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A strengths-based approach engenders client\u00a0affirmation and improves their capacity to reduce drug use-related harms\u00a0by leveraging existing capabilities. Exploring this paradigm, we conducted and analyzed interviews with 46 PWUD who were clients at syringe services programs in New York City and rural southern Illinois, two areas with elevated rates of opioid-related morbidity and mortality, to assess respondents\u2019 perceived strengths. We located two primary thematic modalities in which strengths-based ethos is expressed: individuals (1) being and advocate and resource for harm reduction\u00a0knowledge and\u00a0practices and (2) engaging in acts of continuous self-actualization. These dynamics demonstrate PWUD\u00a0strengths populating and\u00a0manifesting in complex ways that both affirm and challenge humanist and biomedical notions of individual\u00a0agency, as PWUD\u00a0refract enacted, anticipated, and perceived stigmas. In conclusion, programs that blend evidence-based, systems-level interventions on drug use stigma and disenfranchisement with meso and micro-level strengths-based interventions that affirm\u00a0and leverage personal identity, decision-making capacity, and endemic knowledge may help disrupt health promotion cleavages among PWUD.<\/jats:p>","DOI":"10.1186\/s12954-024-00981-4","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T10:02:04Z","timestamp":1712570524000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["How do people who use opioids express their qualities and capacities? 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