Peer Recovery Support Specialists for Improving Access to Harm Reduction Services in Rural Communities

Author: Philip Korthuis, Gillian Leichtling, Andrew Seaman, Judith Leahy, Ann Thomas, Joanna Cooper, Larry Howell, Kelly Jones, Ali Mirzazadeh-Javaheri , Ryan Cook

Theme: Epidemiology & Public Health Research Year: 2023

Background: Harm reduction approaches can reduce risk of overdose and infection among people who use drugs (PWUD), but such services are rare in many rural communities. Peer recovery support specialists (peers) are trusted voices for PWUD not seeking treatment. We assessed the feasibility, acceptability, and correlates of a novel rural peer-delivered harm reduction model.

Methods: Peers recruited PWUD with any past-30-day injection drug use (IDU) or non-injection opioid use through community outreach and syringe service programs (SSPs) in 5 rural Oregon counties. Peers received training and offered PWUD naloxone overdose kits and training, mobile syringe exchange, fentanyl test strips, and other supports. Peers surveyed participants about drug use and documented services provided in the subsequent 90 days. Logistic regression identified predictors of services received.

Results: Participants’ (N = 608) mean age was 39 [SD 11] years; 64% were male, 82% white, and 8% Hispanic. Most common drugs used in the past 30 days were methamphetamine (94%) and opioids (72%); 91% reported IDU, 25% reported sharing needles or supplies, and 12% reported overdosing in the past 6 months. 70% engaged with any peer services within 90 days; 37% engaged in peer-delivered harm-reduction services including mobile syringe exchange (35%), naloxone kit distribution and training (24%), and fentanyl test strips (9%). Participants with past 30 day IDU (OR=4.25, 95% CI 1.9-11.2) and who lived more than 1 hour away from an SSP (OR=3.0, 95% CI 1.9-4.9) were more likely to receive peer-delivered harm reduction services, while those who had been incarcerated in the last 6 months were less likely (OR=0.4, 95% CI 0.2-0.6).

Conclusions: Peer harm reduction services were feasible and acceptable to PWUD in rural communities, particularly for IDU and those living more than an hour from an SSP. Peer training can potentially improve access to harm reduction services for rural PWUD.

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