Table 2.

Common Themes of Harm Reduction-Informed Care

Themes	Examples	Illustrative Quote(s)
Provider as both learner and informer	Provider views patients as experts in their own drug use and strives to learn what patients’ goals in treatment are	“Letting the patient feel like they're autonomous in their treatment decisions is really important. I actually will tell patients, consider me a tool for your health and I will take on the doctor role and I will tell you what my advice is and my recommendations, but I don't ever want you to feel like I'm trying to tell you what to do.”
	Providers are not directive or forceful but function as sources of information for patients, providing a realistic range of support options to develop a treatment plan consistent with? patient’s goals.
	Provider aims to be compliant to patient’s needs (not vice versa) and to help patients adopt safer behaviors.	“Harm reduction means you're giving somebody all the tools, you're informing the person, the participant. You're giving them all the tools they have to make the safest decisions, but ultimately, their decisions are their decisions”
Pragmatic measures of success	Providers recognize that complete abstinence may not be a realistic goal for many patients.	“I would qualify that success is that they're engaging with us, having an honest relationship with us, and are able to come to us when there are new problems coming up for them.”
	Focus is placed on the process of treatment rather than outcomes
	Measures of success based on care processes (ie, patient engagement and retention), having an open, honest relationship with patients, and reaching patients’ self-identified goals.	“We're not expecting that people are going to be completely abstinent, that might not even be their goal and that's totally okay. But just seeing progress and being happy with that. Like, patients like coming in time to get a refill, that's great”
Collaborative and interdisciplinary care teams	Ensuring a wide range of providers and specialists are available to address varied patient needs	“We’re constantly talking to each other. We have weekly team meetings. We’re constantly emailing each other about the various needs of our patient. We know each other, we’re a small team and I think that makes it very easy for me to pick up the phone and call.”
	Routine staff meetings to collaboratively discuss issues and questions related to patient care
	Relying on other team members for support during difficult situations
Developing a stigma-free culture	Having strong leadership team dedicated to harm-reduction	“We create an environment where people are free to discuss their drug use without fear of being stigmatized or judged, so that we can give people the tools to reduce their harms around the health issues that arise for people who inject drugs” “We do interview all of our clinic-facing providers, like nurses and front desk and everything. They do an interview with the team huddle. And this guy came on last week and he was like, I just really want to treat addicts and everyone’s eyes rolled. And that was the end, the guy didn’t get the job”
Developing a stigma-free culture	Intentional hiring and screening practices for culture-fit Ongoing training and education on using stigma-free language versed in trauma-informed care (ie, in charting) and treating all patients with respect Constant communication and check-ins between staff to ensure fidelity to harm-reduction principles
Creating a comfortable and welcoming physical space	Providing showers, bathroom, and laundry facilities on site	“Patients have a comfortable relationship with the clinic. Some of them, they come in, and often we're not even registering them with the doctor. They're just sitting and talking to us in the nurse’s office. We're not busy, and they can come in and talk to us.” “Our staff works really hard at making sure that patients don't feel stigmatized, that they don't feel judged or looked upon as less than. I think physically the fact that patients can come in and grab a cup of coffee, which if you're injection drug users, the fact that you have the space to do that safely in, I think is really quite critical.”
Creating a comfortable and welcoming physical space	Allowing patients to bring belongings such as large bags, carts, pets in the clinic Handing out snacks to patients to make wait times less onerous Remembering patients’ names Reducing paperwork burden for patients
Low-threshold care with flexible scheduling	Adopting a walk-in model for appointments with no penalties for no-shows or late arrivals	“In our clinic, we have basically a policy that patients certainly need appointment times, but often they're late for their appointment times or early for their appointment times, and we'll basically see them whenever. So that just allows a lot more flexibility for them to be able to be seen.” “We do urine toxicology tests. We try to say that very much upfront, this is not punitive, this is it just to have an open conversation. We're not trying to stop your prescription. Even if you're using opioids”
Low-threshold care with flexible scheduling	No penalties or discontinued services for disclosing medication misuse Using urine toxicology to start conversations rather than for punitive purposes Enacting policies to protect patient privacy (i.e. to courts)
Reaching beyond the clinic to disseminate harm reduction orientation	Carving out time to teach harm reduction principles in medical schools and residency training programs	“Very few current internal medicine residency programs even teach what harm reduction is, or how to provide low threshold MAT. We are involved in a training program locally to do just that.”
	Holding training sessions with other local community organizations
Creating robust referral networks to enhance transitions of care	Developing referral networks to ensure patients are treated with respect when receiving services outside of the clinic Supporting patients during external transitions (ie, scheduling external appointments, providing MetroCards)	“We don't send people to places where they're going to be treated poorly or abused by providers, we're not going to send them because that reflects back on us. So, we're careful about our referrals naturally.”