From Comprehensive Distrust to Unquestioned Trust in Street-based Outreach Work With People Who Use Drugs in Finland

People who use drugs may experience comprehensive distrust in other people due to drug-related stigma and other violating experiences in services and in their life course. This may prevent them from seeking help. The goal of strengthening trust in services has been supported in street-based outreach work that aims to reach people who use drugs outside services. This discursive study analyses outreach work service user and worker interviews conducted in Finland from 2021 to 2023, asking: How do people who use drugs reflect on the meanings of trust and the risks associated with it in the interviews? What kinds of features and qualities do they associate with trustworthy outreach work encounters? How do outreach workers reflect the promotion of a trustworthy atmosphere in those encounters in the interviews? The service users constructed comprehensive distrust of several parties in their personal relationships, service systems, and society. Despite these trust-related risks they face, they constructed outreach work as trusted without question and built strong partnerships with the workers. According to service users, they were able to be honest and vulnerable with outreach workers without fear of being punished; their needs were taken seriously, and they were supported comprehensively. Workers’ reflections included verbal, bodily, practical, and choice-making strategies through which they situationally promoted trustworthy atmospheres in individual encounters. The service users’ accounts of what kind of features or qualities they considered trustworthy were in line with the workers’ strategies in building a trustworthy atmosphere in practice. To conclude, outreach work is a crucial link between the service system and people who use drugs experiencing comprehensive distrust, with the ability to build needed chains of trust between them and services. Outreach workers’ trustworthiness strategies should be widely applied in services to reach people outside service systems and to comprehensively reduce drug-related harm.