Harm Reduction Principles and Tactics Every Ambulatory Care Nurse Should Know

Every year, over 20 MILLION people use drugs. Opioids, in particular (but not exclusively), took the lives of over 100,000 people in the USA in 2020, up from 70,000 people in 2019. Additionally, healthcare dollars are spent every year on emergency room care for cellulitis, cardiovascular disease, hepatitis C, and HIV care linked to drug use. As nurses, we care for people daily who use drugs, sometimes knowingly, and other times unknowingly. People use drugs recreationally, and others suffer from substance use disorder or addiction. People who use drugs may not seek care, and if they do, they rarely admit use to their healthcare providers due to fear of judgment and stigma, so there are lost opportunities for health promotion and education.

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. They are in alignment with the Future of Nursing 2020-2030 report, calling for nurses to assist individuals and communities through clinical care, political advocacy, thorough assessment, and awareness and use of community resources. Registered nurses are well positioned to assist with educating and caring for people who use drugs and, in doing so in a compassionate and respectful way, changing the fate of individuals and communities, and potentially reducing the suffering and death that the opioid epidemic is causing. This can and must be done, in alignment with the ANAs code of ethics for nurses, provision 1, which states that nurses practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person. We can meet all people where they are and build from there.

Myths to dispel: All people who use drugs are addicts. All drugs are bad. Heroin is the most addictive substance. All people who use drugs have a moral failure. People who use drugs choose to do so and can stop at any time. All people who use drugs are liars and commit crimes.

Foundations to lay: A nurse’s language must be person-centered, objective, and take into consideration life circumstances, health, and adverse childhood experiences. The language used in communicating with patients, providers, and colleagues shape the care provided, and that power cannot be underestimated. One’s actions must be collaborative and not punitive, and the patient and provider must be able to find common ground to build upon. Recovery is a return to physical health, financial stability, and meaningful social and familial connections. This is the end game, not necessarily abstinence.

This poster presentation will provide information on these basic principles of harm reduction and also outline the specific evidence-based tactics employed by harm reductionists that improve the lives of people who use drugs, namely: narcan, needle exchange programs, fentanyl test strips, safer injection practices, low-threshold bupenorphine prescribing, and overdose prevention sites.

Participants will be able to articulate the effect of person-centered language on the care of people who use drugs and evaluate/share with others a variety of harm reduction interventions that can be considered for people who use drugs.