Community Care in Reach: Mobilizing Harm Reduction and Addiction Treatment Services for Vulnerable Populations

Regis, Craig; Gaeta, Jessie M.; Mackin, Sarah; Baggett, Travis P.; Quinlan, Joan; Taveras, Elsie M.

doi:10.3389/fpubh.2020.00501

Cited by 27 publications

(19 citation statements)

References 5 publications

(8 reference statements)

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“…Harm reduction specialists can potentially bridge these gaps in care and offer an accessible and patient-centered model of care delivery. Harm reduction specialists, who often have lived experience with drug use, continue to refine their expertise by working with clients in the community setting [ 29 ]. When these harm reduction specialists enter the hospital setting, they bring those skills and relationships with them.…”

Section: Discussionmentioning

confidence: 99%

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

et al. 2022

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Background Community-based harm reduction programs reduce morbidity and mortality associated with drug use. While hospital-based inpatient addiction consult services can also improve outcomes for patients using drugs, inpatient clinical care is often focused on acute withdrawal and the medical management of substance use disorders. There has been limited exploration of the integration of community-based harm reduction programs into the hospital setting. We conducted a qualitative study to describe provider perspectives on the implementation of a harm reduction in-reach program. Methods We conducted 24 semi-structured interviews with providers from three different primary work sites within a safety net hospital in Boston, MA, in 2021. Interviews explored perceived facilitators and barriers to the implementation of the harm reduction in-reach program in the hospital setting and solicited recommendations for potential improvements to the harm reduction in-reach program. Interviews were analyzed using an inductive approach that incorporated principles of grounded theory methodology to identify prevailing themes. Results Twenty-four participants were interviewed from the harm reduction in-reach program, inpatient addiction consult service, and the hospital observation unit. Thematic analysis revealed seven major themes and multiple facilitators and barriers to the implementation of the harm reduction in-reach program. Participants highlighted the impact of power differences within the medical hierarchy on inter-team communication and clinical care, the persistence of addiction-related stigma, the importance of coordination and role delineation between care team members, and the benefits of a streamlined referral process. Conclusions Harm reduction programs offer accessible, patient-centered, low-barrier care to patients using drugs. The integration of community-based harm reduction programs into the inpatient setting is a unique opportunity to bridge inpatient and outpatient care and expand the provision of harm reduction services. Trial registration: Not applicable.

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Section: Discussionmentioning

confidence: 99%

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

et al. 2022

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“…MHUs have been used in studies to link high risk individuals to OUD, HIV, and HCV prevention and treatment services as described in Table 2, with only one focused specifically on a CJ-involved population. A demonstration study by Regis, et al provided undomiciled individuals with an elevated risk of opioid overdose the opportunity to use a MHU, placed in "hotspots" where overdoses commonly occurred, to easily access harm reduction services, addiction treatment, and other medical care (Regis et al, 2020). Another study demonstrated the role of MHUs in the distribution of naloxone, overdose education and prevention services for high-risk CJ-involved individuals, as well as linkage to general health care (Maxwell, Bigg, Stanczykiewicz, & Carlberg-Racich, 2006).…”

Section: Mobile Health Units (Mhus)mentioning

confidence: 99%

Linking criminal justice-involved individuals to HIV, Hepatitis C, and opioid use disorder prevention and treatment services upon release to the community: Progress, gaps, and future directions

Taweh

Schlossberg

Frank

et al. 2021

International Journal of Drug Policy

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“…State agencies and harm reductionists should partner with county health departments and community-based organizations in those regions of rural Appalachia that are highly vulnerable (13) to overdose mortality and currently lack access (14) to OEND programs and other harm reduction services. Mobile harm reduction and treatment services (34,35) may be particularly effective in reaching small, at-risk communities where brick and mortar programs may not be feasible. Finally, to enhance access to harm reduction services in rural Appalachia, state o cials must reverse regulations that currently prohibit pharmacy-based naloxone distribution by mail (36).…”

Section: Willingness To Participate In An Overdose Prevention Trainingmentioning

confidence: 99%

Factors associated with inappropriate overdose response among people who use prescription opioids non-medically in rural Appalachia: A cross-sectional study

Macmadu¹,

Gurka²,

Linn³

et al. 2021

Preprint

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Background Opioid-related overdose deaths have accelerated in recent years. In response, overdose education and naloxone distribution (OEND) programs have been implemented across the United States, although many rural Appalachians continue to lack access. Despite the growing number of OEND programs, risk factors for inappropriate overdose response among persons who are training-naïve are currently unknown. Methods We used respondent-driven sampling to recruit and enroll 169 adults who use prescription opioids non-medically from three rural counties in West Virginia. Participants were interviewed to ascertain experience with witnessed overdose (lifetime and prior-year), characteristics of the most recent witnessed overdose, responses to the witnessed overdose, and OEND acceptability. Logistic regression was used to assess factors associated with inappropriate response to opioid-related overdose. Results Among the 73 (43% of the total sample) participants who witnessed an opioid-related overdose, the majority (n = 53, 73%) reported any inappropriate response. Participants were significantly more likely to report an inappropriate overdose response when the overdose victim was unresponsive (OR = 3.36; 95% CI = 1.07, 10.58). The most common appropriate responses were staying with the victim until recovery or help arrived (n = 66, 90%) and calling 911 (n = 63, 86%), while the most common inappropriate responses were hitting or slapping the victim (n = 37, 51%) and rubbing the victim with ice or placing them in a cold shower or bath (n = 14, 19%). While most (n = 60, 82%) had never heard of overdose prevention training, the vast majority (n = 69, 95%) were willing to participate in training, particularly those who had responded inappropriately (n = 52, 98%). Conclusions These findings underscore the urgent need for expanded access to OEND programs in at-risk rural communities that lacked coverage. Indeed, information generated by this study informed the development of a statewide naloxone distribution program in WV. These findings also indicate OEND programs are highly acceptable to training-naïve people who use opioids in rural Appalachia. Additional approaches to expand access to harm reduction services in the region, including mobile services and mail-based naloxone distribution should be aggressively pursued.

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Community Care in Reach: Mobilizing Harm Reduction and Addiction Treatment Services for Vulnerable Populations

Cited by 27 publications

References 5 publications

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

Linking criminal justice-involved individuals to HIV, Hepatitis C, and opioid use disorder prevention and treatment services upon release to the community: Progress, gaps, and future directions

Factors associated with inappropriate overdose response among people who use prescription opioids non-medically in rural Appalachia: A cross-sectional study

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