Understanding the damage of stigma

As far back as she recalls, Jane Dicka has experienced addiction in some shape or form.
 
‘I’ve been dependant on a range of different things for as long as I can remember. Some of them were illicit and some weren’t,’ she told newsGP.
 
‘In fact, I don’t recall any period of time when I wasn’t dependent on something? I can recall frantically rushing home from school to make sure I didn’t miss my daily fix of afternoon TV shows.’
 
With more than 35 years of lived experience, Jane is passionate about the health and human rights of people who use drugs (PWUD) and is a strong advocate against stigma and discrimination.
 
But gaining the title of ‘lived experience advocate’ was not always something Jane wanted.
 
‘I’m an advocate by default,’ she said.
 
‘I wished I’d never disclosed [my drug use] but once it was out there, I figured I may as well try and use it for some good, kinda like taking one for the team.
 
‘Prohibition means that no one is willing to be a spokesperson for PWUD, like why would you? But once my mouth put it out there, it’s not something you can take back – so here I am!’
 
Having worked with PWUD in various frontline roles for more than twenty years, Jane currently coordinates the Health Promotion Team at Harm Reduction Victoria.
 
Additionally, she has a seat on the Board of the International Network of People Who Use Drugs, and the Australian Injecting and Illicit Drug Users League, the national peak organisation focused on advancing the health and human rights of people with living or lived experience of drug use. 
 
‘My work with Harm Reduction Victoria is something I am very passionate about, coming from a belief that drug use is a human right and should be treated as such,’ Jane said.
 
‘The Health Promotion Team is responsible for all our blood-borne virus and overdose education.
 
‘We aim to increase access to testing and treatment for all blood-borne viruses with a strong focus on hepatitis C as we work toward the strategic goal of elimination by 2030.’ 
 
In Australia, uptake of hepatitis C treatment is not meeting targets due to ongoing stigma, with the latest Kirby Institute report revealing that 40% of people who inject drugs had experienced stigma in a healthcare setting.
 
Alarmingly, one in five have experienced stigma even within drug and alcohol services, with various national programs aiming to address this are underway, including Beyond the C and mobile outreach clinics.
 
On a broader level, Australia is seeing the rollout of more harm-minimisation strategies, which are supported by the RACGP, including medically supervised injecting centres, needle and syringe programs, take-home naloxone programs, and drug testing sites.
 
But harm reduction starts at the grassroots level, according to the RACGP, with GPs and other healthcare professionals as the vital starting point to eliminate the stigma associated with drug use, and to build a long-lasting, trusted relationship.

 When it comes to supporting people who use drugs, lived experience advocate Jane Dicka says there is ‘no one-size-fits-all’ approach.

For Jane, drawing on her own ‘mixed’ experiences with the healthcare system, she agrees, and said overcoming stigma and discrimination is the first step to supporting people who use drugs.
 
‘I have had some really good experiences and I have had some absolutely dreadful ones too,’ she said.
 
‘The scary part is I have had no control over how they went down. Having to rely on someone else’s attitude and opinion as to whether or not you will receive good healthcare isn’t something anyone should have to deal with.’
 
Later this month, Jane is giving a keynote address at the RACGP’s General Practice in Addiction (GPADD) conference, presenting on stigma, the ‘overlooked pathology’.
 
She hopes this session will engage GPs providing support for people experiencing addiction, including through being aware of suitable approaches and current training opportunities.
 
‘Language first and foremost – addiction is such a loaded word, dependence is a way more acceptable term, but the only way someone is going to be aware of nuances like that is if they keep up to date with training,’ she said.
 
‘For those GPs who have been practising for many years it’s even more important they attend current and relevant training sessions on offer.
 
‘Things change over time, just like new treatments and medications become available as we learn better ways to treat medical conditions, so too does the language we use.
 
‘Remember that we are all individuals and should be treated as such. There is no one-size-fits-all. GPs shouldn’t be afraid to respectfully ask someone about appropriate language to use for an individual patient if they aren’t sure.’
 
Additionally, Jane’s advice to GPs is that many PWUD find it ‘very hard’ to find a GP they feel comfortable enough with to be 100% open and honest with due to the ongoing stigma and discrimination they experience.
 
Jane said because PWUD may often be ‘hidden’, assumptions should be off the table.
 
‘Just like the overweight person who is being treated for high cholesterol doesn’t tell the GP about the sneaky McDonalds hamburger they ate, PWUD find it even harder to disclose their drug use,’ she said.
 
‘People in general need to understand there are way more of us out here than you realise. For every stereotypical visible drug user that you see who isn’t coping with their drug use, there are hundreds more of us who use drugs every day without incident.
 
‘We are hidden, and we choose to be that way due to prohibition and the stigma and discrimination that goes with it. We are your friends and work mates, your brothers and sisters, the people you meet every day.
 
‘We just don’t tell you that we use drugs because of the reasons I have already mentioned.’
 
At the upcoming GPADD conference, Jane has a simple takeaway message for her keynote address.
 
‘I really hope that people understand how much damage stigma does and how it acts as a barrier to people being open and honest with their healthcare providers,’ she said.
 
The GPADD conference is on Saturday 27 July at the Pullman Albert Park, Melbourne, from 9.00 am – 7.00 pm (AEDT). For more information and to register, visit the RACGP website.
 
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addiction medicine AOD GP–patient relationship harm reduction lived experience mental health PWUD stigma substance use