Understanding healthcare engagement for people who inject drugs

Abstract

People who inject drugs (PWID) are at an increased risk of multimorbid mental health and chronic diseases, which are frequently underdiagnosed and under‐treated due to systemic barriers and ongoing substance use. Healthcare engagement is essential to address these conditions and prevent excess morbidity and mortality. The goal of this study was to understand how PWID engage in care for their chronic health conditions and substance use treatment given the known historic and pervasive barriers. We conducted 24 semistructured qualitative interviews informed by the Behavioral Model for Vulnerable Populations between July–September 2019. Participants were sampled across a range of comorbidities, including co‐occurring mental health disorders. Thematic analysis was conducted to explore experiences of healthcare engagement for multimorbid chronic diseases, mental health, and treatment for substance use disorder. Mean age for participants was 58 years; 63% reported male sex and 83% reported Black race. Interviews yielded themes regarding healthcare access and wraparound services, positive patient–provider relationships, service integration for substance use treatment and mental health, healthcare needs alignment, medication of opioid use disorder stigma, and acceptance of healthcare. Taken together, participants described how these themes enabled healthcare engagement. Engagement in care is crucial to support health and recovery. Clinical implications include the importance of strengthening patient–provider relationships, encouraging integration of medical and mental health services, and counseling on substance use treatment options in a non‐ stigmatizing manner. Additionally, policy to reimburse wrap‐around support for substance use recovery can improve care engagement and outcomes related to chronic diseases, mental health, and substance use among PWID.No Patient or Public Contribution: While we acknowledge and thank ALIVE participants for their time for data collection and sharing their perspectives, no ALIVE participants, other people who use drugs, and service users were involved in data collection, analysis or interpretation of data, or in preparation of the manuscript.

Sociocultural and contextual influences on mental health

“…, tobacco and alcohol co-use among college graduates in Spain(Neddermann- Carrillo et al, 2024), and people who inject drugs (PWID) in the United States(Heidari et al, 2023). Taken together, these studies highlight unique challenges and opportunities for addressing sub-stance abuse across the lifespan and through a multitude of community-based and healthcare responses.…”

“…Findings from SUN highlight important demographic, behavioral factors, and personality factors that canbe used to identify sub-populations at the highest risk for alcohol and tobacco co-use (e.g., more frequent coffee drinkers) and protective characteristics that can be leveraged (e.g., promoting physical activity). Findings from interviews with 24 PWIDs further highlight the importance of healthcare responses to include wrap-around services that build on strong patient-provider relationships and integrate substance abuse, mental health, physical health, social needs, and harm reduction approaches(Heidari et al, 2023).The body of research included in this special issue on mental health highlights the complex web of factors that influence risk and experiences for diverse and underserved populations across the globe and provides exemplars of effective strategies to address this significant global public health crisis. Findings highlight the important role that early life exposures, such as ACEs, and structural and social determinants, such as gender inequality, poverty, war, violence, and stress, have on mental health.…”