Support for Safe Consumption Sites Among Peer Recovery Coaches

Background and Purpose: Safe consumption sites (SCSs), hygienic spaces where people can use pre-obtained drugs under the supervision of trained staff, are an effective strategy to reduce overdose fatalities (Poteir et al., 2014) and connect people who use drugs with health and social services (Kerman et al., 2020). Though SCSs have been operating worldwide for decades, the first sanctioned SCSs in the US opened only recently. Peer recovery coaches (PRCs), substance use service providers with lived experience in recovery, can play an important role in the expansion of SCSs. PRCs provide direct services to people who use drugs and have the potential to increase service utilization and engagement. PRCs’ views about SCSs, however, may be shaped by their personal values and beliefs, as well as their attitudes toward the clients they serve. This study assesses support for SCSs among PRCs and identifies personal and professional characteristics associated with support for these sites.

Methods: PRCs (N = 260) working for publicly-funded programs across a variety of settings in Michigan (e.g., treatment and recovery programs, healthcare settings, criminal legal system) were recruited by email to complete a web-based survey (July – September 2021). Surveys assessed demographics (age, gender identity, race/ethnicity, education), lived experience (past opioid use disorder, current 12-step involvement), abstinence orientation (Goddard, 2003), attitudes toward clients (Baldwin-White, 2016), training experiences, and support for legalizing SCSs in Michigan (McGinty et al., 2018). Logistic regression was used to identify personal and professional characteristics associated with support for SCSs.

Results: Half of PRCs (49.0%) expressed support for legalizing SCSs. Race/ethnicity, abstinence orientation, and attitudes toward clients were significantly associated with support for SCSs. Compared to PRCs who identified as white, PRCs who identified as Black (OR = 0.361, p < .001) and Other People of Color (OR = 0.338, p < .001) had lower odds of supporting SCSs. Preference for abstinence-only treatment (OR = 0.452, p < .001) and more stigmatizing attitudes toward clients (OR = 0.921, p = .017) were associated with lower odds of supporting SCSs.

Conclusions and Implications: Bolstering support for SCSs among PRCs may help to increase SCS expansion and utilization. As the primary service providers for people with substance use disorders, social workers often work alongside PRCs and therefore have the opportunity to influence their opinions. Findings highlight key groups and areas where education and stigma reduction may be beneficial. Understanding and addressing the mechanisms linking race/ethnicity to support for SCSs will be important to reduce the growing numbers of overdose deaths among People of Color. Abstinence orientation and stigmatizing attitudes toward clients were associated with lower support for SCSs. Though PRCs should theoretically support many recovery pathways, nearly a third of the sample indicated a preference for abstinence-only treatment. Professional trainings which incorporate strategic framing (Barry et al., 2018) and personal testimonials from people who worked at or accessed services (Corrigan et al., 2012) may help increase support for SCSs among PRCs. However, trainings for PRCs should also directly address cultural identity and deeply rooted values and beliefs.