Moving Beyond Naloxone: Integrating Harm Reduction Into Office-Based Addiction Treatment

The opioid epidemic is now characterized by deaths driven by comorbid use of fentanyl and stimulants. It has become more essential than ever to integrate harm reduction strategies into the care of every patient, particularly among those who inject drugs. While we need to expand treatment access to patients with opioid use and stimulant use disorder, we also need broader engagement strategies that mitigate risks and reduce mortality. We conceptualize harm reduction broadly as part of the treatment continuum with a crucial role of reducing morbidity and mortality while also supporting access and adherence to pharmacotherapy. This focus session will review patient-centered strategies and best practices around integrating harm reduction education and counseling into office-based addiction treatment. We will review strategies for how to counsel patients on reducing overdose risks, and discuss provider scripts for providing safer injection and consumption practice education. In addition, we will discuss clinical guidelines and best practices supporting screening for HIV and Hepatitis C. We will briefly review the most up-to-date treatment guidelines for patients with Hepatitis C and discuss monitoring before and during treatment. We will review guidelines supporting use of pre-exposure prophylaxis (PREP) among people who inject drugs and review how to initiate and manage PrEP for eligible patients. We will discuss strategies related to prescribing buprenorphine using a harm reduction lens, and discuss how this influences logistics, such as urine drug screens, counseling requirements, and clinical documentation. We will conclude with a broader group discussion highlighting the barriers and tension that at times exist with integrating harm reduction into traditional treatment settings, and discussing ways to overcome these leveraging our panel and audience expertise.