Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jul:57:104-110.
doi: 10.1016/j.drugpo.2018.04.004. Epub 2018 Apr 30.

Stigma at every turn: Health services experiences among people who inject drugs

Catherine E Paquette  1 , Jennifer L Syvertsen  2 , Robin A Pollini  3
Affiliations

Stigma at every turn: Health services experiences among people who inject drugs

Catherine E Paquette et al. Int J Drug Policy. 2018 Jul.

Abstract

Background: People who inject drugs (PWID) encounter varying forms of stigma in health services contexts, which can contribute to adverse outcomes. We explored the lived experience of stigma among PWID to elucidate pathways by which stigma influences health care access and utilization.

Methods: We conducted 46 qualitative interviews with PWID in California's Central Valley between March and December 2015, as part of a multi-phase, multi-method study examining implementation of a new pharmacy syringe access law. A "risk environment" framework guided our data collection and we used a deductive/inductive approach to analyze the qualitative data.

Results: Participants repeatedly cited the impact of stigma on syringe access, particularly in the context of meso-level pharmacist interactions. They described being denied syringe purchase as stigmatizing and embarrassing, and these experiences discouraged them from attempting to purchase syringes under the new pharmacy access law. Participants described feeling similarly stigmatized in their meso-level interactions with first responders and hospital staff, and associated this stigmatization with delayed and substandard medical care for overdoses and injection-related infections. Drug treatment was another area where stigma operated against PWID's health interests; participants described macro-level public stigma towards methadone (e.g., equating methadone treatment with illicit drug use) as discouraging participation in this evidence-based treatment modality and justifying exclusion of methadone patients from recovery support services like sober living and Narcotics Anonymous.

Conclusion: Stigma played an undeniably important role in PWID's experiences with health services access and utilization in the Central Valley. Our study illustrates the need to develop and test interventions that target drug use stigma at both structural and individual levels to minimize adverse effects on PWID health.

Keywords: Healthcare disparities; Injection drug use; Methadone; Pharmacies; Stigma; Syringe access.

PubMed Disclaimer

Conflict of interest statement

Declarations of interest: none.

References

    1. Ahern J, Stuber J, Galea S. Stigma, discrimination and the health of illicit drug users. Drug and Alcohol Dependence. 2007;88(2–3):188–196. doi: 10.1016/j.drugalcdep.2006.10.014. - DOI - PubMed
    1. Alderman J, Borkar GG, Garrett A, Hogan L, Kim J, Le W, … Wickersham C. The Most Conservative and Liberal Cities in the United States. 2005 Retrieved from www.votingresearch.org.
    1. Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, Mattick RP. – An overview of systematic reviews of the effectiveness of opiate maintenance therapies: Available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment. 2005;28(4):321–329. doi: 10.1016/j.jsat.2005.02.007. - DOI - PubMed
    1. Barry CL, McGinty EE, Pescosolido BA, Goldman HH. Stigma, discrimination, treatment effectiveness, and policy: Public views about drug addiction and mental illness. Psychiatric Services. 2014;65(10):1269–1272. doi: 10.1176/appi.ps.201400140. - DOI - PMC - PubMed
    1. Brady JE, Friedman SR, Cooper HL, Flom PL, Tempalski B, Gostnell K. Estimating the prevalence of injection drug users in the U.S. and in large U.S. metropolitan areas from 1992 to 2002. Journal of Urban Health. 2008;85(3):323–351. doi: 10.1007/s11524-007-9248-5. - DOI - PMC - PubMed

Publication types