Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis

Phillip J. Summers, Julia L. Hellman, Madison R. MacLean, Vaughan W. Rees, Michael S Wilkes

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Skin and soft tissue infections (SSTIs) are prevalent among people who inject heroin (PWIH). Delays in seeking health care lead to increased costs and potential mortality, yet the barriers to accessing care among PWIHs are poorly understood. Methods: We administered a quantitative survey (N = 145) and conducted qualitative interviews (N = 12) with PWIH seeking syringe exchange services in two U.S. cities. Results: 66% of participants had experienced at least one SSTI. 38% reported waiting two weeks or more to seek care, and 57% reported leaving the hospital against medical advice. 54% reported undergoing a drainage procedure performed by a non-medical professional, and 32% reported taking antibiotics that were not prescribed to them. Two of the most common reasons for these behaviors were fear of withdrawal symptoms and inadequate pain control, and these reasons emerged as prominent themes in the qualitative findings. These issues are often predicated on previous negative experiences and exacerbated by stigma and an asymmetrical power dynamic with providers, resulting in perceived barriers to seeking and completing care for SSTIs. Conclusions: For PWIH, unaddressed pain and withdrawal symptoms contribute to profoundly negative health care experiences, which then generate motivation for delaying care SSTI seeking and for discharge against medical advice. Health care providers and hospitals should develop policies to improve pain control, manage opioid withdrawal, minimize prejudice and stigma, and optimize communication with PWIH. These barriers should also be addressed by providing medical care in accessible and acceptable venues, such as safe injection facilities, street outreach, and other harm reduction venues.

Original languageEnglish (US)
Pages (from-to)200-208
Number of pages9
JournalDrug and Alcohol Dependence
Volume190
DOIs
StatePublished - Sep 1 2018

Fingerprint

Soft Tissue Infections
Heroin
Health care
Abscess
Skin
Tissue
Skin Care
Pain
Substance Withdrawal Syndrome
Delivery of Health Care
Harm Reduction
Syringes
Bioelectric potentials
Health Personnel
Opioid Analgesics
Drainage
Fear
Motivation
Communication
Interviews

Keywords

  • Barriers to health care
  • Harm reduction
  • Health-seeking behaviors
  • Heroin
  • Injection drug use
  • Opiate withdrawal
  • Pain control
  • Skin and soft tissue infections

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis. / Summers, Phillip J.; Hellman, Julia L.; MacLean, Madison R.; Rees, Vaughan W.; Wilkes, Michael S.

In: Drug and Alcohol Dependence, Vol. 190, 01.09.2018, p. 200-208.

Research output: Contribution to journalArticle

Summers, Phillip J. ; Hellman, Julia L. ; MacLean, Madison R. ; Rees, Vaughan W. ; Wilkes, Michael S. / Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis. In: Drug and Alcohol Dependence. 2018 ; Vol. 190. pp. 200-208.
@article{423b8b3295ba4aa1b21b953dd9876db4,
title = "Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis",
abstract = "Background: Skin and soft tissue infections (SSTIs) are prevalent among people who inject heroin (PWIH). Delays in seeking health care lead to increased costs and potential mortality, yet the barriers to accessing care among PWIHs are poorly understood. Methods: We administered a quantitative survey (N = 145) and conducted qualitative interviews (N = 12) with PWIH seeking syringe exchange services in two U.S. cities. Results: 66{\%} of participants had experienced at least one SSTI. 38{\%} reported waiting two weeks or more to seek care, and 57{\%} reported leaving the hospital against medical advice. 54{\%} reported undergoing a drainage procedure performed by a non-medical professional, and 32{\%} reported taking antibiotics that were not prescribed to them. Two of the most common reasons for these behaviors were fear of withdrawal symptoms and inadequate pain control, and these reasons emerged as prominent themes in the qualitative findings. These issues are often predicated on previous negative experiences and exacerbated by stigma and an asymmetrical power dynamic with providers, resulting in perceived barriers to seeking and completing care for SSTIs. Conclusions: For PWIH, unaddressed pain and withdrawal symptoms contribute to profoundly negative health care experiences, which then generate motivation for delaying care SSTI seeking and for discharge against medical advice. Health care providers and hospitals should develop policies to improve pain control, manage opioid withdrawal, minimize prejudice and stigma, and optimize communication with PWIH. These barriers should also be addressed by providing medical care in accessible and acceptable venues, such as safe injection facilities, street outreach, and other harm reduction venues.",
keywords = "Barriers to health care, Harm reduction, Health-seeking behaviors, Heroin, Injection drug use, Opiate withdrawal, Pain control, Skin and soft tissue infections",
author = "Summers, {Phillip J.} and Hellman, {Julia L.} and MacLean, {Madison R.} and Rees, {Vaughan W.} and Wilkes, {Michael S}",
year = "2018",
month = "9",
day = "1",
doi = "10.1016/j.drugalcdep.2018.06.010",
language = "English (US)",
volume = "190",
pages = "200--208",
journal = "Drug and Alcohol Dependence",
issn = "0376-8716",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis

AU - Summers, Phillip J.

AU - Hellman, Julia L.

AU - MacLean, Madison R.

AU - Rees, Vaughan W.

AU - Wilkes, Michael S

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Skin and soft tissue infections (SSTIs) are prevalent among people who inject heroin (PWIH). Delays in seeking health care lead to increased costs and potential mortality, yet the barriers to accessing care among PWIHs are poorly understood. Methods: We administered a quantitative survey (N = 145) and conducted qualitative interviews (N = 12) with PWIH seeking syringe exchange services in two U.S. cities. Results: 66% of participants had experienced at least one SSTI. 38% reported waiting two weeks or more to seek care, and 57% reported leaving the hospital against medical advice. 54% reported undergoing a drainage procedure performed by a non-medical professional, and 32% reported taking antibiotics that were not prescribed to them. Two of the most common reasons for these behaviors were fear of withdrawal symptoms and inadequate pain control, and these reasons emerged as prominent themes in the qualitative findings. These issues are often predicated on previous negative experiences and exacerbated by stigma and an asymmetrical power dynamic with providers, resulting in perceived barriers to seeking and completing care for SSTIs. Conclusions: For PWIH, unaddressed pain and withdrawal symptoms contribute to profoundly negative health care experiences, which then generate motivation for delaying care SSTI seeking and for discharge against medical advice. Health care providers and hospitals should develop policies to improve pain control, manage opioid withdrawal, minimize prejudice and stigma, and optimize communication with PWIH. These barriers should also be addressed by providing medical care in accessible and acceptable venues, such as safe injection facilities, street outreach, and other harm reduction venues.

AB - Background: Skin and soft tissue infections (SSTIs) are prevalent among people who inject heroin (PWIH). Delays in seeking health care lead to increased costs and potential mortality, yet the barriers to accessing care among PWIHs are poorly understood. Methods: We administered a quantitative survey (N = 145) and conducted qualitative interviews (N = 12) with PWIH seeking syringe exchange services in two U.S. cities. Results: 66% of participants had experienced at least one SSTI. 38% reported waiting two weeks or more to seek care, and 57% reported leaving the hospital against medical advice. 54% reported undergoing a drainage procedure performed by a non-medical professional, and 32% reported taking antibiotics that were not prescribed to them. Two of the most common reasons for these behaviors were fear of withdrawal symptoms and inadequate pain control, and these reasons emerged as prominent themes in the qualitative findings. These issues are often predicated on previous negative experiences and exacerbated by stigma and an asymmetrical power dynamic with providers, resulting in perceived barriers to seeking and completing care for SSTIs. Conclusions: For PWIH, unaddressed pain and withdrawal symptoms contribute to profoundly negative health care experiences, which then generate motivation for delaying care SSTI seeking and for discharge against medical advice. Health care providers and hospitals should develop policies to improve pain control, manage opioid withdrawal, minimize prejudice and stigma, and optimize communication with PWIH. These barriers should also be addressed by providing medical care in accessible and acceptable venues, such as safe injection facilities, street outreach, and other harm reduction venues.

KW - Barriers to health care

KW - Harm reduction

KW - Health-seeking behaviors

KW - Heroin

KW - Injection drug use

KW - Opiate withdrawal

KW - Pain control

KW - Skin and soft tissue infections

UR - http://www.scopus.com/inward/record.url?scp=85050334380&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050334380&partnerID=8YFLogxK

U2 - 10.1016/j.drugalcdep.2018.06.010

DO - 10.1016/j.drugalcdep.2018.06.010

M3 - Article

C2 - 30055424

AN - SCOPUS:85050334380

VL - 190

SP - 200

EP - 208

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

SN - 0376-8716

ER -