Integration of harm reduction principles and practices within specialty substance use treatment programs in New Jersey: A qualitative study of program leadership

Introduction

Harm reduction is a philosophical approach to improve the health of people who use drugs (PWUD) that integrates risk reduction, evidence-based treatment, and person-centered care. Specialty substance use treatment programs have historically been siloed from, and often misaligned with, harm reduction principles, but this trend has begun to shift in recent years. This study explored the ways in which some specialty treatment settings are adopting harm reduction principles and practices.

Methods

We conducted qualitative interviews with leaders of 14 New Jersey specialty treatment programs around their opioid use disorder treatment practices. Using thematic analysis, we assessed how aligned treatment practices were with the core pillars, principles, and practice areas outlined in the 2023 Harm Reduction Framework developed by the Substance Abuse and Mental Health Services Administration.

Results

Programs described integrating a range of harm reduction principles, including respect for autonomy, low-barrier treatment, and nonpunitive care, into their approach to care. However, several ongoing practices conflicted with these principles, including imposing attendance requirements, lacking an on-site provider to facilitate same-day medication initiation, and use of urine toxicology testing as a major marker of treatment success. Additionally, while many programs were engaging in some overdose prevention practices (e.g., naloxone distribution), few programs offered other risk reduction services.

Conclusions

Findings highlight that significant opportunities remain to better integrate harm reduction principles and practices into specialty substance use treatment facilities to improve the quality of care provided to PWUD.