Perceived healthcare stigma among patients in opioid substitution treatment: a qualitative study

Abstract

Background People with substance use disorders (SUD) including patients in opioid substitution treatment (OST) are subject to stigma, and have generally poor health and barriers towards seeking healthcare. Experience of stigma might negatively affect healthcare seeking, but this topic is sparsely investigated. The aim of this study was to explore OST patients’ past and present experiences of substance use stigma in healthcare settings, in order to provide insight into the challenges that people with opioid use disorder may face when using health services, and the strategies they use to cope with them. Methods Six focus groups with 23 OST patients were moderated by OST staff, and conducted with a questioning route focusing on health literacy. Experiences associated with stigma and its consequences that were spontaneously brought up by participants were assessed in a secondary analysis using a thematic approach. Results Experiences of stigma from a wide range of healthcare settings were reported. Medical records and patients’ oral information regarding substance use, OST medication or hepatitis C infection were identified as circumstances bringing unwanted attention to the SUD. Participants reported various forms of poor treatment, believed to reflect views of people with SUD as morally culpable, intimidating, curious, untrustworthy and less valuable than other patients, sometimes with tangible effects on the quality of healthcare. Stigma in healthcare settings affected healthcare seeking behaviors, and could result in patients concealing their OST status or substance use history. Conclusion This study highlights several aspects of perceived healthcare stigma that can shed light on difficulties that OST patients might experience when navigating the healthcare system. The results implicate a need to investigate attitudes towards OST patients, and the aptitude to deal with patients with SUD, among healthcare professionals, as well as a need for interventions addressing knowledge deficits and issues tied to values and patient reception among healthcare staff.

Healthcare utilization for somatic conditions among Swedish patients in opioid substitution treatment, with and without on-site primary healthcare

“…It is thus possible that the individuals in this study utilize the NEP, or already established contact at the Infectious diseases clinic, rather than a PHC. This hypothesis is supported by previous qualitative findings from Malmö, Sweden, where OST patients expressed reluctance towards healthcare contacts other than OST and NEP due to fear of stigmatizing treatment [46].…”

“…In the general Swedish population, elderly people aged 80 and older account for almost 20% of ED visits [45], which is in contrast to our study sample where the median age was only 43 years and no one was over 65 years old. Reasons for ED rather than other healthcare utilization from the scientific literature have been suggested to be, e.g., trust issues and fear of stigma [46], psychosocial difficulties and psychiatric comorbidities including periods of active drug use [47]. Specialized secondary care utilization was more prevalent than PHC utilization, which is surprising due to the structure of the Swedish healthcare system, where PHC is the first instance of care.…”

Exploratory Factor Analysis of a French Adapted Version of the Substance Abuse Attitude Survey among Medical Students in Belgium

“…These attitudes are influenced by social and institutional stigmas that lead to suboptimal care including less engagement and empathy by health professionals [ 27 ]. By perceiving these stigmas, and by a phenomenon of self-stigma, SUD people may seek less help and be less involved in treatment, which can lead them to exclude themselves from the healthcare system [ 28 , 29 ].…”

Responding to Ontario’s Overdose Crisis in the Context of the COVID-19 Pandemic

“…This speaks to the urgent need within the Canadian healthcare system to better integrate comprehensive care for people who use substances, including coordination of OAT, harm-reduction approaches and mental healthcare in hospital settings, while also improving transitions in care for outpatient and community-based health and social follow-ups (Kaczorowski et al 2020). Furthermore, people who use drugs report widespread experiences of stigma and discrimination within the healthcare system (Biancarelli et al 2019;Garpenhag and Dahlman 2021;Muncan et al 2020). Urgent action is necessary to address this in healthcare settings, including improved training for healthcare providers in substance use and in the provision of non-stigmatizing and trauma-informed medical care.…”