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Addressing Stigma

Pitfalls in the Treatment of PWIDs (People Who Inject Drugs)

  • It is not uncommon for clinicians to assume that drug users don’t care about their health; such misperceptions are noticed by patients. Fearing this negativity and condescension, many drug users avoid the emergency department by trying to “doctor” themselves.
  • Some providers automatically under-treat or minimize pain when they suspect drug-seeking behavior, or perform procedures (e.g., abscess drainage) with inadequate anesthesia in order to “teach the patient a lesson.”
  • Health care providers occasionally bring in other colleagues to gawk at patients without their permission.
  • However, these insensitive “Look at the crazy thing this junkie did to herself/himself!” conversations are inappropriate.
  • Nurses and doctors should not contact law enforcement without the patient’s knowledge.
  • Vague or unrealistic aftercare plans are futile.
  • Long speeches and shaming life lectures about drug use can and should be replaced by educational information about risk reduction.
  • Patients often overhear health care providers talking about them negatively outside of the room or behind a curtain. Assuming the patient can’t hear them, clinicians can be heard warning other providers about the “druggie” or “drug seeker.”

Counseling Patients with Substance Abuse/Misuse Disorders     

  • Use neutral language when referring to drug use
  • Assess the patient's readiness to change
  • Respect the patient's decision to be honest with providers about any drug use
  • Make information available that is specific to the needs of the patient

Remember the harm principles:

  • Accept and don’t condemn patients who use drugs.
  • Offer resources without pressure or judgment.
  • Improve quality of life for patients with opioid use disorders.
  • See the individual as a person rather than their addiction.
  • Use negative terminology such as “addict” or “junkie.”
  • Tell the patient they are ruining their life or are going to die.
  • Attempt to pressure the patient to begin substance abuse treatment.
  • Make assumptions about the mental or physical health of patients with opioid use disorders.
  • Let the stigma associated with injection drug use affect how a patient is treated.