Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA.
Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Harm Reduct J. 2023 Jun 9;20(1):70. doi: 10.1186/s12954-023-00809-7.
Unprecedented increases in substance-related overdose fatalities have been observed in Texas and the U.S. since the onset of the COVID-19 pandemic and have made clear there is considerable need to reduce harms associated with drug use. At the federal level, initiatives have called for widespread dissemination and implementation of evidence-based harm reduction practices to reduce overdose deaths. Implementation of harm reduction strategies is challenging in Texas. There is a paucity of literature on understanding current harm reduction practices in Texas. As such, this qualitative study aims to understand harm reduction practices among people who use drugs (PWUD), harm reductionists, and emergency responders across four counties in Texas. This work would inform future efforts to scale and spread harm reduction in Texas.
Semi-structured qualitative interviews were conducted with N = 69 key stakeholders (25 harm reductionists; 24 PWUD; 20 emergency responders). Interviews were transcribed verbatim, coded for emergent themes, and analyzed using Applied Thematic Analysis with Nvivo 12. A community advisory board defined the research questions, reviewed the emergent themes, and assisted with interpretation of the data.
Emergent themes highlighted barriers to harm reduction at micro and macro levels, from the individual experience of PWUD and harm reductionists to systemic issues in healthcare and the emergency medical response system. Specifically, (1) Texas has existing strengths in overdose prevention and response efforts on which to build, (2) PWUD are fearful of interacting with healthcare and 911 systems, (3) harm reductionists are in increasing need of support for reaching all PWUD communities, and (4) state-level policies may hinder widespread implementation and adoption of evidence-based harm reduction practices.
Perspectives from harm reduction stakeholders highlighted existing strengths, avenues for improvement, and specific barriers that currently exist to harm reduction practices in Texas.
自 COVID-19 大流行开始以来，德克萨斯州和美国的与物质相关的过量死亡人数空前增加，这清楚地表明需要采取大量措施来减少与药物使用相关的危害。在联邦一级，各项倡议呼吁广泛传播和实施基于证据的减少伤害措施，以减少过量死亡人数。在德克萨斯州实施减少伤害战略具有挑战性。关于了解德克萨斯州当前减少伤害做法的文献很少。因此，这项定性研究旨在了解德克萨斯州四个县的吸毒者（PWUD）、减少伤害者和急救人员的减少伤害做法。这项工作将为未来在德克萨斯州扩大和传播减少伤害的努力提供信息。
对 N = 69 名利益相关者（25 名减少伤害者；24 名 PWUD；20 名急救人员）进行了半结构化的定性访谈。访谈逐字记录、进行主题编码，并使用 Nvivo 12 进行应用主题分析进行分析。社区咨询委员会定义了研究问题、审查了主题的出现，并协助解释数据。
出现的主题突出了微观和宏观层面减少伤害的障碍，从 PWUD 和减少伤害者的个人经验到医疗保健和紧急医疗响应系统中的系统性问题。具体而言，（1）德克萨斯州在预防和应对过量方面有现有的优势，可以在此基础上继续努力；（2）PWUD 害怕与医疗保健和 911 系统互动；（3）减少伤害者越来越需要支持，以接触到所有 PWUD 社区；（4）州一级的政策可能会阻碍广泛实施和采用基于证据的减少伤害实践。
减少伤害利益相关者的观点突出了德克萨斯州目前减少伤害实践存在的现有优势、改进途径和具体障碍。
