Factors Shaping Medical Student Attitudes Toward Harm Reduction.

Introduction: Physicians' biased attitudes toward people who use drugs (PWUD) can impact the care they deliver. Despite recommendations from national organizations, treatment of substance use disorders and harm reduction are often absent from medical school curricula. This absence may influence how medical students, as future physicians, perceive PWUD and therefore, impact the care they provide. Our study aimed to assess medical students' attitudes and, to a lesser extent, knowledge and self-confidence regarding substance use and harm reduction by identifying factors associated with positive beliefs about PWUD and students' self-confidence in managing their care. Methods: We emailed an optional, anonymous Qualtrics survey of multiple-choice and Likert-type questions to all students at Florida International University's Herbert Wertheim College of Medicine (FIU HWCOM). The survey included demographics, prior exposure to PWUD, attitudes regarding drug acceptability, and substance use treatment. Results: Of 496 medical students who received the survey, 172 (34.7%) responded to all questions. The primary outcome was attitudes, while secondary outcomes were knowledge and self-confidence. Clinical students reported significantly more positive attitudes toward PWUD compared with preclinical students. Similarly, students with personal or professional experience with PWUD had more positive attitudes and reported increased knowledge about substance use and treatment. Conclusion: Our findings show that exposure to PWUD may positively impact medical students' attitudes and knowledge in caring for patients with substance use disorders. However, gaps in knowledge and self-confidence persist, particularly in preclinical years. Introducing harm reduction and substance use topics earlier in the curriculum may address knowledge gaps, shift attitudes, and ultimately equip students to provide equitable care.