SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Prejudice continues and must be challenged (Oct 2006)

Joan, a longstanding patient of mine, died a few weeks ago. She was in her seventies and had had a full life - sometimes joyful, sometimes difficult. She had worked most of her life until retirement a few years ago, birthed 3 children, married and divorced, had 2 grandchildren, had a number of good friends and was a long-term maintained injectable methadone user. Her death was nothing to do with her drug use and it was one small part of her life, but it was often how she was defined. She dreaded every time she had to go into hospital fearing the reactions of the staff - during one admission, a classic statement by a doctor, one of many, that made me so angry was "what is a nice lady like you doing taking those horrible drugs? You don't really need them do you". We had to "negotiate" the continuation of her medication for every admission she had and, although she had been on the same dose of 120mg methadone for at least the last 10 years, the hospital team always wanted to reduce it.

During her last illness she was rarely visited by her family at home or in hospital. But she was visited as least daily by Alice, her best friend, who also did her shopping, collected her prescription and generally cared for her. Alice was also a patient and a long-term methadone user.

After her death, her best friend was distraught and the eldest son took on the funeral arrangements. When Alice phoned him to find out the details, his first question was "are you taking methadone"? She enquired why he wanted to know but also answered yes. He then said Alice was not welcome and refused to tell her where the funeral was. Alice, and ourselves/or/the practice, tried hard but unsuccessfully to find out when and where the funeral was to take place.

It is very rarely that I feel so appalled by a person's behaviour born out of such ignorance and prejudice. Both Joan's treatment in hospital and Alice's treatment by her friend's family shockingly remind me that foul misguided prejudice against people who use drugs is still very much alive/ever present. Those who use drugs experience frequent prejudice and mistreatment that damage the resilience and wellbeing of the person.

Those of us who feel that this is wrong, of which I hope and know there are many, need to confront it whenever we see or hear it and admit when we get it wrong. We need to avoid colluding with organisations that support this prejudiced view, and we need to challenge funders, trainers and others who reinforce it. We need to take care around language and not define a person solely by one element of them/by one aspect of their life? We need to support and empower our friends, patients, clients and colleagues to feel that they too can challenge this behaviour. It is a basic human right to be treated with respect and dignity and we forget this at our individual and collective peril.

- Dr Chris Ford