Awareness, Utilization, and Preferences of Harm Reduction Interventions among Street-Involved Young Adults in Boston

Abstract

Objectives

This study explores knowledge and utilization of, barriers to, and preferences for harm reduction services among street-involved young adults (YA) in Boston, Massachusetts.

Methods

This cross-sectional survey of YA encountered between November and December 2019 by a longstanding outreach program for street-involved YA. We report descriptive statistics on participant-reported substance use, knowledge and utilization of harm reduction strategies, barriers to harm reduction services and treatment, and preferences for harm reduction service delivery.

Results

The 52 YA surveyed were on average 21.4 years old; 63.5% were male, and 44.2% were Black. Participants reported high past-week marijuana (80.8%) and alcohol (51.9%) use, and 15.4% endorsed opioid use and using needles to inject drugs in the past six months. Fifteen (28.8%) YA had heard of “harm reduction”, and 17.3% reported participating in harm reduction services. The most common barriers to substance use disorder treatment were waitlists and cost. Participants suggested that harm reduction programs offer peer support (59.6%) and provide a variety of services including pre-exposure prophylaxis (42.3%) and sexually transmitted infection testing (61.5%) at flexible times and in different languages, including Spanish (61.5%) and Portuguese (17.3%).

Conclusions

There is need for comprehensive, YA-oriented harm reduction outreach geared toward marginalized YA and developed with YA input to reduce barriers, address gaps in awareness and knowledge of harm reduction, and make programs more relevant and inviting to YA.

Keywords:

• Harm reduction
• substance use
• opioid-related disorders
• opioid epidemic
• young adult

Acknowledgments

The authors are grateful to the Grayken Center for Addiction Medicine, the Kraft Center for Community Health, and the Hearst Foundation for their support of the Community Care in Reach mobile van’s work in providing harm reduction and mobile health services to adolescents and young adults in Boston.

Declaration of interest

Dr. Amy Yule currently receives NIH funding and is currently a consultant to the Gavin House and BayCove Human Services (clinical services). The other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Box 1. Representative free text responses to a question asking participants to define “harm reduction”:

Responses graded as correct:

“Narcan, keeping clean needles”

“To reduce or prevent risk of injury or death”

Responses graded as incorrect:

“Reducing urge to harm oneself”

“Coping methods”

“Self care”

“Staying safe”

“Pain reduction”

“Violence prevention”

“I need to stop doing drugs”

“I don’t know”

Additional information

Funding

Dr. Amy Yule currently receives funding through the American Academy of Child and Adolescent Psychiatry Physician Scientist Program in Substance Abuse (K12DA000357-17). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The other authors received no financial support with respect to the research, authorship, and/or publication of this article.