Most people aren’t “drug-seeking”
Most people aren’t “drug-seeking” yet our team hears this phrase often from other medical staff as we support our patients in navigating the ER and other visits. The predominant stereotype is, that if someone is experiencing homelessness, or if someone reports current or past substance use history, they must be in there for one reason and one reason only: drugs.
If people on the street want adequate pain medication, they can find WAY stronger things on the street than the hospital will ever offer them. In fact, many folks on the street and many people who use drugs actively Avoid emergency rooms due to stigma, mistreatment, medical trauma/distrust and the likelihood their legitimate pain will not be taken seriously.
A lot of people we support anticipate the hospital not addressing their legitimate pain and will self-medicate prior to going in--if they must go in-- to ensure they are not completely without pain management. This shouldn’t be the case. Alternatively, it can often take an outside advocate (such as our team) to request medical staff adequately address the patient’s health needs rather than dismiss their complaints and rush them out the door.
A patient’s frequent loss of prescriptions and returning for refills does not always mean drug-seeking. Living unhoused in our community means belongings are thrown out and destroyed regularly by Police and City workers, regardless of if medications are stowed in those belongings.
A patient reporting severe pain or higher than expected discomfort for the issue at hand does not always mean drug-seeking. People who use or have used opiates for long stretches can develop hyperalgesia, a heightened sensitivity making things feel much worse than they are. This person’s pain is legitimate, even if they are more sensitive as a result of opioid use. Also, sometimes, people are in legit extreme pain and no their body’s baseline and thresholds-- we all have different tolerances regardless of substance use history.
A person sleeping or dozing off while waiting for care does not mean drug-seeking (or drug-using). For many people on the street, the luxury of having a place to sit still without bother by police, City and business owners or NIMBYs is rare. Survival is exhausting. Survival while also navigating complex health issues? even more exhausting
A person who seems eager to leave and asks specifically for what they need is not necessarily drug-seeking. Many people--especially people experiencing homelessness and people who use drugs--have histories of institutional trauma. The medical world can be especially triggering and people do not wish to be there any longer than they need to. Bright lights, people asking for urine samples, people in their personal space, loud beeps, lack of control…these things can all be triggering for anyone, but especially people with institutional trauma and or previous traumatic medical experiences.
In addition, unhoused individuals often times must leave their belongings elsewhere with no guarantee they’ll be there when they return. Getting needs met and getting on their way can be stressful.
People who have ongoing chronic conditions or backgrounds in medicine (yes, even people who use drugs or live unsheltered can have this background!) may know what they need/what’s worked in the past and ask for it by name to facilitate faster care.
Stereotyping, treating poorly, dismissing and rushing care for patients simply because of their housing and substance use status perpetuates distrust in the medical field and avoidance of care later on, reduces health outcomes, and can ultimately be the death of people.
Are there some people who are “drug-seeking”--especially in emergency rooms? Sure! People will always find ways to get their needs met, housed or unhoused. In the past decade providers became more cautious, but pain hasn’t gone away. Under-prescribing , not listening to or supporting a patient’s complex needs has lead many to seek alternatives to find relief, often leading people to an unregulated and much more dangerous supply elsewhere, sometimes leading to fatalities.
As medical practitioners in various roles, we urge our fellow colleagues to consider their own internal biases when working with patients: Am I thinking this about this person because of the because of judgements I have about the way they are dressed? their lack of address? their past or current substance use? Would I treat a nicely dressed, housed person this same way? Could it be that this person is behaving a certain way simply because of trauma? exhaustion? survival? pain?