Headline

This study identifies facilitators and barriers of hospital- and community-based harm reduction collaboration efforts and highlights hospital-based opportunities to better serve people who use drugs.

Context

People who use drugs often seek care at emergency departments and hospital settings due to health issues commonly driven by injection drug use, including overdoses, skin/soft tissue damage and infection, communicable disease, etc.  There has been limited exploration of the integration of community-based harm reduction programs into the hospital setting. This qualitative study describes perspectives gleaned from 24 semi-structured interviews with providers from three different primary work sites within a safety net hospital in Boston, Massachusetts, on the implementation of a harm reduction in-reach program. The study highlights facilitators and barriers to successful implementation.

Findings

The study authors interviewed 24 participants from the harm reduction in-reach program, inpatient addiction consult service, and the hospital observation unit. Thematic analysis of interview responses revealed seven key themes, including barriers and facilitators to implementation of harm reduction efforts:

Barriers

1. The US health care system neglects social determinants of health and incentivizes expediency, which often conflicts with harm reduction work.
2. Addiction-related stigma toward patients negatively impacts both patients and harm reduction specialists, contributing to hospital clinical provider  (non-harm reduction staff) burnout and patient mistrust of the medical system.
3. The inpatient setting and inherent power hierarchies in the clinical environment feel unfamiliar and unwelcoming to community-based harm reduction specialists.
4. Miscommunication negatively impacts patient care and hinders the provision of harm reduction services.

Facilitators

1. Clearly delineated roles reduce redundancy and streamline harm reduction services.
2. Harm reduction program staff should reflect the patient populations they serve, in terms of cultural/ethnic background, lived experience of using drugs, and geographic community representation.
3. The referral process for in-reach harm reduction services should be low barrier and facilitate the identification of patients who would benefit from harm reduction services. ​​

Takeaways

Given harm reduction’s effectiveness in engaging people who use drugs in a non-judgmental way that meets them “where they are,” harm reduction-hospital collaboration efforts aimed at better serving this population holds great potential for positive impact. This study is most relevant for hospital leadership, hospital-based providers, and health system leaders interested in improving care engagement and health outcomes for people who use drugs who are seen in an acute care setting.  The study offers valuable insights on barriers and facilitators of integrating harm reduction services into addiction care services in a hospital setting.