Building trust with people using illicit drugs: An interview study of street-based harm reduction services in Finland

Background: The use of illicit drugs and the resulting harm have increased in Finland; for example, the number of drug-related deaths among young people has risen. Despite the existing harms and the possible need for help, not all individuals who use drugs seek physical social and health services. Previous research has indicated, for instance, that individuals who use illicit drugs may not always trust authorities or other people. This may be because they have had trust-breaking experiences, such as stigmatizing encounters with services, or may fear the disclosure of their drug use to authorities. Researchers argue that to reduce the social and health-related harms associated with drug use more effectively, there is a recognized need for new approaches to reach and encounter people who use illicit drugs. One such approach is the development of street-based outreach services.

Methods: Based on previous studies, we assume that trust (or the lack thereof) is important in reaching people who use drugs outside the service system and reducing the harms associated with drug use. In this discursive analysis, we explore the meanings attributed to trust, how trust is built, and the factors that promote it in street-based outreach work with people who use illicit drugs. The concept of trust generally refers to expectations of reliability, predictability, and fairness in interpersonal encounters.we understand trust as being consciously constructed (or dismantled) and negotiated in interactions among people and with society. We interpret trust from a constructionist perspective: as a changing, situationally defined process that interaction participants can influence. The interview data were collected in Finland between 2021 and 2023 as part of a postdoctoral research project (“Anonymous Encounters on Illegal Paths: An Ethnographic Study of the Dark Web and Street-Based Harm Reduction Services for People Using Drugs”, Kone Foundation). The data include 26 interviewees (18 interviews) from four street-based harm reduction services. Three of the services engage in social and health counselling, and the other conducts homelessness work.

Results and conclusions: Our research demonstrates that in street-based outreach work, trust plays a significant role. It is built towards not only the outreach workers but also the entire social and health service system. Trust is built through concrete work practices. Such practices include protecting clients’ privacy through pseudonymous encounters and reaching potential clients in their living environments or meeting them at locations that accord with their situational preferences. Trust is also reinforced through nonverbal and verbal interactions. Clients are approached without moralizing; they are shown empathy, their autonomy is respected, and they are given freedom of choice. Trust-building practices should be given special attention across the service system to better reduce the risks related to of drug use.