"People who do this work care deeply… and that makes it harder": A qualitative study of harm reduction workers'...

Harm reduction workers are on the frontlines of the U.S. opioid crisis, providing life-saving non-clinical services to highly marginalized people who use drugs. Despite mounting evidence of occupational stress and burnout among helping professionals, community-based workers, such as harm reduction workers, are largely excluded from such conversations, further perpetuating inequities within the substance use and behavioral health workforce.

In-depth virtual interviews were conducted with N=32 harm reduction workers to understand their perceptions, experiences, consequences, and responses to occupational stressors. Applied thematic analysis was used to identify and examine descriptive themes related to the a priori research questions.

Data revealed four interrelated categories of stressors related to the role of harm reduction workers: burdensome workloads, health and safety hazards, emotional labor, and relational boundaries. Data also revealed stressors related to the multi-level context within which participants work. Specifically, participants described the inherent tension and resultant burden of doing harm reduction within the broader non-profit industrial complex in that competition for scarce resources contributes to understaffed organizations, inadequate pay, and job insecurity. Participants described stressors adversely affected every aspect of their well-being and often left them feeling burned out, and, for some in recovery, a return to substance use (relapse).

Study findings add to existing literature by distinguishing occupational stressors that are unique to harm reduction workers, and underscore the need for research focused on developing and testing multi-level interventions that identify and address occupational stress and burnout among this critical workforce.