The Persistence of Stigma
Who knows if the stain of stigma will ever be erased from the practice of recreational drug use. Probably not. At least not while it’s illegal. As I’ve said before, that illegality is pretty much a directive to our society from our lawmakers to practice discrimination.
But it can be reduced. And apparently, there are efforts under way to achieve this. Governments have released policy documents addressing the issue, pronouncing their intentions to ‘eliminate’ stigma, yet thus far any efforts to address it seem piecemeal at best.
The reason people are paying attention to the issue of stigma is Hep C (and to a certain extent hep B). It is thought that if IDUs – a large percentage of who are leery of any contact of an official kind – are treated with the natural respect accorded an average citizen, then they will be more willing to step forward for treatment. Whether or not this is true, we are in possession of a rare opportunity to utilise government resources to an end that might improve quality of life for a marginalised and often struggling section of our community.
Not too long ago, when I was distributing promotional material for our Liver Tonic! event, I had an opportunity to see a cross section of contact points at which IDUs intersect with the medical establishment. These were generally the larger community clinics which provide pharmacotherapy and health care to a significant number of clients.
I’d like to share some of my impressions, without being too specific.
Some of these venues were white-walled and clinical. With potted plants, uniformed personnel and glass-fronted counters. The kind of places where one feels surveilled and subject to a long litany of regulations. Not quite ‘methadone mills’ but almost. Some were indistinguishable from any community medical centre in a poorer area, but an IDU seeking treatment at one of these places would be expecting at best a businesslike, rather than welcoming reception. Absent were any reassuring signs they would be accepted for themselves and not be subject to judgement. The tendency at these locations was for an unsmiling, dubious-looking receptionist to accept my Liver Tonic! posters and inform me they would find out from their superiors if displaying them was in line with establishment policy.
At the other end of the spectrum, and thankfully more common among the ten or so locations I visited, were clinics which barely seemed like clinics at all. Places with smiling, easy-going staff, designated chill-out areas, garishly decorated walls, and stacks of HRVic’s Whack Magazine. It’s obvious that an effort was being made to put the client at ease. At these places, I would be greeted with genuine interest rather than incomprehension, and invited immediately to paper the place with my posters and leaflets.
It’s clear which of these two species of venue is more likely to attract IDUs into treatment. The latter presents itself as a place for drug users, where a maximum effort is made to address their needs, while the former merely tolerates, tooling themselves against potential behaviours of the lowest common denominator.
It’s no secret that some drug users can be difficult to manage and prone to anti-social behaviours. It’s a sad fact, but true. However, it doesn’t mean that all should be tarred with that same brush. If anything is going to deter people from seeking treatment, it is an environment which perceives them as potentially threatening, violent, offensive or unreliable, and which visibly guards against these things. It is a horrible feeling being viewed like that, and it is entirely understandable that people would shy from it. The signs can be subtle, perhaps only revealed via the atmosphere of the premises, but instantly readable by a person sensitised through long years of stigmatisation. They can also be overt, expressed through signs on the wall, or behaviour-related contracts.
My own clinic probably falls on the less-welcoming end of the spectrum. It has a hoarding out front which mentions the word ‘addiction’, so even walking through the gate is something of a trial. But my doctor operates out of there these days, and I’m prepared to endure the place so I can continue to interface with a practitioner who knows and respects me.
Last week, I popped in to collect my pharmacotherapy script. I go there only once every few months, so I’ve never really gotten familiar with the place, or its vibe. But I do tend to notice the unpleasant transformation from normal citizen in the street to drug-fiend in the clinic.
When I entered, one of the receptionists was taking flash-photos of some of the clients. I almost backed out, but of course did not. I couldn’t. As I waited at the counter, he turned to me and asked for a photo. I shielded my face and replied, ‘very funny.’ It was the last place I wanted my photo taken, indeed I found it inappropriate that I would even be asked. After I sat down to wait, the receptionist assured me that they really did want my photo. I told him I thought he’d been joking, but nevertheless did not want my photo taken. It was only then that he handed me a printed sheet explaining that the clinic was seeking some kind of accreditation in the new year and required photographs of its clientele. I left it on the counter as I slipped in to see my doctor.
If you don’t understand why being asked for a photo in such a place is a disturbing thing, let me assure you my reaction was visceral and unpleasant. I’m sensitive about my drug-history, particularly in the official setting of a doctor’s surgery. I felt stigmatised, straight up, and it’s a horrible feeling. If I get asked again, I’ll tell them I’ll agree to a photo after my local civilian GP makes the same request. There are circumstances in which photos are required - in fact the clinic already has possession of a photo connected with my pharmacotherapy program - but to demand one in public with no explanation evinces a basic lack of respect.
Later in the day, I was shopping with my daughter and dropped off one of the scripts I’d acquired earlier at a nearby pharmacy. When I returned, I was informed that unless I wanted them to contact my doctor, I could only have it filled at the pharmacy designated on the script. I was confused and surprised. I thought there’d been a mistake. What if I’d been out of town? I imagined all kinds of circumstance in which I would not have been able to obtain my medication.
Now, the script in question was for valium, a drug I use for anxiety and as an occasional sedative. It is a benzo and as such can be associated with dependence, but for me it has never been more than a very useful medication. I compared this valium script with another I had been given that day, this time for a drug with no ‘potential for abuse’. This second script made no mention of a designated dispensing pharmacy.
By this stage, I was already irritated and angry. I thought I knew why this was happening. The pharmacy named on the script was where I pick up my monthly supply of suboxone (I’m lucky enough to be on a low maintenance program). I immediately suspected that because I was on opiate pharmacotherapy, it had been assumed I would abuse the valium and should obtain it from a pharmacist familiar with my situation. No matter that I have never been addicted to benzos, nor am likely ever to be. No matter that it is a drug which any regular person can obtain from any pharmacy they prefer.
Again, that feeling of being judged. The stigma feeling. You can’t mistake it. Worst of all, no one had bothered to inform me of the change in conditions. No one had assessed my case and used it to make a decision – it had happened automatically. An assumption had been made, a poor assumption, and I believed I knew then why my (very caring) pharmacist had asked me on several occasions if I wanted my valium dispensed daily from the ‘booth of shame’ where clients line up for their pharmacotherapy.
I’ve inquired a little about it since. There appear to be government guidelines suggesting such a thing, but I’ve never been subject to it before and I was not informed of the change. However, if you want an example of how stigma can infiltrate the life of even a stable, ‘low-maintenance’ client, this is a fine one. All up, it was an unpleasant day. I intersect so rarely with the system that I can sometimes forget how the system regards me, and I could really have done without its opinions.
These stories may give you some idea of how relatively subtle things can trigger a feeling of social exclusion and judgement. Stigma is a slippery, insidious hydra. It can never be slain, but it can be suppressed with increased awareness, thoughtfulness and care.
The Golden Phaeton
P.S. If you want our opinion on which are the best clinics to attend. Just give us a call.