Unveiling Occupational Stressors of Harm Reduction Workers to Strengthen and Sustain Their Social Impact

Background and Purpose: The U.S. opioid crisis is a growing and urgent public health concern. Harm Reduction Workers (HRWs) are helping paraprofessionals on the frontlines of the epidemic, providing life-saving services (e.g., overdose reversals) to high-need, underserved communities. In this work, HRWs are exposed to considerable amounts of trauma and adversity, which contributes to poor outcomes for HRWs (e.g., compassion fatigue). This is particularly concerning, as HRWs often lack access to necessary mental health supports and resources, which may be a driver of significant unmet mental health needs, relapse, burnout, and turnover. HRWs are critical for driving and sustaining equitable social impact in epidemic response efforts, yet scant research is available on what specific stressors HRWs’ face in their work. This study uses the Revised Ecological Model of Occupational Stress (Meischke et al., 2020) to elucidate the unique occupational stressors HRWs experience across five socio-ecological levels (i.e., individual-, micro-, organizational-, peri-organizational, extra-organizational)

Methods: This secondary analysis draws on qualitative open-text response data collected via REDcap as a part of a study on HRWs’ occupational health. A non-probability sample of Texas-based HRWs (n=168) was recruited through voluntary response and snowball sampling methods. Participants held a range of roles within their organizations: 53% peer support, 49% street outreach, 32% managerial/administrative, and 21% drop-in appointments/case management. Participants were middle-aged (M=45.6, SD=12.4), predominantly cisgender women (n=106, 63%) and non-Hispanic White (n=64, 60%). A three-member coding team analyzed the data using the Consensual Qualitative Research-Modified (CQR-M) approach. Coding domains were determined a priori according to the guiding theoretical framework, and specific codes were grounded in participants’ responses. Domain and code frequencies were calculated according to the CQR-M method.

Results: Data analysis revealed eight distinct yet interrelated distal factors. Extra-organizational factors included: 1) the illegality of harm reduction, 2) community attitudes towards harm reduction, 3) criminalization of clients, and 4) intersectional issues. Peri-organizational factors included: 1) stigma, prejudice, and discrimination towards clients, 2) lack of resources, 3) funding environment, and 4) local law enforcement. Respondents also highlighted factors at the organizational, micro-system, and individual levels that impact their occupational stress.

Conclusion and Implications: Though harm reduction has long been established as evidence-based, HRWs charged with their implementation face a host of barriers that impede their work, perpetuate injustice, and, in turn, contribute to their occupational stress. This study provides a thorough and nuanced understanding of the numerous and interconnected challenges HRWs must consistently navigate in order to provide life-saving services and support to marginalized communities. Unveiling the occupational stressors HRWs face is the first of many steps needed to strengthen and sustain this critical workforce. These findings have laid the foundation for a collaborative research project with key stakeholders focused on co-designing and pilot-testing a multi-level intervention that aims to reduce occupational stress and prevent burnout among HRWs. The ways in which study findings have been leveraged to inform intervention development and advocacy efforts will be discussed.