Medical care experiences of people who use drugs: Considerations for development of accessible services

Background: ACA facilitates medical care access for many Americans, but barriers remain for those with psycho-social concerns.  People who use drugs (PWUD), particularly people who inject drugs (PWID), face health problems affecting all Americans and those related to drug use and associated lifestyles. Despite increased care need, PWID receive fewer healthcare services.  This project examines attitudes about healthcare access and experiences of PWID in order to develop more accessible healthcare services for PWID.

Methods: In-depth interviews were recorded with 20 PWUD (15 men and 5 women, injectors and non-injectors) at Prevention Point Philadelphia, a multi-service public health organization dedicated to harm reduction in Philadelphia PA. Transcripts were reviewed and coded with emergent themes identified and discussed.

Results:A perceived hierarchy of judgment in healthcare settings was noted by type and method of use, with heroin users viewed as “bad” and injectors as “worst”. A perceived hierarchy of trust in healthcare professionals was noted with physicians viewed as most and office staff as least trustworthy. Healthcare ranged from none, to ER visits, regular mental healthcare, and regular primary or subspecialty care. Most subjects had Medicaid insurance and reported Prevention Point actively assisted with their application. Respect, reported as providers seeing and treating a PWUD as a person rather than a drug problem, led attributes of trusted and acceptable providers.

Conclusions: PWUD want and seek medical care. Concerns of judgment and respect impede provider-patient relationships. Harm reduction training for all staff, from physicians to receptionists, will benefit patients and medical practices.