Malia E Haddock, APRN-PMHNP
Integrating the Language of Harm Reduction in Clinical Teaching and Care
When reflecting on your clinical and teaching practices as they relate to patients with substance use disorder, it is important to consider the following:
- The extent to which drug use and people who use drugs are subject to stigma and judgement
- The extent to which stigmatization impacts how health care providers and trainees talk about and communicate with patients who use drugs
- The extent to which stigma, judgment and internalized shame produce reluctance among patients who use drugs to communicate openly and honestly with their health care team
If contemplating this feels like uncharted or uncomfortable territory, Harm Reduction provides a framework and language to help bridge gaps between providers/trainees and patients who use drugs.
What is Harm Reduction?
“Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs” (Harm Reduction Coalition [HRC], 2021).
Click on below to watch a short video:
National Harm Reduction Coalition – Harm Reduction Truth
The Harm Reduction Coalition, a leader in Harm Reduction education and advocacy, offers specific guidance on how patients who use drugs can approach their health care providers. As providers and trainees, becoming familiar and comfortable with this kind of approach will support therapeutic encounters with individuals who have histories of negative experiences with the health care system. The HRC training guide includes the following topics, described more fully in attached brochure (HRC, 2021):
- Talking about drug use is personal
- Reasons why it may be hard to talk about drug use (and why some people decide not to)
- Some reasons why it is good to talk about your drug use
- When talking about your drug use, it’s OK to build trust first
- If the doctor is focusing too much on your drug use
- Examples of things you can say to the doctor when you don’t want to talk about drug use
Facilitate Honest and Compassionate Communication through Harm Reduction
- Harm Reduction provides a framework for providers and trainees to meet patients where they’re at
- Harm Reduction removes judgement and stigmatization from the narrative
- Harm Reduction reduces the power differential between those providing and seeking care
Harm Reduction Strategies – Theory into Practice
- Use person-first language, e.g. person with a substance use disorder or person who uses drugs
- Create safe opportunities for patients to talk about their drug use
- Familiarize yourself with safer use practices
- Prescribe medication for OUD and naloxone at discharge
- Facilitate viable connections to outpatient support, including local syringe access services
References:
Harm Reduction Coalition. (2021). Principles of harm reduction. https://harmreduction.org/about-us/principles-of-harm-reduction/
Harm Reduction Coalition. (2021). Quality health care is your right. https://harmreduction.org/wp-content/uploads/2020/08/Resource-SaferDrugUse-QualityHealthcareIsYourRight.pdf
Further reading:
HRC Training Guide
Addiction Technology Transfer Center Network, Language Matters Guide
https://attcnetwork.org/sites/default/files/5-Language_Matters_9-18-17.pdf
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