Background:
Many people who use drugs (PWUD) have unmet healthcare needs yet face pervasive barriers to engagement. This study’s objective was to understand recent healthcare utilization and avoidance among PWUD who accessed a harm-reduction site in Vancouver, Canada.
Methods:
A cross-sectional survey was administered to a cohort of supervised consumption site clients between January and December 2024 in Vancouver, Canada. We compared characteristics using chi-square, Fisher’s Exact, and Kruskal-Wallis tests. We estimated the association of healthcare avoidance and drug-use stigma in healthcare with logistic regression, adjusting for potential confounding by sociodemographic factors.
Results:
Of 299 participants, 166 (55.5%) were men and the median age was 41.0 years (Q1, Q3: 34.0, 47.5). Among all participants 74% reported regular primary care access, 85% engaged in any primary care in the previous year. However, more than one-third (36%) reported also avoiding at least one type of healthcare. Participants with primary care access were less likely to report unstable housing (46% vs 78%) and were slightly older (median: 41 vs 39). Hospital emergency care was the most common type of care accessed by the participants (57%), yet also the most avoided (58%). Drug-use stigma in healthcare was reported by almost half (46%) of participants and was associated with healthcare avoidance (OR: 2.3, 95%CI: 1.4 to 4.0) after adjusting for sexual orientation and daily substance use. Other barriers which motivated healthcare avoidance included anticipation of poor experience (36%) and previous inadequate care experience (29%).
Conclusion:
This cohort of PWUD accessing harm-reduction services had high levels of both healthcare avoidance and primary care utilization. Experiencing drug-use stigma in healthcare more than doubled the odds of avoidance. Understanding healthcare engagement patterns and reasons underlying them can help in designing primary-care services for PWUD that reduce stigmatization and other barriers, thus decreasing healthcare avoidance in the long term. |