Abt Associates, Rockville, MD, USA.
Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA; Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
Int J Drug Policy. 2021 Apr;90:103080. doi: 10.1016/j.drugpo.2020.103080. Epub 2020 Dec 16.
Harm reduction services, which typically provide overdose education and prevention with distribution of naloxone and other supplies related to safer drug use, help reduce opioid-related overdose and infectious disease transmission. However, structural stigma and the ongoing criminalization of drug use have limited the expansion of harm reduction services into many non-urban communities in the United States that have been increasingly affected by the health consequences of opioid and polysubstance use.
We conducted qualitative interviews with 22 professionals working with people who use drugs in cities and towns across Rhode Island and Massachusetts to understand challenges and strategies for engaging communities in accepting harm reduction perspectives and services.
Our thematic analysis identified several interrelated challenges to implementing harm reduction services in non-urban communities, including: (1) limited understandings of harm reduction practice and preferential focus on substance use treatment and primary prevention, (2) community-level stigma against people who use drugs as well as the agencies supporting them, (3) data reporting and aggregating leading to inaccurate perceptions about local patterns of substance use and related health consequences, and (4) a "prosecutorial mindset" against drug use and harm reduction. From key informants' narratives, we also identified specific strategies that communities could use to address these challenges, including: (1) identifying local champions to advocate for harm reduction strategies, (2) proactively educating communities about harm reduction approaches before they are implemented, (3) improving the visibility of harm reduction services within communities, and (4) obtaining "buy-in" from a wide range of local stakeholders including law enforcement and local government.
These findings carry important implications for expanding harm reduction services, including syringe service programs and safe injection sites, into non-urban communities that have a demonstrated need for evidence-based interventions to reduce drug-related overdose and infectious disease transmission.
减少伤害服务通常提供过量教育和预防，同时分发纳洛酮和其他与更安全药物使用相关的用品，有助于减少阿片类药物相关的过量和传染病传播。然而，结构性污名和对吸毒的持续刑事化限制了减少伤害服务在美国许多非城市社区的扩展，这些社区越来越受到阿片类药物和多药物使用带来的健康后果的影响。
我们对罗德岛和马萨诸塞州城镇的 22 名与吸毒者合作的专业人员进行了定性访谈，以了解在接纳减少伤害观点和服务方面，社区面临的挑战和策略。
我们的主题分析确定了在非城市社区实施减少伤害服务的几个相互关联的挑战，包括：（1）对减少伤害实践的理解有限，优先关注药物使用治疗和初级预防；（2）对吸毒者和支持他们的机构的社区层面污名化；（3）数据报告和汇总导致对当地药物使用模式和相关健康后果的不准确看法；（4）对吸毒和减少伤害的“起诉心态”。从主要知情人的叙述中，我们还确定了社区可以用来解决这些挑战的具体策略，包括：（1）确定当地的拥护者来倡导减少伤害策略；（2）在实施之前主动向社区教育有关减少伤害的方法；（3）提高社区内减少伤害服务的可见度；（4）从广泛的当地利益相关者（包括执法部门和地方政府）获得“认同”。
这些发现对扩大减少伤害服务具有重要意义，包括注射器服务计划和安全注射场所，这些服务对于有明确需要的非城市社区具有重要意义，以减少与药物相关的过量和传染病传播。
