"People who do this work care deeply… and that makes it harder": A qualitative study of harm reduction workers' occupational stressors, stress reactions, and coping responses.

BACKGROUND: Harm reduction workers are on the frontlines of the U.S. opioid crisis, providing life-saving non-clinical services to highly marginalized people who use drugs. Despite mounting evidence of occupational stress and burnout among helping professionals, community-based workers, such as harm reduction workers, are largely excluded from such conversations, further perpetuating inequities within the substance use and behavioral health workforce.

METHODS: In-depth virtual interviews were conducted with N=32 harm reduction workers to understand their perceptions, experiences, consequences, and responses to occupational stressors. Applied thematic analysis was used to identify and examine descriptive themes related to the a priori research questions.

RESULTS: Data revealed four interrelated categories of stressors related to the role of harm reduction workers: burdensome workloads, health and safety hazards, emotional labor, and relational boundaries. Data also revealed stressors related to the multi-level context within which participants work. Specifically, participants described the inherent tension and resultant burden of doing harm reduction within the broader non-profit industrial complex in that competition for scarce resources contributes to understaffed organizations, inadequate pay, and job insecurity. Participants described stressors adversely affected every aspect of their well-being and often left them feeling burned out, and, for some in recovery, a return to substance use (relapse).

DISCUSSION: Study findings add to existing literature by distinguishing occupational stressors that are unique to harm reduction workers, and underscore the need for research focused on developing and testing multi-level interventions that identify and address occupational stress and burnout among this critical workforce.