Importance: Harm reduction is associated with improved health outcomes among people who use substances. As overdose deaths persist, hospitals are recognizing the need for harm reduction services; however, little is known about the outcomes of hospital-based harm reduction for patients and staff.

Question: What are the perspectives of patients and staff on the impacts and challenges of hospital-based harm reduction services?

Findings: In this qualitative study that included semistructured interviews with 20 hospitalized patients receiving harm reduction services and 20 staff serving such patients, major themes included expanded access to harm reduction services for structurally marginalized patients, improved trust between patients and staff, and decreased staff stigma toward patients who use substances. Challenges included staff hesitancy regarding regulations and limited prior substance use education among staff.

Meaning: These findings suggest that, amidst a continuing overdose crisis, providing hospital-based harm reduction services may expand access to critical interventions and positively improve hospital care.