Breaking the vicious cycle of delayed healthcare seeking for people who use drugs

Background: People who use drugs (PWUD) are at increased mortality risk, yet they typically avoid healthcare settings due to stigma and shunning. Understanding the healthcare journey from the viewpoint of PWUD has been understudied, although it is essential for informing solutions to increase healthcare access to improve their healthcare outcomes. We aimed to understand the process of accessing healthcare for PWUD, including perceived barriers and facilitators, by exploring their experiences, attitudes, and beliefs. Methods: We employed purposive sampling to recruit PWUD to participate in nine focus group discussions (FGDs) (N = 57) in Athens, Greece. Inclusion criteria required a history of injection drug use, internet access, and Greek verbal fluency. The FGDs were audio-recorded, transcribed, translated into English, and de-identified. We analyzed FGD transcripts using modified grounded theory. Results: Participants’ mean (standard deviation) age was 47.9 (8.9) years, 89.5% (51/57) were male, 91.2% (52/57) were of Greek origin, and 61.4% (35/57) had attended at least 10 years of school. We identified three key themes from the FGD transcript analysis: (1) seeking care after an individual’s rapid health decline, (2) facing barriers in accessing healthcare, and (3) building trust to improve access to healthcare for PWUD. Participants disclosed that they tended to seek healthcare after a rapid deterioration in their health. They experienced multiple barriers to healthcare access such as stigma, healthcare system mistrust, unresponsive emergency medical services and competing priorities such as homelessness, mental health challenges, and ongoing manifestations of substance use disorder (SUD). Participants’ recommendations to build patient-provider trust and improve healthcare access include stigma minimization, promotion of empathy in the patient-provider relationship, and engaging community organizations that serve PWUD to build bridges with healthcare providers and institutions. Conclusions: PWUD in Athens, Greece demonstrate delayed health-seeking behaviors and report multifaceted healthcare access barriers including stigma, delays in emergency care, poor mental health, homelessness, and SUD manifestations. Key trust-building processes to expand healthcare access include minimizing stigma and promoting empathy in healthcare encounters, enhancing healthcare staff education on SUD, improving the responsiveness of emergency medical services, engaging community organizations, and exploring telehealth’s role in improving healthcare access for PWUD.