People who use drugs (PWUD) experience a disproportionately high burden of acute and chronic wounds. Care is often complicated by delayed presentation, infection risk, comorbidities, and barriers to accessing services¹⁻⁴.

In November 2025, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), the Harm Reduction Nurses Association (HRNA), and the Ontario Network of People Who Use Drugs (ONPUD) published the Canadian Best Practice Recommendations in Wound Care for People Who Use Drugs: A Harm Reduction Approach¹. The document summarizes evidence-informed recommendations for delivering wound care that improves engagement and outcomes for an underserved population.

At Biomiq, we develop evidence-based wound care solutions that support clinicians in delivering safe, effective, and compassionate care. We also aim to share high-quality guidance that can help teams deliver practical, real-world wound care across a range of care settings. This article highlights the most actionable takeaways from the Canadian recommendations for wound clinicians, outreach nurses, and community clinic teams supporting PWUD.

4 Practical Takeaways for Clinical Teams

1. Treat harm reduction as a clinical engagement strategy. When care meets people where they are, teams often see better continuity and earlier presentation.

2. Plan for continuity, not just a one-time visit. Warm handovers, peer support, and simplified follow-up steps can reduce loss to follow-up.

3. Make assessment nonjudgmental and voluntary. Ask about wounds, routes of administration, and related risks without making disclosure a condition of care.

4. Choose topical plans that are feasible for self-care when appropriate. Prioritize accessibility, simplicity, and products or dressings that clients can realistically use and store.

Harm Reduction As a Clinical Framework

The guideline authors emphasize that wound care for PWUD should be delivered within a harm reduction framework¹. Two definitions from the document are especially useful for clinical teams:

For wound teams, the relevance is practical: when care aligns with client-defined goals and reduces avoidable barriers, continuity improves. That continuity is often what enables earlier assessment, earlier infection recognition, and more realistic topical plans.

Addressing Stigma, Structural Barriers, and Bias in Practice

The recommendations describe stigma, criminalization, and historical harms as major contributors to delayed care and poor outcomes because they can create distrust and discourage people from seeking services¹.

For clinical teams, this section has two practical implications:

• Build trust intentionally. Trauma-informed and person-centred approaches can support engagement without imposing abstinence-based conditions.
• Use reflective practice. The document calls out bias awareness and cautions against unnecessary reporting practices that can damage the therapeutic relationship¹.

Health System and Program Design: Bringing Wound Care to Low-Barrier Settings

The guideline authors support integrating wound care into low-barrier environments where trust and continuity may already exist, including syringe service programs, mobile outreach, and supervised consumption sites¹.

Key operational themes include:

• barrier-free access and individualized care plans
• interprofessional teams that address physical, psychosocial, and sociodemographic needs¹
• peer-run and peer-led services, with PWUD included in care planning and governance

Goals of Wound Care: Align With the Client’s Priorities

A recurring theme in the recommendations is that wound care goals should be co-developed with the client and may not align with typical biomedical priorities¹. Practical ways to apply this include:

• confirming the client’s goals for the visit
• agreeing on a realistic plan the client can carry out
• revisiting goals over time, as circumstances change

Continuity in Action: Warm Handovers

The document makes a specific, highly actionable point about why cold referrals break down in real-world care:

Our perspective here is straightforward: warm handovers can reduce preventable gaps in care. For wound management, fewer gaps often means fewer escalations, less recurrence, and more opportunities to intervene early.

Clinical Assessment and Risk Identification

The recommendations encourage teams to ask, without judgment, about substance use patterns and routes of administration while respecting any decision not to share¹. Assessment can be framed as collaborative and safety-oriented rather than gatekeeping.

The document also calls attention to injection-related injuries (including abscesses, ulcers, and cellulitis), atypical wound locations, pain severity, chronicity, and signs of infection¹.

Factors That Can Impair Wound Healing

The recommendations prompt clinicians to assess and address factors that can limit healing, including¹:

• comorbid disease
• mental health
• pain
• medication interactions
• impacts of an increasingly toxic and adulterated drug supply

Education on safer injection practices, avoiding injection into or near wounds, and connecting to drug checking services may support prevention in community settings. In inpatient settings, harm reduction–aligned supports may improve adherence and outcomes.

Education, Prevention, and Community Capacity

The guideline authors emphasize capacity-building across both clinical teams and community settings¹. This includes:

• training for providers and outreach teams
• education for PWUD on when advanced care is needed
• access to wound care supplies
• peer-based support to enable ongoing self-care where appropriate

Topical Wound Management

For topical management, the guideline authors point back to standard wound bed preparation principles:

They also call out feasibility explicitly:

Our takeaway is that “best practice” only works when it is usable. Where self-care is part of the plan, topical choices should be simple, realistic, and aligned to the client’s constraints, not just the ideal protocol.

How to Use This Guidance With Your Team

If your team provides wound care for PWUD in hospitals, clinics, or community settings, consider using the recommendations as a firm prompt for you to:

• review intake and assessment language for stigma and practicality
• map referral pathways and identify where warm handovers are feasible
• confirm what supplies and topical plans are realistic for self-care
• align screening and microbiology practices with local protocols

For a comprehensive overview, including full clinical and program recommendations, we encourage you to read the full guideline found on the Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC®) website at the following link: Canadian Best Practice Recommendations in Wound Care for People Who Use Drugs.

We believe better wound care starts with practical, evidence-informed approaches that clinicians can apply in the real world.

By combining strong clinical fundamentals with care models that prioritize dignity, feasibility, and continuity, teams can reduce preventable complications and support safer healing pathways for people who use drugs.