Strategies used by people who inject drugs to avoid stigma in healthcare settings

“Stigma, defined by Goffman as a “deeply discrediting attribute,” is well researched among the larger population of people who use illicit drugs (Goffman, 1963; Kulesza et al., 2013).”

“Internalized stigma carries harmful effects on health and wellbeing (Ahern et al., 2007; Cama et al., 2016; Hatzenbuehler et al., 2013; Kamaradova et al., 2016; Luoma et al., 2007; Rivera et al., 2014; Skeer et al., 2018; von Hippel et al., 2018).”

“We reviewed transcripts for quality and to identify emergent themes (DeCuir-Gunby et al., 2011).”

“, “external reactions to stigma”) as they emerged (Earnshaw and Chaudoir, 2009).”

“Although little research has focused on building resilience among PWID, some group therapy interventions have demonstrated modest efficacy in building resilience among people living with mental illness and HIV (Corrigan et al., 2009; Mittal et al., 2012; Rao et al., 2018).”

“interventions could help increase cultural competency and decrease stigma towards PWID at multiple levels within health organizations, such models require further research and evaluation (Brener et al., 2017; Livingston et al., 2012).”

“Internalized stigma carries harmful effects on health and wellbeing (Ahern et al., 2007; Cama et al., 2016; Hatzenbuehler et al., 2013; Kamaradova et al., 2016; Luoma et al., 2007; Rivera et al., 2014; Skeer et al., 2018; von Hippel et al., 2018).”

“Injection drug use increases the risk of serious health harms, including fatal and non-fatal overdose, and blood-borne and skin and soft tissue infections (Akselrod et al., 2014; CDC, 2018; Haber et al., 2009; Liebling et al., 2018; Mathers et al., 2010).”

“Internalized stigma carries harmful effects on health and wellbeing (Ahern et al., 2007; Cama et al., 2016; Hatzenbuehler et al., 2013; Kamaradova et al., 2016; Luoma et al., 2007; Rivera et al., 2014; Skeer et al., 2018; von Hippel et al., 2018).”

“Two studies have documented stigma experienced by methadone patients in New Haven, CT, and PWID in California’s Central Valley (Earnshaw et al., 2013; Paquette et al., 2018).”

“At minimum, cultural competency training, whether online or in-person, should address the importance of using accurate, person-first terminology when referring to PWID, as terms such as “addict” and “substance abuser” promote judgmental perceptions among healthcare providers (Kelly and Westerhoff, 2010; Goddu et al.,…”

“Although little research has focused on building resilience among PWID, some group therapy interventions have demonstrated modest efficacy in building resilience among people living with mental illness and HIV (Corrigan et al., 2009; Mittal et al., 2012; Rao et al., 2018).”

“Unfortunately, the majority of practicing providers and medical students in the United States believe that they lack adequate training in assessing and treating people with addiction (Bäck et al., 2018; Miller et al., 2001).”

“…but until stigma in mainstream healthcare systems can be addressed, innovative strategies for improving PWID access to health services in more familiar, trusted venues warrant further exploration and support (Auschra, 2018; Bruggmann and Litwin, 2013; Treloar et al., 2010; Treloar et al., 2014).”

“Two studies have documented stigma experienced by methadone patients in New Haven, CT, and PWID in California’s Central Valley (Earnshaw et al., 2013; Paquette et al., 2018).”

“Several international studies have found that stigma can adversely affect decisions to seek healthcare among PWID (Habib and Adorjany, 2003; Heath et al., 2016; Lang et al., 2013; Neale et al., 2007; Simmonds and Coomber, 2009; Treloar et al, 2016; Wilson, et al., 2014).”

“Stigma, defined by Goffman as a “deeply discrediting attribute,” is well researched among the larger population of people who use illicit drugs (Goffman, 1963; Kulesza et al., 2013).”

“Integrating a broader range of healthcare services into CBOs will present challenges, including addressing space, staffing, and resource limitations, but until stigma in mainstream healthcare systems can be addressed, innovative strategies for improving PWID access to health services in more familiar, trusted venues w…”

“In this paper, we describe how stigma impacts PWID healthcare utilization in the United States where the prevalence of injection drug use is increasing in the context of the ongoing opioid crisis (Cicero and Ellis, 2017; Cicero et al., 2017; SAMHSA, 2016).”

“Compared to other routes of drug administration, injection drug use may carry additional stigma because it results in distinct physical traits (e.g., track marks) that are easily identifiable, and is associated with undesirable health and social conditions such as HIV, Hepatitis C virus (HCV), transactional sex, crime…”

“In this paper, we describe how stigma impacts PWID healthcare utilization in the United States where the prevalence of injection drug use is increasing in the context of the ongoing opioid crisis (Cicero and Ellis, 2017; Cicero et al., 2017; SAMHSA, 2016).”

“death and are also extremely costly to the healthcare system (Binswanger et al., 2008; Ciccarone et al., 2016; Tookes et al., 2015).”

“Related to building resilience, altering self-stigmatizing views can increase general self-efficacy to act on personal goals and may be linked to recovery from addiction (Corrigan et al., 2009; Luoma et al., 2007; Rudzinski et al., 2017).”

“Therefore, presenting for treatment earlier and avoiding complications of skin and soft tissue infections could result in substantial healthcare savings, as demonstrated through the creation of specialty clinics serving PWID (Harris and Young, 2002; Tookes et al., 2015).”

“We employed a collaborative codebook development process involving six research team members (Bazzi et al., 2018).”

“dangerous, unpredictable, and lacking self-control (Barry et al., 2014; Blendon and Young, 1998; Humphreys, 2017).”

“Indeed, the integration of Hepatitis B, HCV, HIV, and wound care into syringe service programs, safe injection sites, and outpatient drug treatment programs, which often aligns with these organizations’ missions, has been shown to be feasible, acceptable, and efficacious in achieving improved patient outcomes (Altice…”

“Injection drug use increases the risk of serious health harms, including fatal and non-fatal overdose, and blood-borne and skin and soft tissue infections (Akselrod et al., 2014; CDC, 2018; Haber et al., 2009; Liebling et al., 2018; Mathers et al., 2010).”

“Internalized stigma carries harmful effects on health and wellbeing (Ahern et al., 2007; Cama et al., 2016; Hatzenbuehler et al., 2013; Kamaradova et al., 2016; Luoma et al., 2007; Rivera et al., 2014; Skeer et al., 2018; von Hippel et al., 2018).”

“Resilience, or the ability to “bounce back” and overcome adversity, helps mitigate the harmful health effects of stigma and can be built over time (Corrigan et al., 2009; Firmin et al., 2016; Mittal et al., 2012; Rudzinski et al., 2017).”

“Integrating a broader range of healthcare services into CBOs will present challenges, including addressing space, staffing, and resource limitations, but until stigma in mainstream healthcare systems can be addressed, innovative strategies for improving PWID access to health services in more familiar, trusted venues w…”

“Indeed, the integration of Hepatitis B, HCV, HIV, and wound care into syringe service programs, safe injection sites, and outpatient drug treatment programs, which often aligns with these organizations’ missions, has been shown to be feasible, acceptable, and efficacious in achieving improved patient outcomes (Altice…”

“Research in Thailand, Canada, Australia, and the United Kingdom has also described reluctance of PWID to seek care due to their status as a person who injects drugs (Boucher et al., 2017; Habib and Adorjany, 2003; Heath et al., 2016; Neale et al., 2007).”

“Indeed, providers have reported struggling to gain accurate medical histories from PWID, with one study on patient-provider communication finding that providers reacted positively when patients employed “stigma management” communication in which they downplayed their substance use (Chang et al., 2016; Henderson et al.…”

“Internalized stigma carries harmful effects on health and wellbeing (Ahern et al., 2007; Cama et al., 2016; Hatzenbuehler et al., 2013; Kamaradova et al., 2016; Luoma et al., 2007; Rivera et al., 2014; Skeer et al., 2018; von Hippel et al., 2018).”

“Indeed, the integration of Hepatitis B, HCV, HIV, and wound care into syringe service programs, safe injection sites, and outpatient drug treatment programs, which often aligns with these organizations’ missions, has been shown to be feasible, acceptable, and efficacious in achieving improved patient outcomes (Altice…”

“Indeed, the integration of Hepatitis B, HCV, HIV, and wound care into syringe service programs, safe injection sites, and outpatient drug treatment programs, which often aligns with these organizations’ missions, has been shown to be feasible, acceptable, and efficacious in achieving improved patient outcomes (Altice…”

“Indeed, healthcare providers and staff may view people who use illicit drugs and alcohol negatively, mistrust their motives, and fear deception, in turn limiting the consistency and quality of care provided (Brener et al., 2010; Henderson et al., 2008; Merrill et al., 2002; van Boekel et al., 2013).”

“Several international studies have found that stigma can adversely affect decisions to seek healthcare among PWID (Habib and Adorjany, 2003; Heath et al., 2016; Lang et al., 2013; Neale et al., 2007; Simmonds and Coomber, 2009; Treloar et al, 2016; Wilson, et al., 2014).”

“Therefore, presenting for treatment earlier and avoiding complications of skin and soft tissue infections could result in substantial healthcare savings, as demonstrated through the creation of specialty clinics serving PWID (Harris and Young, 2002; Tookes et al., 2015).”

“death and are also extremely costly to the healthcare system (Binswanger et al., 2008; Ciccarone et al., 2016; Tookes et al., 2015).”

“Although little research has focused on building resilience among PWID, some group therapy interventions have demonstrated modest efficacy in building resilience among people living with mental illness and HIV (Corrigan et al., 2009; Mittal et al., 2012; Rao et al., 2018).”

“Indeed, the integration of Hepatitis B, HCV, HIV, and wound care into syringe service programs, safe injection sites, and outpatient drug treatment programs, which often aligns with these organizations’ missions, has been shown to be feasible, acceptable, and efficacious in achieving improved patient outcomes (Altice…”

“Compared to other routes of drug administration, injection drug use may carry additional stigma because it results in distinct physical traits (e.g., track marks) that are easily identifiable, and is associated with undesirable health and social conditions such as HIV, Hepatitis C virus (HCV), transactional sex, crime…”

“While efforts to improve general training in addiction medicine are underway, an area that deserves particular attention is pain management, as patients with opioid use who downplay pain may receive lower quality of care (Paschkis and Potter, 2015; Ti et al., 2015).”

“interventions could help increase cultural competency and decrease stigma towards PWID at multiple levels within health organizations, such models require further research and evaluation (Brener et al., 2017; Livingston et al., 2012).”

“Several international studies have found that stigma can adversely affect decisions to seek healthcare among PWID (Habib and Adorjany, 2003; Heath et al., 2016; Lang et al., 2013; Neale et al., 2007; Simmonds and Coomber, 2009; Treloar et al, 2016; Wilson, et al., 2014).”

“, track marks) that are easily identifiable, and is associated with undesirable health and social conditions such as HIV, Hepatitis C virus (HCV), transactional sex, crime, and homelessness (Ahern et al., 2007; Akselrod et al., 2014; Crawford et al, 2012; Habib and Adorjany, 2003).”

“Several international studies have found that stigma can adversely affect decisions to seek healthcare among PWID (Habib and Adorjany, 2003; Heath et al., 2016; Lang et al., 2013; Neale et al., 2007; Simmonds and Coomber, 2009; Treloar et al, 2016; Wilson, et al., 2014).”

“Unfortunately, irrelevant services and poor quality care can result from providers lacking important patient health information (Lee, 1995).”

“Unfortunately, the majority of practicing providers and medical students in the United States believe that they lack adequate training in assessing and treating people with addiction (Bäck et al., 2018; Miller et al., 2001).”

“While efforts to improve general training in addiction medicine are underway, an area that deserves particular attention is pain management, as patients with opioid use who downplay pain may receive lower quality of care (Paschkis and Potter, 2015; Ti et al., 2015).”

“Compared to other routes of drug administration, injection drug use may carry additional stigma because it results in distinct physical traits (e.g., track marks) that are easily identifiable, and is associated with undesirable health and social conditions such as HIV, Hepatitis C virus (HCV), transactional sex, crime…”

“To be well received, messaging should address the uniqueness of addiction as a disease while acknowledging that negative interactions between healthcare providers and PWID may occur (Humphreys, 2017).”

“However, PWID in the United States typically have limited healthcare utilization outside of emergency services (Baumann et al., 2012; Drug Abuse Warning Network, 2010; Vivolo-Kantor et al., 2018).”

“Resource allocation and clinical practice with embedded stigma and discrimination has a prohibitive effect on healthcare utilization by individuals with SUD (14).”