Meeting People Where They Are: Implementing Hospital-Based Substance Use Harm Reduction

Rachel Perera, Louise Stephan, Ayesha Appa, Ro Giuliano, Robert Hoffman, Paula Lum & Marlene Martin
Case Example
February 2022


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A hospital successfully integrated a harm reduction services intervention for patients whose substance use goals did not include abstinence.


Over 100,000 Americans died of drug overdose in 2021, according to data from the CDC, and substance use disorders (SUD) and substance-use related emergency departments visits are rising. Evidence-based addiction care is becoming more widely available in hospital settings, but hospital-based harm reduction interventions are often limited to naloxone prescribing. Given that syringe services program laws and regulations vary across states, many U.S. health care settings have not implemented harm reduction equipment provisions. This article describes the implementation of a hospital intervention that provides both harm reduction education and equipment (e.g., syringes, pipes, fentanyl test strips, and other safe use supplies) in an urban safety-net hospital in San Francisco.


An interprofessional addiction care team composed of patient navigators, nurses and clinicians implemented the harm reduction intervention. The team educated hospital staff and clinicians on harm reduction through clinical consultations. The team also educated hospitalized patients with SUD about harm reduction support, including the infection risks associated with drug use. For patients whose substance use goals did not include abstinence, harm reduction kits were distributed at discharge. Harm reduction kits were assembled by substance use and route of use, based on individual patient needs, and all kits included information about harm reduction and mental health services. Over a one-year period, 196 harm reduction kits were distributed.


This article demonstrated how a hospital can integrate harm reduction services into patient education and discharge planning. A key element to the program’s success was obtaining leadership buy-in, which was secured by conducting a needs assessment on the patient population prior to piloting the intervention and through partnering with a community-based organization that supplied the harm reduction equipment.

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