Trends from the Rhode Island Harm Reduction Surveillance System: 2021-2024.

Amid the increase in fatal overdoses in Rhode Island (RI) over the past decade, understanding substance use and harm reduction practices is critical for informing prevention strategies. This work aimed to evaluate trends in substance use behaviors, overdose experiences, and harm reduction practices among people who use non-prescribed substances in RI. In a convenience sample of 673 participants from the 2021-2024 Harm Reduction Surveillance System (HRSS), the most reported substances used in the past 30 days were: alcohol (73%), crack cocaine (72%), cannabis (69%), cocaine (42%), and fentanyl/heroin (39%). We observed a decrease in harm reduction practices in 2024, including always using fentanyl test strips and always using substances in the presence of others after an increase from 2021 to 2023. Notably, 86% of respondents reported having a disability. These findings emphasize the ongoing need for comprehensive harm reduction programs to engage high-risk individuals, tailored to those with disabilities.