Mental Health Prescribers' Perceptions of Patients With Substance Use Disorders and Harm Reduction Services

The Veterans Health Administration (VHA) has published guidelines outlining the legal authority to operate syringe services programs. To aid in the implementation of harm reduction programs at VHA medical centers in Maryland; Washington, DC; and West Virginia, the perceptions of harm reduction tools by mental health prescribers were evaluated.

A mixed-methods analysis examined mental health prescriber perceptions of patients with substance use disorders (SUDs) and their willingness to provide harm reduction tools. A survey was conducted followed by a voluntary postsurvey interview. A descriptive analysis was performed on responses. Notes from postsurvey interviews were analyzed using the Prosci Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR) Model for Change Management.

Prescribers felt comfortable and confident in their abilities to educate patients to reduce harm related to substance use. Survey results were mixed regarding comfort in working with people with or without SUDs. Prescribers were represented across the continuum of the ADKAR change model and were more willing to provide naloxone than fentanyl test strips or syringes. Prescribers expressed mixed opinions on the use of harm reduction tools for patients with SUDs. Some prescribers viewed harm reduction as part of a treatment plan, while others viewed a return to drug use as a failure of treatment.

This study highlights the need for additional interventions to address clinician hesitancy and concerns surrounding harm reduction tools to successfully implement harm reduction programs across the VHA.