Harm-reduction as a component of opioid use disorder management

“You are going to have to quit eating.”

“If your A1C indicates that you’ve been eating carbs, I won’t be able to continue treating you.”

It is not hard to imagine the adverse outcomes for patients if these strategies were adopted to manage their diabetes. Like diabetes, opioid use disorder (OUD) is a chronic disease. The treatment trajectory for patients suffering from OUD often includes multiple relapses. Most management strategies prioritize abstinence, which often leads to “firing” the patient from care when relapse is detected which creates barriers to successful treatment.

Super-potent illicitly manufactured opioids like fentanyl are flooding the streets. While we quickly see the impact of such agents through the marked increase in opioid overdose mortality, we are likely not yet seeing the impact that the pharmacokinetics of these drugs have on morbidity. The central actions of these highly potent agents are terminated by distribution out of the brain, which means these agents have much shorter pharmacodynamic half-lives than less potent agents. The shorter duration of action leads to more frequent need for dosing, which in turn leads to an increase in risk for infectious diseases.   

Integration of harm-reduction strategies into the outpatient management of patients suffering from OUD will improve the quality of life, reduce risks for patients, and reduce the potential for spread of resistant pathogens. Harm reduction incorporates humanism, pragmatism, patient-centered care, autonomy, and pragmatism through accountability without discharge from care 1, 2. Evidence-based harm reduction interventions include1:

  • Provide treatment on demand, with accommodation for late-shows and walk-ins
  • Provide non-judgmental patient-centered care
  • Reduce stigma during patient encounters
  • Prevent, detect, and treat infections
  • Provide harm-reduction supplies including items such as intranasal naloxone, syringes, sterile water for injection, and condoms
  • Teach patients sterile technique

We need to begin treating opioid use disorder like a chronic disease rather than a moral issue.

Mary Beth Babos, PharmD, BCPS
Professor of Pharmacology & Chair of Pharmacology
DeBusk College of Osteopathic Medicine
Lincoln Memorial University

1. Taylor, J. L., Johnson, S., Cruz, R., Gray, J. R., Schiff, D., & Bagley, S. M.  Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings : Harm Reduction in Outpatient Addiction Treatment. Journal of general internal medicine, 2021;36(12): 3810–3819. doi: 10.1007/s11606-021-06904-4.

2. Hawk M, Coulter RWS, Egan JE, et al. Harm reduction principles for healthcare settings. Harm Reduct J. 2017;14(1):70. doi: 10.1186/s12954-017-0196-4.

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