A qualitative exploration of harm reduction in practice by street-based peer outreach workers

• Published in: Harm reduction journal Vol. 21; no. 1; pp. 161 - 11
• Main Authors: Owczarzak, Jill, Martin, Emily, Weicker, Noelle, Evans, Imogen, Morris, Miles, Sherman, Susan G
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30.08.2024; BioMed Central; BMC
• Subjects: Abstinence; Adult; Beliefs, opinions and attitudes; Community health aides; Community-Institutional Relations; Data analysis; Data collection; Drug abuse; Drug addiction; Drug overdose; Drug policy; Drug use; Drugs; Epidemics; Female; Fentanyl; Harm Reduction; Humans; Interviews; Male; Naloxone; Naloxone - therapeutic use; Narcotic Antagonists - therapeutic use; Narcotics; Needle-Exchange Programs; Nonlinear systems; Opioid-Related Disorders - prevention & control; Opioids; Outreach; Peer Group; Peers; Practice; Public health; Qualitative Research; Recovery; Residual effects; Social aspects; Streets; Substance use; Syringes; Urban areas; Workers; United States; United States > US; Substance use; Harm reduction; Outreach; Peers
• ISSN: 1477-7517; 1477-7517
• DOI: 10.1186/s12954-024-01076-w

Despite the widespread use of the phrase "harm reduction" and the proliferation of programs based on its principles during the current opioid epidemic, what it means in practice is not universally agreed upon. Harm reduction strategies have expanded from syringe and needle exchange programs that emerged in the mid-1980s primarily in response to the HIV epidemic, to include medication for opioid use disorder, supervised consumption rooms, naloxone distribution, and drug checking technologies such as fentanyl test strips. Harm reduction can often be in tension with abstinence and recovery models to address substance use, and people who use drugs may also hold competing views of what harm reduction means in practice. Street-based outreach workers are increasingly incorporated into harm reduction programs as part of efforts to engage with people more fully in various stages of drug use and nonuse. This paper explores how peer outreach workers, called "members," in a street-based naloxone distribution program define and practice harm reduction. We interviewed 15 members of a street-based harm reduction organization in an urban center characterized by an enduring opioid epidemic. Inductive data analysis explored harm reduction as both a set of principles and a set of practices to understand how frontline providers define and enact them. Analysis revealed that when members talked about their work, they often conceptualized harm reduction as a collection of ways members and others can "save lives" and support people who use drugs. They also framed harm reduction as part of a "path toward recovery." This path was complicated and nonlinear but pursued a common goal of life without drug use and its residual effects. These findings suggest the need to develop harm reduction programs that incorporate both harm reduction and recovery to best meet the needs of people who use drugs and align with the value systems of implementers.