Decreasing Stigma Toward People Who Inject Drugs: Harm Reduction Training for First-Year Medical Students

Tucker Avra; Amanda Cowan; Joseph Friedman; Jack Fukushima; Andrew Nelson; Kyla Truman; Autumn Stevens; Philippe Bourgois; Helena Hansen; Chelsea Shover; David Goodman-Meza

doi:10.1097/ACM.0000000000005675

Decreasing Stigma Toward People Who Inject Drugs: Harm Reduction Training for First-Year Medical Students

Acad Med. 2024 Feb 27. doi: 10.1097/ACM.0000000000005675. Online ahead of print.

Authors

Affiliations

¹ T. Avra is a medical student, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
² A. Cowan is executive director, Los Angeles Community Health Project, Los Angeles, California.
³ J. Friedman is an MD/PhD student, Center for Social Medicine and Humanities, University of California, Los Angeles, Los Angeles, California.
⁴ J. Fukushima is a medical student, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
⁵ A. Nelson is a medical student, School of Osteopathic Medicine, A.T. Still University, Mesa, Arizona.
⁶ K. Truman is a medical student, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
⁷ A. Stevens is a graduate student, Antioch University Los Angeles, Los Angeles, California.
⁸ P. Bourgois is professor of anthropology and director, Center for Social Medicine and Humanities, Department of Psychiatry, University of California, Los Angeles, Los Angeles, California.
⁹ H. Hansen is interim chair, Department of Psychiatry and Biobehavioral Sciences, and interim director, UCLA Semel Institute for Neuroscience and Human Behavior, professor of psychiatry and biobehavioral sciences and co-chair of research theme in translational social science and health equity, David Geffen School of Medicine, University of California, Los Angeles, and interim physician-in-chief, Resnick Neuropsychiatric Hospital, Los Angeles, California.
¹⁰ C. Shover is assistant professor-in-residence, Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
¹¹ D. Goodman-Meza is assistant professor, UCLA Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.

PMID: 38412474
DOI: 10.1097/ACM.0000000000005675

Abstract

Problem: Stigma in health care toward people who inject drugs (PWID) is a well described, significant barrier to quality care, resulting in poor health outcomes. Harm reduction offers a person-centered counter-framework for minimizing harm for people who use drugs. Despite the evidence in support of harm reduction, medical students typically receive minimal training on harm reduction and the care of PWID.

Approach: To fill this gap, medical students at University of California, Los Angeles organized around the principles of harm reduction to improve the medical school curriculum related to PWID. Students screened lectures for stigmatizing language and collaborated with faculty to improve lecture materials. They partnered with a community organizer and hosted a mandatory 1-hour lecture and 30-minute discussion introducing the principles of harm reduction within an overdose prevention, recognition, and response training for first-year medical students during medical school orientation in August 2022. An anonymous online pre- and posttest survey, assessing student attitudes toward PWID, was used to evaluate the effects of the training.

Outcomes: A total of 156 students completed the pretest survey, and 107 students completed the pre- and posttest survey (68.5% response rate). The overall posttest mean stigma score was 1.8 (standard deviation [SD] = 0.5) and was significantly lower than the pretest mean of 2.1 (SD = 0.7; P < .0001), indicating a reduction in stigma among medical student attitudes after the course. There was statistically significant improvement in attitudes for 7 of 13 component measures.

Next steps: This analysis demonstrated that the mandatory class has the capacity to improve medical student attitudes toward PWID. The authors plan to further evaluate the program's effectiveness through measuring and reporting outcomes for future student cohorts. The authors are working with curriculum directors to further incorporate harm reduction principles into other lectures and problem-based learning exercises.