Reflection Blog Post 1

I believe that stigma is a huge barrier of why patients do not seek treatment for their healthcare.  Patients try to hide their disorders because they fear this will become their identity.  They fear every medical decision is going to be made based on the fact that they suffer from a substance abuse disorder.   They even avoid any general check ups or visits for illnesses or an injury because they feel healthcare staff always assume “they are after something.”  They fear if they come in for a cough, “They just want Phenergan with Codeine” when they truly feel they need an antibiotic. If they have a fall with injury “It doesn’t hurt that bad they just want narcotics.”  This stigma has a negative impact on the patient’s health not just in relation to substance use but just their general well- being.

The community of which our practice resides has a lot of stigma related to opioid and any substance use in general, but we also have a significant percentage of our population who are suffering from these disorders.  Before our practice started our MAT program, a lot of the residents of our community had to travel a long distance for treatment, were on a forever long waiting list, or would not have access at all. Three years ago, our health center and a private practice merged.  Our patients and staff both voiced concerns about how the “different” types of patients would react being in the same waiting room together or assumed we would have “conflicts” or “difficult situations” with patients in out MAT program.  Which these instances have occurred, but they have also occurred with patients who are not in the MAT program over blood pressure medications.

We all have unconscious bias, maybe not necessarily related to substance use.  Its natural, anyone who says they do not is naive.  It is important as your work in healthcare to be aware of your own bias to ensure it does not affect the care you give to patients.  I think stigma can be a result of lack of knowledge and exposure.  Not all people that have a stigma feeling towards someone are trying to be hateful or malicious.  I think the hardest part for people is to admit they don’t understand.  Even people in healthcare carry stigma related to this issue and they have medical knowledge regarding addiction.  As you can imagine someone without medical knowledge doesn’t understand that it’s not just “poor choices”.  They don’t realize addiction makes your brain function differently.  That being said I think there needs to be A LOT more education for healthcare staff regarding substance use along with community education.  The media doesn’t help. Very rarely do you see success stories of patients overcoming addiction, it usually just reinforces the negative stigma that people already have, and also further discourages patients that are suffering from it.

Our practice has future plans to start a needle exchange as part of a harm reduction program.  We foresee stigma from our community.  We expect to have to defend and give explanations as people will assume, we are “promoting” patients to use by providing needles and we are just “making things worse.” A co-worker explained it in a way giving a good perspective:  We are trying to reduce harm.  We could go to the beach and pass out sunscreen and it’s the same idea.  People are well aware sun exposure has a negative impact and can cause skin cancer.  They are going to go to the beach regardless, so we provide sunscreen.  Our patients suffering from substance use disorder, if they are participating in a needle exchange they are injecting.  They are going to continue injecting until an intervention is done.  If they are going to do it regardless at that point in time, its better to use a clean needle rather than a used one.  Further, statistics have shown patients who use a needle exchange are more likely to seek treatment.  They come to trust the staff that is supporting them and do not feel judged aka providing care WITHOUT stigma!

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