Wound care for people who inject drugs is considered a critical component of harm reduction by providers. But people who inject drugs (PWID) in Boston, Massachusetts hesitate to access medical care because of perceptions that the medical system will not meet their needs, found a study by Boston Medical Center (BMC). And drug user activists recently spoke out about their own experiences with the hospital.
The majority of surveyed Bostonians who inject drugs (64 percent) have had a skin and soft tissue infection in the past year, and the vast majority (89 percent) eventually seek medical treatment. Yet on average, they delay care by nearly a week and end up in the emergency department at a proportion (87 percent) significantly higher than other contexts, the study authors noted. And this all happened despite the majority of survey participants having insurance and primary care physicians—the lack of which are “traditional barriers” for PWID.
A third of survey participants attempted self-treatment, and a third of them never ended up seeking medical treatment. Their avoidance of clinical settings seemed to be motivated by beliefs that their wounds were not serious enough, desires to continue using drugs, and “dislike and fear” of the medical establishment.
People who had more wounds from injection drug use in the past year were more likely to self-treat their infections; the study authors “speculate” that this is due to them having “greater confidence” in their ability to manage the issue without medical intervention. Such interventions include draining and cleaning the area, as well as taking antibiotics.
These findings seem to come as no surprise to people who use drugs in Boston.
“A lot of us drug users will NOT go to ERs unless we’re nearly on the brink of death because of how hospitals, PARTICULARLY and especially [BMC], treat us and other people who use drugs,” Boston Drug Users Union tweeeted on January 11. “[W]e’re often very critical of [BMC] for their callous glaringly harmful & stigmatizing Drs & staff plus the undeniable lack of safe non-stigmatizing healthcare access for many people who use drugs – especially homeless individuals who come to them for care.”
One of the study’s authors seems to agree. “There are many clinicians who don’t care for PWID as they might for other patients, are careless with their language, and at times undertreat them,” Professor Michael Stein of Boston University told Filter. “Much PWID distrust is probably justified.”
BMC is working to improve its services and alleviate distrust through: informal mentorships between clinicians seasoned in working with PWID and novices; hiring more peer recovery coaches; creating institutional bodies that focus on “addiction education”; and collaborating with community-based organizations.
“Hearing individual and community feedback about how care can be better,” like that offered by Boston Drug Users Union over Twitter, will “give providers the chance to improve,” said Stein. “All hospitals, BMC included, have more to do to treat PWID’s equitably and with cutting edge care.”
Photograph of a Boston Drug User Union (BDUU) volunteer by Jim Duffy.