Hospital adoption of harm reduction and risk education strategies to address substance use disorders

Zoe Lindenfeld, Berkeley Franz, Cory Cronin, Ji Eun Chang

Research output: Contribution to journalArticlepeer-review


Background: Hospitals are well-positioned to integrate harm reduction into their workflow. However, the extent to which hospitals across the United States are adopting these strategies remains unknown. Objectives: To assess what factors are associated with hospital adoption of harm reduction/risk education strategies, and trends of adoption across time. Methods: We constructed a dataset marking implementation of harm reduction/risk education strategies for a 20% random sample of nonprofit hospitals in the U.S (n = 489) using 2019–2021 community health needs assessments (CHNAs) and implementation strategies obtained from hospital websites. We used two-level mixed effects logistic regression to test the association between adoption of these activities and organizational and community-level variables. We also compared the proportion of hospitals that adopted these strategies in the 2019–2021 CHNAs to an earlier cohort (2015–2018.) Results: In the 2019–2021 CHNAs, 44.7% (n = 219) of hospitals implemented harm reduction/risk education programs, compared with 34.1% (n = 156) in the 2015–2018 cycle. In our multivariate model, hospitals that implemented harm reduction/risk education programs had higher odds of having adopted three or more additional substance use disorder (SUD) programs (OR: 10.5: 95% CI: 5.35–20.62), writing the CHNA with a community organization (OR: 2.14; 95% CI: 1.15–3.97), and prioritizing SUD as a top three need in the CHNA (OR: 2.63; 95% CI: 1.54–4.47.) Conclusions: Our results suggest that hospitals with an existing SUD infrastructure and with connections to community are more likely to implement harm reduction/risk education programs. Policymakers should consider these findings when developing strategies to encourage hospital implementation of harm reduction activities.

Original languageEnglish (US)
Pages (from-to)206-215
Number of pages10
JournalAmerican Journal of Drug and Alcohol Abuse
Issue number2
StatePublished - 2023


  • addiction
  • buprenorphine
  • community health
  • harm reduction
  • Hospitals
  • opioid use disorders
  • substance use disorders

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health


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