Understanding Resilience Strategies and Occupational Stressors Among Harm Reduction Workers

Background and Purpose: In 2023, the United States was estimated to have experienced over 110,000 deaths due to drug overdose. Importantly, harm reduction workers (HRWs) provide low-barrier services and supplies to people who use drugs along the continuum of care for overdose prevention, including distributing naloxone and referring individuals to treatment. However, HRWs often work within challenging occupational circumstances that create barriers to effectively providing services. Little is known about how HRWs bolster resilience among their teams and what specific strategies are used to mitigate burnout. The purpose of this study was to understand the circumstances around burnout and stress injuries as well as resilience and peer support strategies in use among HRWs.

Methods: Focus groups were conducted with HRWs and programmatic leaders of harm reduction programs in Texas (N=16). Our sample predominantly identified as female (50% female; 38% male; 12% non-binary/gender fluid), White (81% White; 13% Native American or Alaskan Native; 6% Black or African American), and there was an even distribution of Hispanic/Latinx participants and non-Hispanic/Latinx participants (50% Hispanic/Latinx; 50% non-Hispanic/Latinx). All participants provided services at grant and/or state-funded harm reduction programs and these programs were dispersed throughout the state (50% Central Texas; 25% West Texas; 19% North Texas; 6% Upper Gulf Coast). Participants were recruited via snowball and purposive sampling methods, including reaching out to contacts known from a preexisting community-based participatory research project via email. Focus groups were transcribed verbatim and preliminary thematic analyses were conducted via framework matrix. Formal analyses including systematic coding and Applied Thematic Analysis with NVivo 14 are currently underway.

Findings: Emergent themes highlighted the occupational challenges that HRWs experience and strategies that teams use to mitigate burnout and stress injuries occurring on the job. HRWs indicated that (1) limited resources for staffing and supplies, (2) proximal harassment from law enforcement, and (3) secondary trauma from clients passing away are significant threats to occupational well-being. HRWs also exhibited traits (i.e., lived experience, unique passion for their work) that exemplified their resilience and indicated specific protocols and strategies to mitigate burnout potential, including (1) debriefing sessions following outreach, (2) breathing techniques, (3) modelling, (4) team building, and (5) forming community-wide coalitions to provide collateral support for their service provision. Cohesion and connection within and between harm reduction programs were central to the resilience expressed among HRWs.

Conclusions and Implications: Perspectives from HRWs and programmatic leaders exemplified the unique challenges of providing services within a sociopolitical context that offers limited support and, in some cases, punishes the work they do. Additionally, this workforce exhibits trait-level resilience and practice strategies within their teams to support each other and mitigate the impact that these challenging circumstances can have on provider well-being and burnout. These findings will inform interventions to enhance occupational and peer support for HRWs amidst the overdose crisis.