Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting
Background: Increased drug use has disproportionately impacted rural areas across the U.S. People who use drugs are at risk of overdose and other medical complications, including infectious diseases. Understanding barriers to healthcare access for this often stigmatized population is key to reducing...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-11-01
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| Series: | Frontiers in Sociology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fsoc.2020.593925/full |
| _version_ | 1828787354377125888 |
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| author | Kaitlin Ellis Suzan Walters Samuel R. Friedman Lawrence J. Ouellet Jerel Ezell Kris Rosentel Mai T. Pho |
| author_facet | Kaitlin Ellis Suzan Walters Samuel R. Friedman Lawrence J. Ouellet Jerel Ezell Kris Rosentel Mai T. Pho |
| author_sort | Kaitlin Ellis |
| collection | DOAJ |
| description | Background: Increased drug use has disproportionately impacted rural areas across the U.S. People who use drugs are at risk of overdose and other medical complications, including infectious diseases. Understanding barriers to healthcare access for this often stigmatized population is key to reducing morbidity and mortality, particularly in rural settings where resources may be limited.Methods: We conducted 20 semi-structured interviews with people who use drugs, including 17 who inject drugs, in rural southern Illinois between June 2018 and February 2019. Interviews were analyzed using a modified grounded theory approach where themes are coded and organized as they emerge from the data.Results: Participants reported breaches of trust by healthcare providers, often involving law enforcement and Emergency Medical Services, that dissuaded them from accessing medical care. Participants described experiences of mistreatment in emergency departments, with one account of forced catheterization. They further recounted disclosures of protected health information by healthcare providers, including communicating drug test results to law enforcement and sharing details of counseling sessions with community members without consent. Participants also described a hesitancy common among people who use drugs to call emergency medical services for an overdose due to fear of arrest.Conclusion: Breaches of trust by healthcare providers in rural communities discouraged people who use drugs from accessing medical care until absolutely necessary, if at all. These experiences may worsen healthcare outcomes and further stigmatize this marginalized community. Structural changes including reforming and clarifying law enforcement's role in Emergency Departments as well as instituting diversion policies during arrests may help rebuild trust in these communities. Other possible areas for intervention include stigma training and harm reduction education for emergency medicine providers, as well as developing and implementing referral systems between Emergency Departments and local harm reduction providers and medically assisted drug treatment programs. |
| first_indexed | 2024-12-12T00:29:53Z |
| format | Article |
| id | doaj.art-bd8bbad4423a49a7bbe392f5297c998a |
| institution | Directory Open Access Journal |
| issn | 2297-7775 |
| language | English |
| last_indexed | 2024-12-12T00:29:53Z |
| publishDate | 2020-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Sociology |
| spelling | doaj.art-bd8bbad4423a49a7bbe392f5297c998a2022-12-22T00:44:31ZengFrontiers Media S.A.Frontiers in Sociology2297-77752020-11-01510.3389/fsoc.2020.593925593925Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural SettingKaitlin Ellis0Suzan Walters1Samuel R. Friedman2Lawrence J. Ouellet3Jerel Ezell4Kris Rosentel5Mai T. Pho6Pritzker School of Medicine, University of Chicago, Chicago, IL, United StatesRory Meyers College of Nursing, New York University, New York, NY, United StatesDepartment of Population Health, NYU Grossman School of Medicine, New York, NY, United StatesCOIP/Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, United StatesAfricana Studies and Research Center, Cornell University, Ithaca, NY, United StatesSection of Infectious Disease, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United StatesSection of Infectious Disease, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United StatesBackground: Increased drug use has disproportionately impacted rural areas across the U.S. People who use drugs are at risk of overdose and other medical complications, including infectious diseases. Understanding barriers to healthcare access for this often stigmatized population is key to reducing morbidity and mortality, particularly in rural settings where resources may be limited.Methods: We conducted 20 semi-structured interviews with people who use drugs, including 17 who inject drugs, in rural southern Illinois between June 2018 and February 2019. Interviews were analyzed using a modified grounded theory approach where themes are coded and organized as they emerge from the data.Results: Participants reported breaches of trust by healthcare providers, often involving law enforcement and Emergency Medical Services, that dissuaded them from accessing medical care. Participants described experiences of mistreatment in emergency departments, with one account of forced catheterization. They further recounted disclosures of protected health information by healthcare providers, including communicating drug test results to law enforcement and sharing details of counseling sessions with community members without consent. Participants also described a hesitancy common among people who use drugs to call emergency medical services for an overdose due to fear of arrest.Conclusion: Breaches of trust by healthcare providers in rural communities discouraged people who use drugs from accessing medical care until absolutely necessary, if at all. These experiences may worsen healthcare outcomes and further stigmatize this marginalized community. Structural changes including reforming and clarifying law enforcement's role in Emergency Departments as well as instituting diversion policies during arrests may help rebuild trust in these communities. Other possible areas for intervention include stigma training and harm reduction education for emergency medicine providers, as well as developing and implementing referral systems between Emergency Departments and local harm reduction providers and medically assisted drug treatment programs.https://www.frontiersin.org/articles/10.3389/fsoc.2020.593925/fullruralopioidinjectdrugshealthcarestigma |
| spellingShingle | Kaitlin Ellis Suzan Walters Samuel R. Friedman Lawrence J. Ouellet Jerel Ezell Kris Rosentel Mai T. Pho Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting Frontiers in Sociology rural opioid inject drugs healthcare stigma |
| title | Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting |
| title_full | Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting |
| title_fullStr | Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting |
| title_full_unstemmed | Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting |
| title_short | Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting |
| title_sort | breaching trust a qualitative study of healthcare experiences of people who use drugs in a rural setting |
| topic | rural opioid inject drugs healthcare stigma |
| url | https://www.frontiersin.org/articles/10.3389/fsoc.2020.593925/full |
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