{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T18:19:45Z","timestamp":1783621185692,"version":"3.55.0"},"reference-count":14,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use &amp; Addiction Journal"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Undergraduate medical education is increasingly incorporating harm reduction (HR). Assessments of HR curricula have focused on skills like overdose reversal. The literature lacks evaluations of curricula that more broadly teach HR-based physician-patient communication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>From academic years 2022 to 2024, a Harvard Medical School student working group collaborated with faculty to take a quality improvement approach to incorporating HR into the substance use interview curriculum. We implemented two Plan-Do-Study-Act cycles. We measured the effectiveness of HR education in the 2023 Substance Use interview session by surveying students on a 5-point Likert scale (ranging from 1\u2009=\u2009strongly disagree to 5\u2009=\u2009strongly agree). We also conducted a focus group with four students to provide qualitative insights into the curriculum\u2019s impact and areas for improvement. We thematically analyzed the focus group session based on Borkan\u2019s Immersion\/Crystallization methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirty-three students completed the pre-survey and post-survey (19.4% response rate). In the survey, self-reported HR understanding improved, from mean 3.6 on the Likert scale to 4.2 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Students strongly agreed with being interested in harm reduction before and after the session (mean pre-survey score: 4.3). In the focus group, students identified patient stories as helpful for improving understanding of HR communication. They expressed difficulty understanding the relationship between HR and abstinence-based approaches like Alcoholics Anonymous and recommended more diverse patient perspectives during the session and more HR exposure throughout medical school.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A half-day session on the substance use interview showed promise for teaching HR communication principles. For future HR communication curricula, our results favor retaining an emphasis on patient narratives and ensuring representation of diverse patients. Future research can assess whether harm reduction education translates into improved patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342261452657","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T09:48:06Z","timestamp":1783417686000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quality Improvement Initiative to Prepare Medical Students With Harm Reduction Principles for Substance Use Care"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1049-553X","authenticated-orcid":false,"given":"Natalie","family":"Swartz","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Lowder","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9946-0403","authenticated-orcid":false,"given":"Sabina","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irving","family":"Barrera","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahin","family":"Saberi","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Oles","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly","family":"Woo","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Krieger","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Atrius Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary Smith","family":"Connery","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"McLean Hospital, Belmont, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"e_1_3_3_2_2","volume-title":"Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction","author":"Szalavitz M","year":"2022","unstructured":"Szalavitz M. Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction. First paperback edition. Hachette Go; 2022."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2019.1621241"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40596-023-01768-8"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/29767342251313595"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-023-04931-9"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.15766\/mep_2374-8265.11499"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/aet2.10095"},{"key":"e_1_3_3_9_2","doi-asserted-by":"crossref","unstructured":"Black E Howley L Farmakidis A Singh A Weems K Blood A. Addiction Medicine Substance Use and Pain Management in Medical School Curricula. AAMC; 2025. Accessed May 31 2026. https:\/\/www.aamc.org\/media\/83346\/download?attachment","DOI":"10.15766\/datasnapshot_addiction_0425"},{"key":"e_1_3_3_10_2","volume-title":"Alcoholics Anonymous: The Big Book","author":"Anonymous","year":"2002","unstructured":"Anonymous. Alcoholics Anonymous: The Big Book. 4th ed. Alcoholics Anonymous World Services, Inc.; 2002.","edition":"4"},{"key":"e_1_3_3_11_2","unstructured":"The Call. This American Life. Published online August 30 2023. Accessed December 30 2023. https:\/\/www.thisamericanlife.org\/809\/the-call"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2013.02.018"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2022.108752"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201700076"},{"key":"e_1_3_3_15_2","first-page":"179","volume-title":"Doing Qualitative Research","author":"Borkan J","year":"1999","unstructured":"Borkan J. Chapter 10. Immersion\/crystallization. In: Crabtree BF, Miller WL, eds. Doing Qualitative Research. 2nd ed. Sage Publications; 1999:179-194.","edition":"2"}],"container-title":["Substance Use &amp; Addiction Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/29767342261452657","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/29767342261452657","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/29767342261452657","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:47:31Z","timestamp":1783619251000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/29767342261452657"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,7]]},"references-count":14,"alternative-id":["10.1177\/29767342261452657"],"URL":"https:\/\/doi.org\/10.1177\/29767342261452657","relation":{},"ISSN":["2976-7342","2976-7350"],"issn-type":[{"value":"2976-7342","type":"print"},{"value":"2976-7350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,7]]},"article-number":"29767342261452657"}}