Examining health care from the drug user perspective: what works, what doesn't and what needs to change

The NSW Users and AIDS Association (NUAA) is a peer-based drug user organisation. NUAA was commissioned by the NSW Ministry of Health to explore current perspectives on health care by people who use drugs in NSW. This presentation examines the challenges faced by people at the intersection of drug use and mental health.

Thirty-four current and former drug/alcohol users were recruited from organisational networks as participants of this project. Structured interviews were conducted by trained peers. Interviews continued until no new themes emerged. Analysis was done by two coders working independently.

Participants typically had complex health care needs that included drug and alcohol, mental health and pain management. Positive health care experiences were characterised by being listened to and receiving thorough explanations around treatments delivered in plain English. Many positive experiences were the result of long-established relationships with a general practitioner.

Each person interviewed for this project reported negative health care experiences that included public shaming, cursory medical treatment and not receiving adequate treatment for serious health conditions. Overwhelmingly, participants believed that drug use had resulted in being judged and as a result, receiving poor quality care. Impersonal environments, such as emergency departments or high throughput medical centres were frequently cited as problematic. People interviewed very rarely complained or raised issues with health care providers instead preferring to seek care elsewhere or avoid care altogether.

Positive experiences are crucial to effective health care while negative ones can have long term and potentially fatal consequences. The health care community has a duty of care to address the stigma that people who use drugs experience while accessing care with improved clinical education and ongoing training key methods of improving drug user health.