Learn from the experts, people who use drugs, how medical providers can begin to build trusting relationships.

The National Harm Reduction Coalition (NHRC) is a nationwide advocate and ally for people who use drugs and a partner of CA Bridge. In collaboration with the California Department of Public Health, NHRC established the California Harm Reduction Initiative to strengthen the state’s response to substance use disorder by supporting syringe services programs (SSPs). This initiative included $15.2 million, making it the largest investment in harm reduction in California’s history. With this support, NHRC conducted a point-in-time survey to gain feedback from people who use SSP services in California. We spoke with NHRC’s Savannah O’Neill, Associate Director of Capacity Building and longtime supporter of people who use drugs, and Luka Bair, Evaluation Consultant and drug user, about what they have learned from the community.

What the Experts Have to Say

Understanding the History

Over the past 40-50 years, stigma against people who use drugs has become the standard in medicine. This belief system has cultivated a deep mistrust between people who use illicit drugs and medical providers. It is essential to understand that, although individual medical providers may not be responsible for this loss of trust, they must carry the burden of this history in order to change it. Practicing trauma-informed care and using destigmatizing language can help to shift interactions with patients.

Deepening Our Understanding of Treatment Options

Historically, medication for addiction treatment has included medications like buprenorphine and methadone for the treatment of opioid use disorder, with the goal of ceasing use. However, this premise does not reflect the reality of many people who use drugs. Many are not aiming to cease use but are hoping to manage their use better to improve their quality of life. In addition, the surveys found that while 20% of respondents were interested in buprenorphine, many were not interested for various reasons. For instance, while buprenorphine may relieve withdrawal symptoms, it does not provide the euphoria of full opioid agonists.

Thinking Beyond Opioid Use Disorder

A common misconception is that problematic drug use is limited to illegal opioids, such as the injection of heroin, but this does not reflect the current drug landscape. The addiction treatment space is falling behind the increasing diversity of drug options available on the street. For decades, opioid overdose has been a misnomer since many people in California were experiencing overdoses with multiple drugs in their systems. Polysubstance use is increasingly becoming the norm. We must expand our treatment options and modalities to include use disorders beyond opioid use disorder. Learn more about our Centers of Excellence to see how we tackle this issue.

Transforming Relationships with Patients Who Use Drugs

To develop trusting relationships with people who use drugs, providers must accept that patients are the experts of their own experiences. Instead of making assumptions about what is best, ask what support your patients want. What are their goals? Often, patients hope to increase their autonomy, livability, and quality of life. As a provider, gathering this information before developing a treatment plan is crucial. People who use drugs deserve medical care and agency. It is important to support more positive health outcomes for patients who wish to keep using drugs. Informing patients that the provision of care is not conditional on their decision to use (or not use) drugs is essential to building trust. By nurturing a partnership, providers have the power to positively impact patients’ lives.


Developing trusting relationships is key to improving outcomes for patients. Providers are often expected to have all of the answers, but this dynamic does not consider patients’ expertise based on their own experiences. Expanding harm reduction services is a great way for hospitals to implement evidence-based, widely successful initiatives to shift the health care experience, one patient at a time. Implement harm reduction services in your hospital with our Guide to Harm Reduction in the Emergency Department.