Scottish experts voice concern over impact of ‘inappropriate’ healthcare stigma on action to prevent drug deaths
2 March 2013
EFFORTS to reduce Scotland’s “tragic” toll of drug-related deaths may be being hindered by healthcare workers offering “less sympathetic and supportive” services to people with drug problems because of inappropriate stigma associated with addiction, the National Forum on Drug-related Deaths in Scotland has suggested.
“Normalisation” of drug treatment in general practice and secondary care is one of the highest priorities for reducing Scotland’s drug deaths figures which reached a record high of 584 in 2011, the Forum says in its 2011/12 Annual Report published yesterday.
“Despite previous recommendations, health care workers in primary care, secondary care and community pharmacies may still offer a service to drug users which is less sympathetic and supportive than that to other patient groups. This is based on an inappropriate stigma associated with addiction and sometimes erroneous beliefs of the efficacy of treatment.”
Addiction problems are increasingly associated with chronic disease, the population of dependent patients with co-morbidity is increasing as time passes and there is a need to encourage all GPs to consider treatment of drug users as essential, rather than optional, work, says the expert group.
Evidence is showing that drug deaths occur most often in ageing, male, chronic drug users from Scotland’s most deprived communities, the Report says, and more work needs to be done by the Scottish Government and ADPs to investigate the specific needs of older drug users (35+years) with a view to improving services for them.
Many people who die are not in structured opiate substitute treatment and have multiple morbidities including polysubstance use, problematic alcohol use and psychiatric problems which may be additional risks for death.
Drug death prevention services should be most targeted for this group of drug users – they are at-risk people who may well be in contact with other acute and primary care services who have an opportunity to recognise risks and take appropriate actions as they would for any other group of individuals with high risk of poor outcomes, said the Report.
However, integration of the whole range of requirements of drug users into General Practice and Primary Care is still underdeveloped, it says.
“This may be due to inadequate guidance, poorly targeted resources and lack of recognition of the central position General Practice has in managing these problems,” according to the Forum.
Analysis of drug deaths in 2010 showed that nearly 60 percent had been in contact with drug treatment services at some point prior to death and 25 percent had been in contact with services in the month prior to death including addiction services, the patient’s GP, an Accident and Emergency Service, a psychiatric service and social work services.
“With so many individuals who died having contact with services prior to their death, it is imperative that we promote the recognition of drug death risks and an appropriate and co-ordinated response by such service providers,” the Report states.
Possible reluctance among doctors to work with stigmatised drug and alcohol users has already been cited this year by the British Medical Association (BMA) in a major report Drugs of Dependence: The Role of Medical Professionals.
Doctors' sense of pessimism about being able to do anything and avoidance of antagonising patients are other possible reasons for reluctance to explore drug and alcohol use with patients, says the BMA report.
But doctors should “show understanding of the illness of drug addiction and respond in the way that we would with any other illness,” according to BMA board of science chair Professor Averil Mansfield.
Meanwhile, a survey of over 200 GPs by researchers from the University of Aberdeen into GP awareness of Scotland’s Naloxone programme found it was “minimal” and also found “negative attitudes to drug users were generally evident”.
The study published last month - General Practitioner Engagement with the Scottish National Naloxone Programme: A Needs Assessment Project - said that the possibility of opportunistic intervention for reducing Drug Related Deaths, including through Naloxone provision – among GPs seemed to be “off their radar”.
This was despite GPs being in an “ideal position” to direct patients to Naloxone training and supply schemes or provide the service themselves.
A key barrier is the typecasting of Naloxone prescribing as a specialist service that only specialists should provide, according to study, which also called for the “potential stigmatisation” of drug users as a patient group to be reviewed.
The National Forum on Drugs Related Deaths in Scotland’s Report says that the BMA report highlights “many of the issues which are germane to the views of the Forum” and highly recommended it to Ministers and Health Boards as well as people working with drug dependent patients in the NHS.
Specific examples of how issues raised in the BMA Report might be addressed might be the inclusion of drug and alcohol services in the current discussions on a separate Scottish Contract for General Medical Practice and Primary Care and updated guidelines for clinical practice, the Forum suggests.
National Forum on Drug-Related Deaths in Scotland - Annual Report 2011/12.
Call for more Naloxone kits in the community to cut drug death toll.