Missouri Safe Project

An innovative recovery community organization model that provides the community with both recovery support services and harm reduction services

The Missouri Safe Project (MOSAFE) is a harm reduction program that works to address the opioid crisis and reduce the spread of infectious diseases, such as HIV and Hepatitis C, among Missourians who inject drugs. 

The project grew out of the Missouri Network for Opioid Reform and Recovery, a non-profit, peer-based recovery community organization (RCO) created in 2015 and led by members of the recovery community, a hybrid model providing both harm reduction services and recovery support services.  In 2018, the Missouri Safe Project received funding from the Elton John Aids Foundation for a syringe service program; its goal is to provide services to more than 800 at-risk individuals over the next two years.  

The Missouri Safe Project’s syringe service program aims to reduce the use of unclean, unsafe needles by intravenous drug users and to link users with substance use, mental health and other health care treatment, as well as needed programs such as housing and food assistance. 

The program also focuses on providing community education to Missourians on substance use disorders, overdose prevention education, and the importance of harm reduction programs such as syringe service programs.  

This model can leverage the peer support workforce used in the recovery continuum to also provide harm reduction services to people who use drugs.

Continuum of Care
Harm Reduction
Type of Evidence
Response Approach
Comprehensive services
Overdose prevention
Syringe service program / Needle exchange
Peer-reviewed Article

Evidence of Program Effectiveness

The Missouri Safe Project provides preliminary evidence that providing harm reduction services under the umbrella of a recovery community organization (RCO) may be an innovative way to engage a high-risk population. The RCO can leverage the peer support workforce used in the recovery continuum to also provide harm reduction services to people who use drugs. In addition to reducing the risk of infection, engaging a vulnerable population, targeted naloxone distribution to a high-risk population, and providing valuable resources, a relationship between the peers and the people who use drugs after multiple engagements may lead to linkage to treatment and other motivations to make a positive change. Several subpopulations were identified as less likely to have multiple engagements with the RCO (those involved with the criminal justice system, unstable housing, and minorities) suggesting that addressing social determinants of health, outreach, and cultural competency may improve the effectiveness of this hybrid type of RCO (Ashford, Curtis, and Brown, 2018).