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Abstract Details
Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings : Harm Reduction in Outpatient Addiction Treatment
J Gen Intern Med. 2021 Jun 22;1-10. doi: 10.1007/s11606-021-06904-4.Online ahead of print.
Jessica L Taylor12, Samantha Johnson34, Ricardo Cruz53, Jessica R Gray67, Davida Schiff8, Sarah M Bagley539
Author information
1Section of General Internal Medicine, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA. jtaylor3@bu.edu.
2Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA. jtaylor3@bu.edu.
3Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.
4Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA.
5Section of General Internal Medicine, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.
6Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
7Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA.
8Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA.
9Division of General Pediatrics, Boston University School of Medicine, Boston, MA, USA.
Abstract
Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care-based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care-based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families.