Resistance, Rurality, and Harm Reduction: Perspectives and Insights from People Who Use Drugs and Treatment Providers in Rural Communities

Background & Purpose: Rural communities across the United States face significant health disparities, especially when compared to their urban counterparts. This is true and exacerbated when looking at people who use drugs (PWUD), people with substance use disorders, and drug-related deaths within rural communities. Existing literature has pointed to less access to treatment providers, existing treatment often relying on abstinence-only treatment models, community perception and stigma, and limited harm reduction resources as major factors in creating and maintaining these major health disparities. To address these existing injustices, research must be conducted with treatment providers and PWUDs in rural settings. This research seeks to address these inequities by engaging with PWUDs and treatment providers across Wyoming. This research focuses on two primary research questions: 1) how are existing models of treatment addressing the needs of the community 2) how are harm reduction models perceived and or practiced amongst treatment providers and PWUDs across rural Wyoming.

Methods: The researcher partnered with 8 substance use treatment facilities that received state funding to provide substance use treatment across Wyoming. Semi-structured interviews were conducted with staff at each agency to gain an understanding of treatment approaches, community needs, and harm reduction perspectives. Focus groups were conducted for patients at each clinic. All active patients at the clinics were invited to attend the focus group. Each of the 8 focus groups followed the same discussion guide, which included open-ended questions that probed the experiences of the participants at the treatment facility, their perceived strengths of treatment, recommendations, and thoughts and opinions on harm reduction. All interviews and focus groups were recorded, with participant consent, transcribed, cleaned, and analyzed by the research team using reflexive thematic analysis (RTA).

Results: Staff across the clinics echoed similar sentiments about the strengths of the programs, including serving a community that has been underserved and marginalized, as well as creating a space for community collection for their patients. Key limitations from staff included limited funding, serving hard-to-reach populations, and lack of other community resources for referrals. Staff at the clinic had very mixed perspectives on harm reduction. Analysis of focus groups across the clinics resulted in 5 key themes: 1) Barriers in accessing treatment due to their community's rurality, 2) Treatment utilizing a one-size-fits-all approach, 3) Lack of non-abstinence-based treatment options, 4) The healing power of the therapeutic process, and 5) Community building that a treatment facility provides in a largely rural area.

Conclusions: Results shed light on the barriers and facilitators that rural communities face when accessing and facilitating substance use treatment. Results also highlight the pitfalls of the continued reliance on abstinence-only and punitive-based treatment approaches and call on social work educators, researchers, and practitioners to take a radical departure from this. This shift away from abstinence-only approaches and towards harm reduction methods has promising evidence to support a reduction in the health disparities and inequities faced by PWUD in rural communities.