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Stigma of addiction present within local health care system, but Calif. program provides model for change

Apr 26, 2022

People with substance use disorders encounter stigma from a variety of sources—family, friends, communities and even themselves. When seeking primary care treatment, for addiction-related conditions or other health concerns, people with substance use disorders also encounter stigma from health care providers. 

This was the focus of an April 14 webinar coordinated by Interact for Health. The presentation, which was attended by about 40 people, included results from a local focus group and information about CA Bridge. 

Focus group: Our needs as patients are minimized due to stigma   

The webinar began with a summary of a recent focus group conducted by Interact for Health in partnership with Caracole. The group included 15 people with substance use disorders who participate in Caracole’s harm reduction program. 

All 15 participants received care in an emergency room in Hamilton County, and 14 said they had experienced stigma in the health care system. Participants noted that they use drugs to maintain a feeling of normalcy—none could remember the last time they got high.  

“Once providers find out about substance use, the patient’s needs are minimized,” said Sachi Bhati, a fourth-year student at the University of Cincinnati who will be entering medical school in the fall. Bhati worked on the focus group with Interact for Health’s opioid team as part of her senior capstone project. 

Focus group participants noted that the stigma they encountered within the health care system is so great that they often attempt to treat serious medical conditions—such as skin abscesses—on their own to avoid an encounter with a provider. 

One participant said, “We are all human beings. At the end of the day, we should all be treated the same.” 

After analyzing the feedback from the focus group participants, Bhati and Interact for Health Senior Program Officer Sonya Carrico noted three areas for improvement: 

  1. Providers need to treat people with addiction like people. 
  2. Providers need to be willing to have whole health conversations.
  3. Providers and patients need to be able to call out stigma when they see it.

“Everyone deserves to be treated well, especially when they’re not feeling well,” Bhati said. 

Building a health care culture that cares 

The second part of the webinar featured speakers from CA Bridge, a program working to provide universal access to addiction treatment in all California emergency departments. CA Bridge began in 2018 with eight pilot sites and is currently in 133 sites. 

Between April 2019 and September 2021, it identified 52,719 people with substance use disorder and provided medication-assisted therapy to 23,848 people.  

The model consists of three parts: Treatment in the emergency department with buprenorphine, connections to community-based treatment and efforts to build a culture of harm reduction among providers, said Jennifer Zhan, an emergency medical physician at California Hospital Medical Center and the director of CA Bridge at the Public Health Institute.  

Dr. Rais Vohra provides CA Bridge services at UCSF Fresno Hospital. He presented a compelling example of the stark differences in emergency department treatment of a person with a seizure disorder and someone in addiction withdrawal.  

The health care system typically treats some brain illnesses—like seizure disorder—well, but the system fails patients with the chronic brain illness of opioid use disorder, Vohra said. 

CA Bridge navigators—many of whom are in recovery themselves— are present in the emergency departments to assist people with substance use disorders. This frequently includes setting up treatment referrals and harm reduction support. Navigators follow up with patients on an ongoing basis as well. 

Most importantly, the CA Bridge model is working to build a culture of care, Zhan said. It does not stigmatize substance use, it promotes harm reduction and trauma-informed practices, and it builds trust and respect, she said.  

Tommie Trevino, a CA Bridge navigator based at UC Davis hospital, noted, “I don’t ask people if they need treatment. I ask what they need right now. ... we are planting a seed.” 

While CA Bridge has seen success, Zhan noted that progress can be challenging at times, and may require systems and policy changes as well. But with health care providers as champions, she said, changes in how our health care systems treat people with substance use disorder is possible. 

For more information on CA Bridge, visit https://cabridge.org/.  

A recording of the webinar, presention slides and info about other recent webinars is available at https://www.interactforhealth.org/substance-use-disorder-webinars/.  

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