ObjectiveAlthough an increasing number of emergency departments (ED) offer opioid agonist treatment (OAT), naloxone, and other harm reduction measures, little is known about patient perspectives on harm reduction practices delivered in the ED. The objective of this study was to identify patient-focused barriers and facilitators to harm reduction strategies in the ED. MethodsWe conducted semi-structured interviews with a convenience sample of individuals in Massachusetts diagnosed with opioid use disorder (OUD). We developed an interview guide and interviews were recorded, transcribed, and analyzed in an iterative process using reflexive thematic analysis. After initial interviews and coding, we triangulated the results among a focus group of four individuals with lived experience. ResultsWe interviewed 25 participants with opioid use disorder, 6 recruited from one ED and 19 recruited from OAT clinics. Key themes included accessibility of harm reduction supplies, lack of self-care resulting from withdrawal and hopelessness, the impact of stigma on the likelihood of using harm reduction practices, habit and knowledge, as well as the need for user-centered harm reduction interventions. ConclusionIn this study, people with lived experience discussed the characteristics and need for user-centered harm reduction strategies in the ED that centered on reducing stigma, treatment of withdrawal, and availability of harm reduction materials.