How do relational practices co-constitute care for people who use drugs? The social and political dimensions of peer-led harm reduction

Introduction: People who use drugs have a long history of mobilising to reduce harm within their communities, significantly influencing harm reduction efforts globally. Peers with lived experience contribute through needle exchange programs, harm reduction education, and community-based research. Despite facing stigma, their initiatives have generated multiple benefits for communities. Collaborations between peers and researchers are increasingly recognised, emphasising meaningful participation in decisions affecting their lives. This paper focuses on the role of peers in mitigating drug-related risks and harms through community care. Methods: Semi-structured interviews were conducted with 30 people who use drugs, exploring peer support and harm reduction. Data were analysed by the lead author and a coding framework was developed in which key theme-categories were organised. Theoretical framing from science and technology studies informed analysis, recognising the political dimensions of research. Results: Peers play a crucial role in bridging gaps in formal services, offering stigma-free, relational care spaces. These spaces, both physical and social, affirm dignity and solidarity, countering marginalisation. Participants highlight the importance of peer involvement in driving change, promoting safer use practices, and advocating for a holistic harm reduction approach that considers systemic factors. Conclusions: Our data highlight the vital role of peer connections and peer-led harm reduction practices in fostering safety, solidarity, and connection among communities of people who use drugs. Future research should continue to explore peer-led initiatives within evolving healthcare contexts, considering broader social dynamics and employing innovative conceptual frameworks to promote equitable peer-led harm reduction strategies.