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

Krawczyk, Noa; Allen, Sean T.; Schneider, Kristin E.; Solomon, Keisha T.; Shah, Hridika; Morris, Miles; Harris, Samantha J.; Sherman, Susan G.; Saloner, Brendan

doi:10.1186/s12954-022-00676-8

Cited by 15 publications

(11 citation statements)

References 36 publications

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“…Our program adds to the growing body of literature that supports the idea that person-centered, trauma-informed care integrating a wide range of services, can lead to improved outcomes, especially in populations that are traditionally considered difficult to engage in treatment [ 8 – 10 , 18 – 21 ]. This body of literature strongly supports the idea that harm reduction services and treatment services are compatible, exist along a spectrum, and in fact, can complement each other.…”

Section: Discussionmentioning

confidence: 99%

“…It is well studied, for example, that many patients receiving treatment for OUD continue to use illicit substances. Similarly, many patients in syringe exchange programs are interested in receiving treatment for OUD [ 21 ]. It is also well-studied that patients with OUD are impacted by higher than average rates of psychiatric illnesses [ 22 ], medical conditions such as hepatitis C [ 23 ], as well as psychosocial difficulties such as unemployment and unstable housing [ 21 ] that can profoundly impact an individual’s life.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, many patients in syringe exchange programs are interested in receiving treatment for OUD [ 21 ]. It is also well-studied that patients with OUD are impacted by higher than average rates of psychiatric illnesses [ 22 ], medical conditions such as hepatitis C [ 23 ], as well as psychosocial difficulties such as unemployment and unstable housing [ 21 ] that can profoundly impact an individual’s life. Integrated care can provide a unique opportunity to successfully meet these varied needs in a timely and convenient manner, and, by doing so, improving outcomes for individuals with substance use disorders.…”

Section: Discussionmentioning

confidence: 99%

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Descriptive study: the novel “full spectrum people-with-opioid-use-disorder care model”

et al. 2023

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Background People with Opioid Use Disorder (PWOUD) represent an underserved and marginalized population for whom treatment gaps exist. Low-barrier programs like mobile care units and street outreach programs have yielded increased access to buprenorphine and social services, however, OUD pertinent co-occurring behavioral health and medical conditions are frequently left unaddressed. A novel, tailored, comprehensive care delivery model may reduce disparities and improve access to care across a range of pathologies in this historically difficult to reach population and enhance efforts to provide universal treatment access in a harm reduction setting. Methods Descriptive data were collected and analyzed regarding patient demographics, retention in treatment and services rendered at a new, wrap-around, low-barrier buprenorphine clinic established at an existing harm reduction site in New Mexico between August 1, 2020, and August 31, 2021. Results 203 people used any service at the newly implemented program, 137 of whom specifically obtained medical and/or behavioral health care services including prescriptions for buprenorphine at least once from the physician onsite. Thirty-seven unique medical and psychiatric conditions were treated, representing a total of 565 separate encounters. The most common service utilized was buprenorphine treatment for opioid use disorder (81%), followed by treatment for post-traumatic stress disorder (62%), anxiety (44.5%) and depression (40.9%). Retention in buprenorphine treatment was 31.2% at 6 months. Conclusions An innovative, multidisciplinary, buprenorphine-centric care model, which targets a wide range of OUD pertinent pathologies while employing a harm reduction approach, can enhance utilization of these services among an underserved PWOUD population in a manner which moves our health system toward universal OUD treatment access thereby potentially reducing overdose and existing disparities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Descriptive study: the novel “full spectrum people-with-opioid-use-disorder care model”

et al. 2023

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“…8 These actions point toward a broader momentum to integrate HR principles and practices in the routine provision of care for patients who use drugs. 9 Yet, despite growing support, little is known around what HR looks like in medical settings. Although HR includes pragmatic activities such as distributing naloxone and educating patients about safe drug use practices, it also necessitates a shift in the philosophy toward patient care.…”

Section: Introductionmentioning

confidence: 99%

Integrating Harm Reduction into Medical Care: Lessons from Three Models

2023

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Background: Substance use disorders (SUDs) are at a national high, with significant morbidity and mortality. Harm reduction, a public-health strategy aimed at reducing the negative consequences of a risky behavior without necessarily eliminating the behavior, represents a useful approach to engage patients with SUDs in care. The objective of this article is to describe how 3 medical practices operationalized harm reduction as a framework toward patient care and identify the common practices undertaken across these settings to integrate harm reduction and medical care.Methods: We conducted a qualitative study using in-depth, semistructured interviews with 20 staff and providers at 3 integrated harm reduction and medical care sites across New York State from March to June 2021. Interview questions focused on how harm reduction approaches were implemented, how harm reduction philosophies were demonstrated in practice, and barriers to adoption.Results: The interviews resulted in 8 main themes of integrated harm reduction medical care: 1) role of provider as both learner and informer; 2) pragmatic measures of success; 3) collaborative and interdisciplinary care teams; 4) developing a stigma-free culture; 5) creating a comfortable and welcoming physical space; 6) low-threshold care with flexible scheduling; and; 7) reaching beyond the clinic to disseminate harm reduction orientation; and 8) creating robust referral networks to enhance transitions of care. These themes existed at the patient-provider level (#1 to 3), the organizational level (#4 to 6), and the level extending beyond the clinic (#7 to 8).Conclusions: All 3 sites followed 8 common themes in delivering harm reduction-informed care, most of which are consistent with the broader movement toward patient-centered care. These practices demonstrate how medical providers may overcome some of the barriers imposed by the medical model and successfully integrate harm reduction as an orienting framework toward care delivery. ( J Am Board Fam Med 2023;36:449-461.

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“…Table 1 provides examples of harm reduction for cigarettes, heroin, opioid pain relievers, and marijuana, explaining why the harm reduction methods are 2 There is some debate over the scope of activities and products included under the term "harm reduction." Historically it was sometimes used for activities that were not medication therapies, although that is changing (Stancli et al, 2012;Krawczyk et al, 2022). The National Harm Reduction Coalition interprets medication for opioid use disorder (MOUD), such as methadone and buprenorphine, as harm reduction (Singer, 2018;National Harm Reduction Coalition, 2023).…”

mentioning

confidence: 99%