Challenges and Recommendations for Overdose Prevention and Harm Reduction in an Era of Fentanyl and Xylazine: Perspectives of Women With Opioid Use Disorder and Professionals

Objective: The current qualitative study examines the perspectives of women with opioid use disorder (OUD) and professionals that serve them on barriers to engaging in overdose prevention and harm reduction practices and recommendations for improving engagement. Method: Semistructured interviews (N = 42) were conducted with women with a history of OUD (n = 20), substance use disorder treatment professionals (n = 12), and criminal legal professionals (n = 10). The interviews were inductively coded to identify themes and subthemes regarding experiences with overdose and harm reduction practices. Results: Themes included heightened vulnerability to overdose, harm reduction challenges faced by women with OUD, and recommendations for overdose prevention and harm reduction practices. Heightened vulnerability to overdose included concerns about toxic supply and concerns about women’s drug use behaviors. Challenges to women’s harm reduction engagement included lack of knowledge and education about harm reduction tools and strategies and continued stigma toward harm reduction practices. Finally, recommendations for improving harm reduction engagement included increasing accessibility of harm reduction tools, expanding harm reduction education, and shifting away from “abstinence-only” paradigms. Conclusions: Finding ways to teach women with OUD about harm reduction, more effectively distribute harm reduction tools to them, and reduce stigma among providers and professionals is essential to reduce overdose risk for women with OUD.