Written by Kate Roberts, MA, MSW, LCSW
In my work to support the inpatient IV drug use service, I see firsthand the importance of addressing stigma and implicit bias related to injection drug use (IVDU). As an inpatient IV drug use service, we seek to engage those hospitalized with infections, usually endocarditis, and osteomyelitis, related to their substance use. These infections can be life-threatening, requiring lengthy antibiotic treatments, and in severe cases, surgery. The scientific literature states that stigma remains a primary hindrance to persons with IV drug use from engaging in treatment (Muncan et al., 2020; Tsai et al., 2019). My personal experience validates that finding.
When I first meet patients, I can sense their hesitation in talking with me. Most, if not all, of the patients I work with, have had some experience with a social worker or medical provider in which they felt judged for their substance use. This stigma often prevents these persons from seeking help for treatable medical conditions, increasing their risk of death related to their substance use. I remember talking with a patient who processed with me her anxiety about being in the hospital. “I don’t want to just be another junkie showing up,” she told me. “I don’t want people to just think I’m a burden.”
Those words continue to stick with me every day when I call a patient or walk into their room. While through our service, hospitalized patients receive comprehensive medical treatment (medication management from an addiction specialist, peer support services, harm reduction resources, information about social services in their home county, and connection to outpatient addiction treatment), I know the most critical service we offer is a judgment-free interaction with a caring provider. To experience stigma from a medical provider can be a form of trauma (Tsai et al., 2019). And this trauma can make it difficult for patients to voluntarily seek treatment. Offering stigma-free care not only means providing patients with quality treatment; it also means understanding the trauma of previous medical encounters and working to build the trust of the patient.
About a month ago, during the daily hustle of patient care, I looked down at my phone to see a text from a patient with whom I worked closely during their hospital stay. “I’m finally going home,” they wrote, “Tell your team I stayed because of them.” This, for me, is why I show up to work.
Resources about undoing stigma related to substance use disorders:
https://www.youtube.com/watch?v=eZ0CafocLsY
Muncan, B., Walters, S. M., Ezell, J., & Ompad, D. C. (2020). “They look at us like junkies”: Influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City. Harm Reduction Journal, 17(1), 53. https://doi.org/10.1186/s12954-020-00399-8
Tsai, A. C., Kiang, M. V., Barnett, M. L., Beletsky, L., Keyes, K. M., McGinty, E. E., Smith, L. R., Strathdee, S. A., Wakeman, S. E., & Venkataramani, A. S. (2019). Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Medicine, 16(11). https://doi.org/10.1371/journal.pmed.1002969