The UK is currently experiencing what experts are calling an opioid crisis or opioid epidemic. Prescriptions for opioids more than doubled from 1998 to 2018 and are used for the long-term treatment of pain despite being extremely addictive. Deaths from opioid overdoses have largely followed the prescription levels. Prescription drug use can also be a gateway to illicit drug use. Many people who use heroin started by taking prescription drugs. Stigma about substance use can be a barrier to people getting support and treatment for drug addiction, and therefore contributes to harm caused by drugs.
Why Do People Take Substances and What Do They Look Like?
Stigma takes away the nuance of substance use and addiction, avoiding the complicated reasons why many people use substances. Many people who have substance use disorders have suffered trauma such as childhood neglect or other abuse and have untreated or mistreated mental health conditions. Trying to treat someone for a substance use disorder without dealing with the underlying reason for their substance use will almost never work. It is necessary to get to the root of their substance use. For many, substance use is not about seeking a fun time but about trying to feel normal and avoid pain and withdrawal symptoms. This requires dealing with the underlying reasons for this pain. Alcohol Rehabilitation often fails for this particular reason, because there is no room to address the underlying depth of despair, only a surface level plaster on a bullet hole in 28 days.
Stigma can also affect how someone sees their own drug use. Many people will downplay their problem with substances because they have a perception of people who use drugs. There is a stereotype that people who use substances are unemployed, homeless, and shooting up on the street. For one, this image should not be seen with such judgement; some people are in this situation and deserve the same support as anyone else. Additionally, most people who have a problem with drugs are not in this situation and may think that they do not have a problem because they do not fit the stigmatic image of someone who uses drugs. Many people who use drugs are in employment, they may snort drugs rather than injecting, they may have a family and many friends. However, drug use can spiral out of control especially if you develop dependence and a substance use disorder.
Drug Policies and Stigma
Drug policies and laws can create and exacerbate harm by feeding into stigma. Penalising people for drug possession can cause them to be scared to seek help if they need it. They may be worried about getting help if their friend overdoses, and this fear could contribute to a fatal overdose.
There are ways that policies can help if they are put in place. Fentanyl is a growing worry as it is increasingly being used either unintentionally due to dealers cutting other drugs with fentanyl or intentionally due to its high potency. Fentanyl is about fifty times more potent than heroin and about one hundred times more potent than morphine. Just a small amount can lead to an overdose. Fentanyl testing strips are cheap and easy to use but are not commonplace. Policies could be put in place to require fentanyl testing strips to be more accessible. In addition, naloxone is a drug which quickly reverses the effects of an opioid overdose. It can be made available to people who use opioids and their friends and family. One reason policies are not put in place to prioritise harm reduction is due to stigma; people focus on abstinence rather than harm reduction.
Stigma is the greatest barrier to addiction treatment. People using substances may feel judged and shameful and not feel worthy of help due to this. Stigma can also prevent families from helping those who need it. They may also feel shame, guilt, anxiety, and blame towards their loved one. This may affect their ability or desire to help them. Family can play an important role in supporting someone with a substance use problem. Having a strong support network through treatment is very important.
Treatment itself is also a target of stigma. Some people believe that drug replacement, which is often used during detox and in some cases for much longer, is just getting a person to use a different substance. However, these methods can be very helpful for some. For example, benzodiazepines are sometimes used in the treatment of alcohol use disorders. Withdrawing from alcohol can be extremely unpleasant and even fatal. Benzodiazepines cause a similar response in the brain so using them can cause less severe withdrawal symptoms. Once a person has detoxed, they can taper off the benzodiazepines until they are free of both substances. It is still important to be careful with these treatments as benzodiazepines and opioid replacement drugs such as methadone are also addictive. Undergoing treatment with the support of a trusted medical professional can help with this.
Another barrier to treatment is portrayed by a problematic saying, “once an addict, always an addict.” The term addict puts the blame on the person taking drugs, and the saying itself makes seeking treatment seem fruitless. While long-term sobriety can be difficult, many go on to live long and happy lives after getting treatment. They may experience setbacks such as relapses and cravings, but this does not mean that they will not manage to stay sober.
Substance-related deaths continue to increase year by year, but not enough is being done to address the silent killer, stigma. Stigma can be a barrier to treatment, it can isolate people who use drugs from their family and friends and inhibit access to much needed interventions which can reduce harm. The focus for drug users is on abstinence-based treatment but dissolving stigma and making harm reduction interventions more available could help. The aim of harm reduction is to keep those who use drugs alive and protect their health. Support is not dependent on whether a person will commit to abstinence or not. This has been shown to be an effective approach. People are likely to use drugs more safely and to seek treatment when they have drug problems. A big reason this approach works is that it requires you to break down stigmas, respecting people who use drugs, their decisions, the reasons they use drugs, and letting them guide their own substance use and treatment.
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