Health Promotion, Disease Prevention, and Recovery Support
Core knowledge
Harm reduction meets people where they are: naloxone distribution with overdose education, syringe services programs, fentanyl and xylazine test strips, and never-use-alone guidance reduce death and infection without requiring abstinence. Infectious disease prevention includes hepatitis B vaccination, hepatitis C and HIV testing with linkage to curative treatment, PrEP for HIV, and STI screening. In pregnancy, methadone or buprenorphine is the standard of care for opioid use disorder and abrupt discontinuation is contraindicated; breastfeeding is generally encouraged on stable medication treatment. Recovery support includes peer specialists, recovery housing, family involvement, and recovery capital - the resources, relationships, and health that sustain remission. Suicide risk in SUD is elevated, so use structured risk assessment, collaborative safety planning, and lethal-means counseling including firearm storage and reducing the quantity of dispensed medication. Tobacco cessation should be integrated rather than deferred. Routine prevention also includes alcohol screening in primary care, safe medication storage and disposal, and immunization review.
Traps
- Requiring abstinence as a precondition for services.
- Advising a pregnant patient to taper off buprenorphine or methadone.
- Presenting harm reduction as condoning use; evidence shows it increases treatment entry.
- Overlooking polysubstance risk, including fentanyl contamination of stimulant supplies.
Rule of thumb
For every patient at risk, provide naloxone and teach the overdose response using ask-tell-ask. Worked example: a patient who uses only methamphetamine is offered fentanyl test strips and naloxone because contamination is common. This is overdose prevention, not enabling, and it builds trust for later treatment conversations.