Non-Prescribing Clinicians' Support for Harm Reduction for Opioid Misuse

Background & Purpose:

Opioid misuse is a grave concern in the United States with drug-related overdoses peaking in 2022 at over 100,000. Harm reduction (HR) strategies reduce risks associated with opioid misuse: sterile syringes, naloxone kits, fentanyl and xylazine test strips, and medication treatments. However, stigmatization limits the accessibility and utilization of these strategies. Research on implementing HR has focused on medical providers. Non-prescribing clinicians (NPCs) also serve important roles in HR implementation. This study sought to identify personal and professional characteristics of U.S. NPCs associated with attitudes toward HR for opioid misuse.

Methods:

An online survey of 447 U.S. NPCs involved in substance use disorders treatment was conducted November 2023. Postcards were mailed to member lists for professional organizations: National Association of Social Workers (NASW), American Counseling Association (ACA), American Association for Marriage and Family Therapy (AAMFT), and Association for Addiction Professionals (NAADAC). A $10 gift card was offered as an incentive. Measures included demographic and practice characteristics; exposure and training related to HR; attitudes toward HR strategies; and the Harm Reduction Assessment Scale (HRAS-2). Descriptive statistics and a linear regression model were conducted.

Results:

The average age of respondents was 47.2 years old (SD = 14.0), and 79.8% had a masters degree or higher. Most identified as female (67.1%) and White non-Hispanic (83.9%). Members of NAADAC were the most represented (38.3%) followed by members of NASW (35.6%), ACA (30.9%), and AAMFT (7.6%). Respondents represented 47 states and the District of Columbia.

Support for naloxone kits was strongest (89.4%). Most were also supportive of providing safe injection supplies (83.1%) and test strips for fentanyl (85.8%) and xylazine (84%). Respondents were more likely to support medication as a short-term vs. long-term treatment: methadone (79.5% vs. 55.0%, p < .001), buprenorphine (87.4% vs. 62.6%, p < .001) and naltrexone treatment (87.0 vs. 60.0%, p < .001).

Included factors predicted 31.6% of the variance in HRAS-2 scores (F[38,322] = 3.91, p < .001). Significant factors included age (β = -.16, p = .004), gender (β = .12, p = .034), race (β = -.11, p = .036), ethnicity (β = -.10, p = .039), education (β = .15, p = .018), religiosity (β = -.16, p = .003), close relationship with someone with SUD (β = .15, p = .003), residential setting (β = -.14, p = .009), percent of clients on buprenorphine (β = .15, p = .008), prior training on HR (β = .20, p < .001), and adoption of medications (β = .13, p = .033).

Conclusions & Implications:

A contingent of NPCs remains unsupportive of long-term medication treatment for opioid use disorder, despite evidence that long-term treatment is safer and more effective than short-term treatment. Exposure and training related to HR were associated with more support for HR. Other factors indicated subgroups of clinicians who may benefit from additional exposure and training related to HR: those who consider themselves religious, those in residential settings, those with less formal education, male clinicians, and Black and/or Hispanic clinicians.