Harm Reduction and Substance Use Disorder: Implications for Practice, Policy and Pedagogy

Proposal: Over 10 North Carolinians die each day of unintended drug overdoses, and thousands more experience drug-associated injury and illness. Inequities in substance use disorder treatment have led to poorer outcomes, including death, among racial/ethnic minorities. Members of racial/ethnic minority groups are less likely to initiate and complete substance use treatment, despite these groups experiencing higher mortality rates than non-Hispanic White people. Disparities in treatment access are perpetuated by culturally inappropriate practices, stigma, and overcriminalization of substance use among historically marginalized groups. National, regional, and local public health entities have outlined key strategies to reduce substance-use-related morbidity and mortality. These strategies can be integrated into health professions training to promote equity in treatment access and care approaches.

Harm reduction refers to evidence-based interventions that aim to minimize the negative consequences of drug use and decrease drug-related stigma. Harm reduction is a key pillar of the North Carolina Department of Health and Human Services (DHHS) Opioid Action Plan. Despite evidence to support harm reduction service integration, many healthcare professionals are reluctant to offer such services to their patients. In addition, there is little to no exposure to these strategies across health professions curricula.

The proposed interactive workshop will facilitate participants’ exploration of substance-use-related disparities within their care communities and academic settings. Discussions will focus on opportunities within and outside of the “traditional” healthcare setting, for professionals to introduce equity-centered education and training, and harm reduction strategies. Through case application, guided discussion, and interdisciplinary collaboration, upon completion participants will be able to:
- Describe the role of harm reduction strategies in mitigating substance-related morbidity and mortality.
- Apply harm reduction principles to the care of populations experiencing or at risk for substance use disorders, including consideration for special populations.
- Identify opportunities to integrate harm reduction pedagogy across healthcare curricula.
- Describe current healthcare disparities related to substance use disorder treatment.
- Discuss pedagogical strategies to promote equity in the management of substance use disorders.

The first part of this workshop will discuss how harm reduction principles can be used to reduce the risk of substance-related illness, injury, and death. Harm reduction strategies including abstinence alternatives, drug testing with test strips, safer consumption practices, overdose reversal agents, and treatment engagement will be identified and discussed. In addition, participants will have the opportunity through case application to apply harm-reduction strategies in the care of patients within and outside of traditional healthcare settings. Discussions will incorporate care for special populations, such as adolescents, child-bearing people, and historically disadvantaged populations. Additional emphasis will be placed on interdisciplinary collaboration and various healthcare perspectives, including providers, nurses, and behavioral health specialists. Participants will collaboratively brainstorm and outline strategies that can be readily applied to their direct care and academic settings.

In the second half of this workshop, participants will more closely examine current substance-use disorder trends and treatment disparities in North Carolina. With an emphasis on ethical, legal, and culturally responsive approaches, participants will discuss the impact of current trends in their direct care and/or academic settings; and using SWOT analysis, will explore strategies to promote equity in substance use disorder treatment in their respective settings. As an exemplar, workshop facilitators will discuss their work to promote equity in substance use disorder treatment, an approach to Nurse Practitioner education.