Abstracts
Abstract
People who use drugs (PWUD) experience stigma when accessing hospital-based healthcare, including emergency care. Rural settings are of particular concern, due to heightened social-structural stigma toward PWUD in smaller communities. These barriers have been exacerbated further by recent narratives in media and political attention on the risks to healthcare providers when exposed to PWUD using substances while in hospital. Nurses’ voices have been used directly and indirectly to influence political discourses to raise moral panic regarding workplace exposure to second-hand smoke from unregulated substances (e.g., fentanyl and methamphetamine). Immediate collective nursing action is required to protect nurses’ professional and ethical obligations and ensure safe and stigma-free access to hospital care for rural PWUD in the current political climate in British Columbia, Canada.
Keywords:
- occupational exposure,
- nursing profession,
- substance use conditions,
- drug policy,
- advocacy
Résumé
Les personnes qui consomment des drogues (PUD) font l’objet d’une stigmatisation lorsqu’elles accèdent aux soins de santé en milieu hospitalier, y compris aux soins d’urgence. Les régions rurales sont particulièrement concernées en raison de la stigmatisation sociale et structurelle accrue à l’égard de ces personnes dans les petites communautés. Ces obstacles ont été amplifiés par les récents récits des médias et de l’attention politique sur les risques encourus par les prestataires de soins de santé lorsqu’ils sont exposés à des PUD qui consomment des drogues pendant leur hospitalisation. La voix du personnel infirmier a été instrumentalisée, directement et indirectement, pour influencer les discours politiques et susciter une panique morale face à l’exposition sur le lieu de travail à la fumée secondaire de substances non réglementées (par exemple, le fentanyl et la méthamphétamine). Le climat politique actuel en Colombie-Britannique au Canada exige une action collective immédiate de la part du personnel infirmier afin de protéger ses obligations professionnelles et éthiques et d’assurer un accès sûr et libre de toute stigmatisation aux soins hospitaliers pour les PUD dans les zones rurales.
Mots-clés :
- exposition professionnelle,
- profession de soins infirmiers,
- troubles liés à l’utilisation de substances,
- politique en matière de drogues,
- plaidoyer
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Appendices
Biographical notes
Kate Hodgson is a nurse practitioner who resides on traditional Tla’amin territory on the Sunshine Coast of BC. She provides low-barrier primary care and substance use treatment to people with intersecting complexities. She is a board member of the Harm Reduction Nurses Association.
Amanda Lavigne is a clinical nurse specialist on the Substance Use Team with Interior Health. Amanda is a leader in substance use program development and clinical expert in substance use care.
Geoff Bardwell is an Assistant Professor in the School of Public Health Sciences at the University of Waterloo. Dr. Bardwell’s research focuses on substance use in rural, Northern, and smaller community settings.
Bibliography
- Bardwell, G., Mansoor, M., Van Zwietering, A., Cleveland, E., Snell, D., & Kerr, T. (2022). The “goldfish bowl”: A qualitative study of the effects of heightened surveillance on people who use drugs in a rural and coastal Canadian setting. Harm Reduction Journal, 19(1), 136. https://doi.org/10.1186/s12954-022-00725-2
- Barry, C. L., McGinty, E. E., Pescosolido, B. A., & Goldman, H. H. (2014). Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness. Psychiatric Services, 65(10), 1269–1272. https://doi.org/10.1176/appi.ps.201400140
- British Columbia Nurses’ Union. (2024, May 7). Controlling Exposure Risks from Illicit Substances. https://www.bcnu.org/a-safe-workplace/health-and-safety/controlling-exposure-risks
- Bourque, S., Pijl, E. M., Mason, E., Manning, J., & Motz, T. (2019). Supervised inhalation is an important part of supervised consumption services. Canadian Journal of Public Health, 110(2), 210–215. https://doi.org/10.17269/s41997-019-00180-w
- Burgess, A., Bauer, E., Gallagher, S., Karstens, B., Lavoie, L., Ahrens, K., & O’Connor, A. (2021). Experiences of stigma among individuals in recovery from opioid use disorder in a rural setting: A qualitative analysis. Journal of Substance Abuse Treatment, 130, 108488. https://doi.org/10.1016/j.jsat.2021.108488
- Chan Carusone, S., Guta, A., Robinson, S., Tan, D. H., Cooper, C., O’Leary, B., de Prinse, K., Cobb, G., Upshur, R., & Strike, C. (2019). “Maybe if I stop the drugs, then maybe they’d care?”—Hospital care experiences of people who use drugs. Harm Reduction Journal, 16(1), 16. https://doi.org/10.1186/s12954-019-0285-7
- DeBeck, K., Cheng, T., Montaner, J. S., Beyrer, C., Elliott, R., Sherman, S., Wood, E., & Baral, S. (2017). HIV and the criminalisation of drug use among people who inject drugs: A systematic review. The Lancet HIV, 4(8), e357–e374. https://doi.org/10.1016/S2352-3018(17)30073-5
- DeRosa, K. (2024, April 5). Nurses speak out about consequences of drug use in hospitals. https://vancouversun.com/news/nurses-speak-out-about-consequences-of-drug-use-in-hospitals
- Dogherty, E., Patterson, C., Gagnon, M., Harrison, S., Chase, J., Boerstler, J., Gibson, J., Gill, S., Nolan, S., & Ryan, A. (2022). Implementation of a nurse-led overdose prevention site in a hospital setting: Lessons learned from St. Paul’s Hospital, Vancouver, Canada. Harm Reduction Journal, 19(1), 13. https://doi.org/10.1186/s12954-022-00596-7
- Eagland, S., Ranger, C. & Wilson, P. (2024, May 23). Fears of exposure to illicit drugs in public places based on politics, not facts. https://healthydebate.ca/2024/05/topic/exposure-illicit-drugs-politics/
- Ellis, K., Walters, S., Friedman, S. R., Ouellet, L. J., Ezell, J., Rosentel, K., & Pho, M. T. (2020). Breaching trust: Qualitative study of healthcare experiences of people who use drugs in a rural setting. Frontiers in Sociology, 5, 593925. https://doi.org/10.3389/fsoc.2020.593925
- Fisher, J. (2007). Mental health nurses: De facto police. International Journal of Mental Health Nursing, 16(4), pp. 230-235. https://doi.org/10.1111/j.1447-0349.2007.00472.x
- Fleming, P. & Sinnot, M-L. (2018). Rural physician supply and retention: Factors in the Canadian context. Canadian Journal of Rural Medicine, 23(1). https://www.srpc.ca/resources/Documents/CJRM/vol23n1/pg15.pdf
- Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821. https://doi.org/10.2105/AJPH.2012.301069
- Henderson, S. (2002). Factors impacting on nurses’ transference of theoretical knowledge of holistic care into clinical practice. Nurse Education in Practice, 2(4), 244–250. https://doi.org/10.1016/S1471-5953(02)00020-3
- Hu, K., Klinkenberg, B., Gan, W. Q., & Slaunwhite, A. K. (2022). Spatial-temporal trends in the risk of illicit drug toxicity death in British Columbia. BMC Public Health, 22(1), 2121. https://doi.org/10.1186/s12889-022-14586-8
- Kennedy-Hendricks, A., Barry, C. L., Gollust, S. E., Ensminger, M. E., Chisolm, M. S., & McGinty, E. E. (2017). Social stigma toward persons with prescription opioid use disorder: Associations with public support for punitive and public health–oriented policies. Psychiatric Services, 68(5), 462–469. https://doi.org/10.1176/appi.ps.201600056
- McEachern, J., Ahamad, K., Nolan, S., Mead, A., Wood, E., & Klimas, J. (2016). A Needs Assessment of the Number of Comprehensive Addiction Care Physicians Required in a Canadian Setting. Journal of Addiction Medicine, 10(4), 255. https://doi.org/10.1097/ADM.0000000000000230
- Moss, M. J., Warrick, B. J., Nelson, L. S., McKay, C. A., Dubé, P.-A., Gosselin, S., Palmer, R. B., & Stolbach, A. I. (2018). ACMT and AACT position statement: Preventing occupational fentanyl and fentanyl analog exposure to emergency responders. Clinical Toxicology, 56(4), 297–300. https://doi.org/10.1080/15563650.2017.1373782
- Muncan, B., Walters, S. M., Ezell, J., & Ompad, D. C. (2020). “They look at us like junkies”: Influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City. Harm Reduction Journal, 17(1), 53. https://doi.org/10.1186/s12954-020-00399-8
- Neale, J., Tompkins, C., & Sheard, L. (2008). Barriers to accessing generic health and social care services: A qualitative study of injecting drug users. Health & Social Care in the Community, 16(2), 147–154. https://doi.org/10.1111/j.1365-2524.2007.00739.x
- Palombi, L. C., St Hill, C. A., Lipsky, M. S., Swanoski, M. T., & Lutfiyya, M. N. (2018). A scoping review of opioid misuse in the rural United States. Annals of Epidemiology, 28(9), 641–652. https://doi.org/10.1016/j.annepidem.2018.05.008
- Pauly, B. (Bernie), McCall, J., Browne, A. J., Parker, J., & Mollison, A. (2015). Toward Cultural Safety: Nurse and Patient Perceptions of Illicit Substance Use in a Hospitalized Setting. Advances in Nursing Science, 38(2), 121–135. https://doi.org/10.1097/ANS.0000000000000070
- Shaw, R. (2024, April 4). ‘Nobody signed up.. to be exposed to fentanyl in the workplace’ says nurse. https://northernbeat.ca/opinion/nobody-signed-up-to-be-exposed-to-fentanyl-in-the-workplace-says-nurse/
- Stangl, A. L., Earnshaw, V. A., Logie, C. H., van Brakel, W., C. Simbayi, L., Barré, I., & Dovidio, J. F. (2019). The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17(1), 31. https://doi.org/10.1186/s12916-019-1271-3
- Sweetman, M. (2024, November 21). Patient overdose death at Nanaimo hospital ‘didn’t have to happen,’ doctor says. https://thediscourse.ca/nanaimo/patient-overdose-death-at-nanaimo-hospital-didnt-have-to-happen-doctor-says
- Taylor, A. (2024, May 7). Campbell River hospital staff exposed to illicit drug smoke: Island Health. https://www.campbellrivermirror.com/local-news/campbell-river-hospital-staff-exposed-to-illicit-drug-smoke-island-health-7326961
- Van Boekel, L. C., Brouwers, E. P. M., Van Weeghel, J., & Garretsen, H. F. L. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug and Alcohol Dependence, 131(1–2), 23–35. https://doi.org/10.1016/j.drugalcdep.2013.02.018
- Van Dyk, S. (2024, May 7). The federal government grants B.C.’s request to recriminalize hard drugs in public spaces. https://www.ctvnews.ca/politics/federal-government-grants-b-c-s-request-to-recriminalize-hard-drugs-in-public-spaces-1.6876913
- Vancouver Coastal Health. (2023, January 1). Possession of controlled substances for personal use. https://www.vch.ca/en/decriminalization-controlled-substances-personal-use
Appendices
Notes biographiques
Kate Hodgson est infirmière praticienne et demeure sur le territoire traditionnel des Tla’amin, sur la Sunshine Coast de la Colombie-Britannique. Elle fournit des soins primaires à faible obstacle et un traitement de la toxicomanie à des personnes souffrant de complexités croisées. Elle est membre du conseil d’administration de I’Association des infirmiers et infirmières en réduction des méfaits.
Amanda Lavigne est infirmière clinicienne spécialisée au sein de l’équipe de lutte contre la toxicomanie d’Interior Health. Amanda est un chef de file dans l’élaboration de programmes de lutte contre la toxicomanie et une experte clinique en matière de soins liés à la toxicomanie.
Geoff Bardwell est professeur agrégé à l’École des sciences de la santé publique de l’Université de Waterloo. Ses recherches portent sur la consommation de substances en milieu rural, dans le Nord et dans les petites communautés.