Between 2022-2023, over 110,000 people died of drug overdoses. Despite promising trends indicating declines nationally, overdose death rates are increasing in some places, including rural areas in the WWAMI region. Most overdose deaths involve illicitly manufactured fentanyl alone or in combination with other opioids and/or stimulants. Harm reduction strategies, like providing naloxone, fentanyl testing strips, and anti-stigma drug education, empower people to make informed decisions and prevent overdose. Overdose deaths are preventable, but life-saving harm reduction strategies are not accessible to many at risk, particularly in rural areas. This translational research program directly supports the CDC’s commitment to preventing overdose deaths and the National Institute for Drug Abuse’s Scientific Priority Areas #2 and #4.
Community-based efforts, like syringe service and naloxone distribution programs, offer harm reduction strategies and non-stigmatizing support for people who use drugs. These programs are effective in reducing overdose death risk, and people who use these programs reduce risk of HIV and Hepatitis C by 50% and are 3x more likely to stop injecting drugs. Harm reduction services are often limited in rural areas due to community-level public stigma. This means many people who use drugs in rural communities have less access to life-saving resources and may experience more stigma (a barrier to help-seeking). At the same time, rates of overdose deaths involving stimulants like methamphetamine are nearly 1.5x higher in rural versus urban counties. Increasing access to harm reduction in rural areas is imperative and time sensitive.
Primary care is often the first point of contact with the healthcare system and is more accessible than substance use disorder specialty care. Clinical efforts focus on increasing access and receipt of medications for opioid use disorder (MOUD) through primary care. Yet, less than 20% with OUD receive MOUD, and no FDA-approved medications for stimulant use disorders exist, and the 80% of patients who use opioids and stimulants nonmedically without substance use disorder diagnoses are excluded. People who use infrequently or recreationally and those not ready or interested in medication or treatment may be more likely to overdose from unknown fentanyl contamination but there are no primary care interventions for these patients.
We propose a novel harm reduction intervention for rural primary care settings to increase access to effective, life-saving harm reduction strategies to prevent overdose deaths in rural communities. We have partnered with patients and clinicians from the WWAMI-region Practice and Research Network (WPRN) to develop a harm reduction package for primary care which can be personalized for patients who use opioids and stimulants nonmedically. This collaborative research is funded through Dr. Blanchard’s UW Institute of Translational Health Sciences career development award funded by the National Institutes of Health. The proposed trial will be Dr. Blanchard’s first as an independent early-stage investigator. Using the evidence-based Discover-Design-Build-Test framework developed at the UW NIMH P50 ALACRITY Center, we will collaborate with rural-serving frontline primary care clinicians and community members. We will discover feasible and important overdose prevention strategies that can be implemented in primary care, design and build the necessary supports, and the test these strategies in a pilot Hybrid Type I feasibility/preliminary effectiveness-implementation study to expedite the translation of research into practice.
For more information, please review this information sheet >>
Increasing Access to Harm Reduction in Rural Primary Care to Prevent Overdose was awarded funding by the Centers for Disease Control and Prevention (CDC) STUDY00021384 (IRB); Project Number: R49CE003565-01.