"No judgment, no preaching": approaches to harm reduction service provision for people who use drugs in North...

Our study examines how harm reduction service providers (providers) throughout North Carolina (NC) provide services to people who use opioids (PWUO), how these service provision strategies align with PWUO preferences, and implications for care.

We conducted semi-structured in-depth interviews and used a thematic analytic strategy to identify common approaches to service delivery among providers (n = 10), rationales for taking these approaches, and how approaches were received by PWUO (n = 30). To be included in the study, service providers had to provide direct care to PWUO, while PWUO had to be 18 + and be in active opioid use (not as prescribed by a doctor); providers and PWUO had to live in NC.

Providers often allowed PWUO to take the lead in service delivery interactions, asked limited questions about what/how participants use drugs, and rarely offered unsolicited information. Providers believed questioning could feel invasive or stigmatizing to PWUO. They also thought questions were unnecessary, assuming PWUO understood the risks that come with drug use. Providers reported that they would take the lead in interactions to correct PWUO's misconceptions that could make their use more dangerous, and would, occasionally, offer unsolicited information related to upcoming events or new services, or if PWUO appeared open to receiving more information. PWUO varied in desired approach by providers, based on the established rapport between providers and PWUO, and whether PWUO were in withdrawal during the interaction. Still, PWUO generally felt syringe service programs were a safe space, and many wanted to be asked more about their use so providers could provide tailored information about risks, trends, and safe use.

Providers offer valuable services and safe spaces for PWUO in NC, but should ask program participants' preferences regarding interaction style to ensure the services provided are aligned with the desires of PWUO to have the maximum possible impact.