In the slow lane

There are many layers of stigma that affect people’s experiences of healthcare, shows a new policy briefing from the Anti-Stigma Network (ASN).

As the briefing makes clear, we’re not recognising anything new – the UK Drug Policy Commission talked in detail back in 2010 about the negative perceptions held by healthcare professionals of people using alcohol and other drugs. 

Dame Carol Black’s 2021 Independent review of drugs highlighted that little had changed over the past ten years, with people who use drugs still ‘feeling unwelcome in many mainstream health and care settings’. Clients are still being referred to as ‘frequent flyers’ and people who are ‘taking up our beds’ says the briefing, with stigmatising situations all too commonplace – people are still being singled out when they collect a prescription for opioid substitution therapy at the community pharmacy.

Holistic healthcare?

A combined substance use and mental health problem gives rise to further inequity – a significant proportion of people in drug treatment and alcohol services experience mental health problems. Rather than enlightening us to enhance our treatment offering, this appears to create even more barriers to support.

We now know that people experiencing early death from opiate use while in treatment are more likely to die from causes other than poisoning – through physical health conditions such as respiratory diseases, blood-borne viruses and diseases of the liver and pancreas. So why aren’t we adapting to respond to this? As the briefing says, ‘Access to early and effective healthcare treatment is vital… yet people told us that experiencing stigma had both immediate and lasting effects on their ability to seek help.’

The 2021 drug strategy stated: ‘We will create a system where no one falls through the gaps, where there is no stigma attached to addiction… where people who need it are provided with long-term support.’ But the National Audit Office (2023) pointed to a lack of action by local authorities while the Public Accounts Committee (2024) highlighted the absence of a joined-up cross-sector response. For people trying to access help, it continues to feel like an inconsistent and unreliable experience: ‘Healthcare professionals within the same service [are] taking very different approaches depending on their knowledge, understanding and personal experiences (either direct or indirect) of substance use,’ says the briefing.

What can we do?

Education and training are essential to improving professionals’ knowledge and understanding, states the briefing – both formally and through involving people with lived experience to help address ‘the widespread misunderstanding of addiction among both healthcare professionals and the public’. For example, personal stories have been used by an advocacy organisation to produce guidance for both pharmacists and people accessing opioid substitution therapy, to understand their rights and responsibilities.

Changing institutional policies and procedures can contribute significantly, and the 2023 NHS long-term workforce plan calls for a step-up of training and competency relating to co-occurring mental health and substance use conditions. At the end of last year the government published a delivery framework to show how local authorities and NHS bodies should work together to achieve integrated care systems.

In short, there is much more to do and clear guidance to tackle it. The briefing demonstrates that as long as we let stigma prevail, we will be prevented from seeing beyond the immediate treatment need and understanding people’s holistic healthcare as a matter of course. 

Stigma towards people who use alcohol and other drugs in healthcare settings and Stigma around drug and alcohol use in the criminal justice system are two new briefings available at the ASN’s site www.antistigmanetwork.org.uk