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