Perceptions of Safe Consumption Sites Among Peer Recovery Coaches in Michigan

Background and Purpose

As drug overdose fatalities continue to climb in the U.S., substance use services are employing more Peer Recovery Coaches (PRCs). PRCs are direct service providers with lived experience in recovery, who draw on experiential knowledge in their work. While most PRC services focus on treatment linkage and recovery support, PRCs are also well-positioned to connect people who use drugs with harm reduction services. Safe consumption sites (SCSs) are one type of harm reduction strategy which provide hygienic supplies, a safe space to use, overdose first-aid services, and social and health service resources. As SCSs scale across the U.S., PRCs will play an important role in connecting people who use drugs with needed services. This study explored PRCs’ perceptions of SCSs and their intentions to refer clients to services.

Methods

Thirty semi-structured phone interviews were conducted with adults who worked or volunteered as a PRC in Michigan between July and September 2021. Participants were recruited from a larger study surveying Michigan’s PRC workforce. Participants were from 27 to 74 years old (M=43, SD=13) and had between two months and eight years of experience working as a PRC (M=2.7, SD=2.3). Most PRCs were female (57%, n=17) and white (77%, n=23); fewer identified as Black/African American (10%, n=3) or other race(s)/ethnicity(ies) (13.3%, n=4). Data were analyzed by three research team members following Braun and Clarke’s (2022) inductive thematic analysis approach.

Results

PRCs identified several benefits of SCSs, such as preventing fatal overdoses, promoting individual health, facilitating engagement with treatment and community resources, reducing the community-level impact of drug use, and reducing stigma toward people who use drugs. However, PRCs also described concerns about SCSs, including worries that sites would enable drug use, stoke law enforcement or legal consequences, and conflict with their employers’ abstinence-based policies. Often PRCs who discussed the benefits of SCSs had previous exposure to harm reduction philosophy or had lost a client or loved one to an overdose. PRCs conveying a personal preference for abstinence-based services were more apprehensive about harm reduction. While most PRCs said they would refer clients to SCSs, they often indicated they would do so only under specific circumstances (as a last resort for clients who “continually relapsed”, or if PRCs were at the SCS and could connect clients to treatment). Almost a quarter indicated they would never refer clients to SCSs due to perceived conflicts with their professional responsibilities or personal beliefs.

Conclusion and Implications

While many participants perceived SCSs as a beneficial harm reduction strategy, PRCs also had concerns rooted in abstinence-only philosophy and systems-level policies that criminalize drug use and harm reduction. Future research should analyze PRCs’ interpretations of and recommendations for agency workplace policies surrounding clients’ use of harm reduction strategies. Research should also explore the disconnect between PRCs’ harm reduction knowledge and their willingness to refer clients to harm reduction services.