Background: Hospitalization is an opportunity to provide medical and behavioral care to patients with substance use disorders (SUD). Harm reduction (HR) is a practical, patient-centered approach that aims to reduce the negative consequences of substance use. People who use non-prescribed stimulants may particularly benefit from HR given a concerning rise in opioid-related deaths that also involve stimulants, a phenomenon known as the “fourth wave” of the opioid epidemic. Much remains unknown about the benefits, drawbacks, barriers, and facilitators to providing HR during hospitalization for people who use stimulants. In this qualitative study, we sought to understand the perspectives of hospitalized people who use stimulants and the clinicians who care for them regarding the provision of HR materials during hospitalization.
Methods: This was a single-site study at a large academic center in metropolitan Denver. We conducted semi-structured key informant interviews with hospitalized patients who use methamphetamine or cocaine and hospital-based clinicians, including nurses, advanced practice providers (APPs), and physicians. We analyzed results using a rapid analytic technique leveraging a matrix analysis. Interviews continued until thematic saturation was reached within both clinician and patient samples.
Results: We interviewed 13 patients and 13 clinicians (4 attending physicians, 3 resident physicians, 4 nurses, and 2 APPs) between November 2024 and May 2025. Three themes emerged: 1. Patients and clinicians described complicated feelings toward harm reduction. Sub-themes: 1a. Patients reported feeling torn between a goal for complete abstinence versus embracing harm reduction, and 1b. Clinicians raised concerns about enabling substance use, which was mitigated by prior experience with harm reduction. 2. Patients and clinicians perceived that harm reduction builds rapport and improves patient trust in hospital-based settings. 3. Clinicians emphasized a need for additional support compatible with hospital workflows to address harm reduction effectively with their patients during hospitalization.
Conclusions: Our results support prior work describing the benefits of integrating HR into the inpatient setting, including perceptions of increased trust and improved patient-clinician relationships. In general, both patients and clinicians in our study viewed HR positively, although some expressed concerns about the ethics of HR, felt uncomfortable with some aspects of HR, or expressed concerns about enabling substance use. Some patients described a desire for abstinence from substances as conflicting with the acceptance of some HR materials. Clinicians with formal and informal prior experience involving HR described these as positively influencing attitudes toward HR. Our findings highlight the need for sensitivity to the unique aspects of providing HR services in a hospital-based setting, as well as the importance of integrating HR within clinical training.