How are substance use disorder treatment providers integrating harm reduction approaches into practice?

Background Harm reduction prioritizes reducing substance use-related harms (e.g., overdose) without requiring abstinence or reducing substance use to receive services. Substance use disorder (SUD) treatment has historically operated on an abstinence-based model, but in recent years there have been efforts to integrate harm reduction approaches into SUD treatment. However, little research has examined its acceptance among individuals who provide treatment in specialty SUD care settings; this study seeks to understand providers' perceptions of harm reduction approaches including perceived and current benefits and challenges. Methods Semi-structured interviews were conducted with 21 individuals from 10 different New York SUD treatment programs. Framework analysis was used to code and analyze the data, which was guided by SAMHSA's Harm Reduction Framework. Results We identified three overarching themes: 1) The landscape of harm reduction approaches is shifting in SUD treatment, 2) Challenges remain in implementing harm reduction approaches, and 3) Resources are needed to support the workforce in using harm reduction approaches. Seven sub-themes were also identified. Conclusions Overall, our findings point to a shift in SUD treatment programs' views on integrating harm reduction approaches; staff support that these approaches can increase patient-centered and wholistic care, in addition to increasing treatment retention. However, ambivalence remains regarding its utility, noting challenges with facilitating mixed groups of patients and conflicting policies that impact their ability to provide informed, appropriate care. Findings point to staff and clinical supervisor training needs and system-level support that could support integration of harm reduction into specialty SUD treatment. Trial registration: NCT04632238.