Can Safer-Use Strategies Improve Opioid and Stimulant Care?

TOPLINE:

Patients and clinicians in primary care settings found that safer-use strategies for opioids and stimulants were acceptable and that they enhanced patient-centered care. Clinicians supported these strategies with resources but sought more training to improve implementation. More than 50% of patients recommended all 33 strategies be offered.

METHODOLOGY:

• Researchers conducted a mixed-method study to investigate the acceptability of offering safer-use strategies to patients in primary care settings who use opioids and stimulants and to characterize those strategies used by patients and supported by clinicians.
• They included 10 patients (mean age, 53 years; 44% women; 50% White) and 12 clinicians (mean age, 36.27; 66.67% women; 75% White) from two clinics in Washington and one in Montana.
• Eligibility criteria for patients included any lifetime use of opioids and/or stimulants, any use of safer-use strategies, and access to a smartphone or internet for participation. Clinicians were recruited from participating clinics and provided insights into the acceptability and support of safer-use strategies.
• Patient participants completed 40-minute semi-structured interviews and 20-minute surveys via telephone on 33 safer-use strategies, drug use experiences, and demographics. Clinicians participated in hour-long interviews via interactive video software and completed a 10-minute online survey assessing the acceptability of harm reduction strategies.
• Data on the strategies were organized into three themes, namely, ways to be safer and healthier without changing use, ways to use more safely, and ways to change how much patients use, with the following subthemes: Patient use, clinician supports, and suggestions or recommendations.

TAKEAWAY:

• More than half the patients recommended all 33 safer-use strategies be offered in primary care settings, with 100% of them recommending 10 specific strategies. Clinicians rated the provision of harm reduction strategies as acceptable (42%), with 58% of them rating it as extremely acceptable.
• Patients reported using multiple safer-use strategies, including infectious disease screening, vein care, and oral hygiene to support their physical health in surveys.
• Clinicians offered fentanyl test strips, as well as naloxone, resources for safer-use strategy discussions, and updated information on current drug contaminants in the community; they also expressed a desire for more training.
• Patients hinted that physician-prescribed medication for opioid use disorder (MOUD) was helpful in reducing or stopping opioid use and suggested flexible scheduling for MOUD and providing treatment information online. Both patients and clinicians expressed the need for stimulant use disorder medication.

IN PRACTICE:

“SUS [safer-use strategies] are an important component of harm reduction, though not the only aspects that need attention,” the authors of the study wrote. “As suggested by clinicians, anti-stigma, trauma-informed care, and compassion training may be needed to address healthcare inequities,” they added.

SOURCE:

This study was led by Brittany E. Blanchard, PhD, of the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine in Seattle. It was published online on March 04, 2025, in the Journal of General Internal Medicine.

LIMITATIONS:

This study’s small sample size may limit the generalizability of its findings. The absence of younger adult patients and older clinicians in the sample may also affect the applicability of the results. Additionally, clinician-perceived acceptability of all safer-use strategies was not assessed, and racial diversity among clinicians was limited.

DISCLOSURES:

This study was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health and a University of Washington Institute of Translational Health Sciences’ planning grant funded by the National Center for Advancing Translational Sciences. One author disclosed receiving support from the National Institute on Drug Abuse Loan Repayment Program. Another author reported ownership, board membership, and equity in HaRT3S and receiving royalties for publishing Harm Reduction Treatment in Substance Use from Hogrefe.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.