Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

Abstract

Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care–based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care–based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06904-4.

Intersecting substance use treatment and harm reduction services: exploring the characteristics and service needs of a community-based sample of people who use drugs

“…In particular, concerns about the increasingly lethal opioid supply [16] have emphasized the need to use any available evidence-based strategies known to reduce opioid-related overdose mortality. These concerns have encouraged more treatment providers to incorporate harm reduction approaches (e.g., naloxone distribution and overdose education) [17], and harm reduction providers to integrate MOUD as a direct service [18].…”

Digital interventions for substance use disorders in young people: rapid review

“…Concerning harm reduction, only one intervention, the Climate Schools course [ 63 – 65 ], a web-based intervention for alcohol and cannabis prevention, used an explicit harm reduction approach that showed promising results for alcohol and cannabis knowledge, and for alcohol consumption and intended use. Harm reduction is an alternative to traditional abstinence-based treatment approaches that create barriers to treatment for young people who continue to use drugs [ 123 , 124 ]. Harm reduction principles also promote more responsive and non-stigmatizing services by recognizing the realities of poverty, racism, social isolation, past trauma, sex-based discrimination, and other social inequities affecting individual vulnerability and the capacity to effectively deal with drug-related harms [ 125 , 126 ].…”

Low barrier medication for opioid use disorder at a federally qualified health center: a retrospective cohort study

“…Although statistical associations were not tested, higher mortality and overdose in the intervention group may suggest greater severity of OUD and reflect the model’s support for patients with ongoing substance use. These rates demonstrate the importance of incorporating harm reduction education and interventions into low barrier treatment [ 40 ]. Prior studies of low barrier treatment have engaged patients who have difficulty accessing traditional treatment [ 23 – 28 ], but less is known about how different models of MOUD comparatively engage specific populations.…”