Study identifies strategies for expanding low-barrier wound care services for people who use drugs

A new study published in the Harm Reduction Journal identifies critical factors and strategies for expanding low-barrier wound care services for people who use drugs (PWUD). The research comes at a crucial time, as the rise of xylazine, a tranquilizer found in the street opioid supply, has led to a significant increase in severe necrotic wounds among this population.

The study, titled "Scaling up low barrier wound care for people who use drugs: a mixed methods study," was conducted in Philadelphia and surrounding regions from April to September 2024. Researchers interviewed wound care providers, administrators, and recovery specialists to understand the challenges and solutions in delivering care that is often lifesaving for PWUD, who frequently face discrimination in traditional hospital settings.

People who use drugs deserve high-quality, compassionate care without judgment. This study provides a roadmap for health systems and communities to better meet the urgent wound care needs of this vulnerable population by embracing harm reduction principles and fostering trust."

Eleanor Turi, PhD, RN, CCRN, lead author, post-doctoral research fellow in Penn Nursing's Center for Health Outcomes and Policy Research

The study identified several significant barriers to scaling up low barrier wound care:

• Funding Gaps: A major challenge is the lack of dedicated, sustainable funding and clear billing mechanisms for these specialized services.
• Workforce Training: There's a critical need for healthcare professionals specifically trained in both harm reduction and wound care.
• Limited Infrastructure: Many organizations lack the physical space, staffing, and administrative capacity to offer comprehensive low-barrier services.
• Poor Communication: A lack of formal referral systems and communication between low barrier providers and acute care services makes it difficult to connect patients with the services they need.
• Stigma and Discrimination: PWUD often experience bias from healthcare staff, leading to distrust and reluctance to seek care.

The research also highlighted promising strategies to overcome these barriers:

• Secure Sustainable Funding: Explore diverse funding models, including grants, government support, and innovative billing solutions.
• Develop a Specialized Workforce: Create training programs focused on harm reduction, advanced wound care techniques, and strategies to reduce stigma.
• Build Organizational Capacity: Invest in dedicated clinical spaces, flexible staffing models, and robust administrative support to deliver services effectively.
• Establish Formal Referral Networks: Create clear pathways and strong communication channels between hospitals and low-barrier clinics.
• Meet Social Needs of Patients: Offer social services such as food, housing support, and criminal justice navigation services within low barrier sites to attract patients to care and meet their highest priority needs.
• Integrate Harm Reduction Principles: Ensure care is patient-centered, non-judgmental, and flexible, prioritizing the patient's immediate needs and dignity.
• Combat Stigma: Implement education, policy changes, and environmental shifts to create a more supportive and less discriminatory healthcare experience for PWUD.

The study underscores the urgent need for a more accessible and empathetic approach to wound care for PWUD, proposing practical steps to ensure this critical service can reach those who need it most. Co-authors include Shoshana V. Aronowitz, PhD, MSHP, FNP-BC (Penn Nursing), Amanda Bettencourt, PhD, APRN, CCRN-K, ACCNS-P (Penn Nursing), Allison Li, (Penn School of Arts & Sciences), Jessica Lin, (Penn School of Arts & Sciences), Rachel McFadden, MPH, BSN, RN, CEN, (Penn Center for Addiction Medicine & Policy, Prevention Point Philadelphia) David Mandell, ScD, (Penn Medicine), and Courtney Benjamin Wolk, PhD, (Penn Medicine). The Leonard Davis Institute of Health Economics Small Pilot Awards provided funding for this story. In addition, The National Institute of Mental Health funded Dr. Turi (T32MH109433) as did the National Clinician Scholars Program. The National Institute of Drug Abuse also provided funding to Dr. Aronowitz (K23DA057528).