The UK has one of the highest rates of recorded illegal drug misuse in the western world despite a rapid expansion over the past 10 years of drug treatment.
Although new posts such as “substance misuse nurse” or “addiction nurse” show a change in the culture of care for addiction, many nurses still loathe and fear substance misusers, describing giving care to them as the most unrewarding and unpleasant experiences of their clinical careers.
This response is hardly surprising given that criminalisation is a powerful stigma, and as a result nurses are bound to find it difficult to provide appropriate and compassionate care to those that society generally regards as criminals. Faced with this reality should nurses support recent calls for the decriminalisation of drug use?
The question comes at a time when health specialists and journalists are looking at Portugal, where drug use has been decriminalised, (not legalised - an important distinction) for the last decade with dramatic results. Users are treated as having a health and social problem. Giving up addiction as a result of legal sanction or coercion is accepted as unrealistic, and resources are put towards mitigating risk for individuals and the wider population by harm reduction, treatment and reintegration. The move has not resulted in higher rates of drug use or turned Portugal into a magnet for drug tourists. In fact there have been recorded reductions in HIV diagnoses, overdose deaths, petty crime and drug experimentation among young people.
Our country’s attitude to drug use is riddled with hypocrisy. Those drugs that have the greatest potential to harm are not necessarily those that are controlled by law. Use of alcohol, tobacco and prescribed tranquillisers are not prohibited, though tens of thousands die prematurely each year from their adverse affects. Conversely, prohibited drugs are used far less and cause fewer fatalities, yet carry massive stigma and the threat of criminalisation.
Nurses may often experience a conflict between personal views on drug use and professional responsibilities towards drug users. A punitive attitude to drug users among some healthcare professionals is a logical outcome of classing a health problem as a crime. Such stigmatisation must hamper effective care and result in inappropriate and judgemental treatment. Negative attitudes may also compromise the rehabilitation of drug users by hindering a professional’s ability to deliver primary health care and health promotion messages with the sincerity required for success.
As a district nurse, I regularly come into contact with this client group and have experienced some of the negative attitudes towards drug users, not only from nurses but also medical staff.
It seems the condemnatory notion that they have ‘brought it upon themselves’ is often applied to drug users, but rarely to those with illnesses associated with smoking, obesity or those over-indulging in prescribed and non-prescribed medication.
Stephen Riddell is a district nurse working in Dumfries and Galloway