This tool has been created for nurses and other clinicians to use while caring for people with substance use-associated wounds in community-based settings. In addition to aiding supporting decision making about wound care, this tool can be used to learn about harm reduction-oriented care for substance-use related wounds.

This includes first-person accounts from wound care providers and people with lived experience about harm reduction-oriented wound care, as well as links to wound care trainings.

 

Harm Reduction Wound Care Series Videos

 

Empowerment and Self Care (3:02)

Wound care is not only a physical healing process but also an important part of emotional and psychological recovery. Taking active ownership of wound care can help patients rebuild self-esteem and regain a sense of control over their health journey. Accepting that some aspects of healing are beyond personal control allows individuals to focus on the effort they can make, fostering growth and wholeness.

 

The Impact of High-Quality Care

High-quality wound care isn’t just about managing pain or infection—it’s about treating the whole person with dignity. Compassionate clinicians can shift a patient’s experience from one of fear or shame to one of safety and reassurance. When providers approach care with gentleness and without judgment, it helps patients feel less defined by their condition and more seen as human beings navigating a difficult recovery.

 

Person-Centered Care

Person-centered care means emphasizing that the person seeking help is worthy of that time and attention. "We hope that someone will leave, not only maybe with supplies for wound care and a sense of how to use them safely and effectively, but also a sense that they can feel cared for and that they can enact care for themself in this way." — Rachel Neuschatz, Harm Reduction Wound Care Nurse

 

The Challenges of the Drug Supply and Unstable Housing

The evolving drug supply is creating new and more severe challenges for patients and clinicians alike. Substances like Xylazine and Medetomidine are contributing to more complex and destructive wounds than previously seen, along with significant side effects such as malnutrition and dental decay. These complications often persist even after a person stops using.

 

Making Wound Care Accessible

Many patients navigating wound care while experiencing unstable housing face overwhelming barriers — not because they lack motivation, but because the system often assumes they do. Clinicians who meet patients where they are — without assumptions about their housing status or substance use — can make a meaningful difference. 

 

Healing

Consistency and keeping up with wound care is a key element of the healing process. "I think I knew my wounds could heal, but I didn't believe that it would actually happen." — Tiffany Bogart, Wound Care Navigator

 

How Nurses Cultivate Supportive Care Environments

When clinicians take time to validate patients’ experiences, involve them in decisions about their care, and offer practical supports like hygiene supplies or nutritious food, they create conditions for both immediate healing and longer-term engagement. 

 

Establishing Trust in Harm Reduction-Oriented Care

Building trust in clinical care is a gradual process, especially for patients who have experienced homelessness, stigma, or prior medical trauma. Clinicians emphasize the importance of allowing patients to lead. Rather than pushing a treatment plan, they focus on listening, respecting patient autonomy, and following through on what they say they will do. Over time, consistent, honest, and nonjudgmental care helps foster trust and opens the door to deeper clinical engagement.

 

Transitions of Care

Transitioning care can involve communication and coordination with other providers. Or, "It may be as simple as things like transportation, helping with some of the nuts and bolts of getting to and from somewhere," says Rachel Neuschatz, a Harm Reduction Wound Care Nurse.

Consentability For People on Tranq Dope

If someone is too drowsy or sedated to respond in the affirmative to a potential care provider, it can be challenging to navigate a direct path to consent. That can require a provider to wait, if feasible, to have a back-and-forth conversation when the person is more responsive later, for example.

 

Challenging Assumptions About Patient Engagement

Too often, the assumptions we make about patients get in the way of their care — especially when it comes to people who use substances or are unhoused.