Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care

• Published in: Social science & medicine (1982) Vol. 260; p. 113183
• Main Author: Harris, Magdalena
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2020; Pergamon
• Subjects: Aged; Care; Cultural safety; Delivery of Health Care; Health; Homelessness; Humans; Infections; London; North America; Pain; People who inject drugs; Pharmaceutical Preparations; Risk; Skin and soft tissue; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - epidemiology; United Kingdom; Violence; London; United Kingdom; North America; Homelessness; Cultural safety; Health; Violence; Skin and soft tissue; United Kingdom; Risk; People who inject drugs; Infections; Care
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2020.113183

In the United Kingdom, increases in premature mortality among the intersecting populations of people made homeless and people who inject drugs map onto the implementation and solidification of fiscal austerity policies over the past decade, rather than drug market fluctuations and trends as in North America. In this context, it is crucial to explore how poverty, multi-morbidity and care delay interplay in exacerbating vulnerability to mortality among an aging population of people who use illicit drugs. The mixed methods Care & Prevent study generated survey data with 455 PWID and in-depth qualitative interviews with a subsample (n = 36). Participants were recruited though drug treatment services and homeless hostels in London from October 2017–June 2019. This paper focuses on qualitative findings, analysed thematically and contextualised in relation to the broader survey sample. Survey participants report an extensive history of rough sleeping (78%); injecting-related bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts emphasise engagement with the medical system as a ‘last resort’, with admission to hospital in a critical or a “near death” condition common. For many severe physical pain and debility were normalised, incorporated into the day to day. In a context of everyday violence and marginalisation, avoidance of medical care can have a protective impetus. Translation of cultural safety principles to care for people who inject drugs in hospital settings offers transformative potential to reduce serious health harms among this population. •Without prompt care, injecting-related infections can progress to systemic illness.•People who inject drugs face multiple barriers to health care access.•Participants incorporated severe debility into their day-to-day lives.•In contexts of normalised violence medical care avoidance can be protective.•Cultural safety provides a framework to reduce injecting-related health harms.