Meeting people where they are, whenever they are here: the implementation of harm reduction programs in two U.S. emergency departments

Complications related to drug use, including overdose, withdrawal, and infection, represent a significant proportion of emergency department (ED) visits in the United States (US). Within addiction medicine, harm reduction focuses on strategies that minimize negative outcomes associated with continued drug use through interventions such as preexposure prophylaxis, naloxone distribution, and safer use supplies. Integration of harm reduction measures into acute care settings may enhance patient trust and engagement in medical care, and may reduce the risk of overdose, viral transmission and serious bacterial infections for patients who use drugs. While there has been an increased interest in incorporation of harm reduction into acute care, data on successful implementation is limited. We describe the successful implementation of two unique programs designed to decrease risk and stigma for patients who use drugs and access acute care services in two tertiary care ED’s in Massachusetts, US. This article details two different implementation strategies utilized to integrate harm reduction into bedside emergency care. We utilize the CFIR framework to identify barriers and facilitators to successful programmatic implementation, and report on reception by ED teams through post-implementation interviews and program utilization data. Integration of harm reduction into acute care can be safe and feasible. Creating partnerships with community organizations, leadership from an ED champion, and pairing implementation with education for ED staff are key for programmatic success.