reduction services also include elements that reduce stigma around PWUD and harm reduction itself. Furthermore, evidence suggests that for optimal service provision, institutional policies must support providers and a harm reduction ethos.

In this paper, we examine barriers that limit health care providers’ willingness to adopt these strategies and effectiveness in delivering them. We also highlight evidence-based, educational and institution-level interventions aimed at reducing those barriers.

Press release: Back to School: What Public Health Practitioners Can Learn from Harm Reduction Programs

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