S2 Ep6: Improving care for racialized people who use drugs

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Summary

In Canada and around the world, colonial histories continue to influence people’s access to determinants of good health. Our society continues to advantage White people, and addiction medicine is no exception.

In this episode, Dr. Robert Fox, David Ball, and their guests discuss the intersections of race, ethnicity, and substance use.  How can we make our clinics more accessible for people of different racial and ethnic identities? How can we unlearn our own racial prejudice? In this episode, we use the term ‘racialized’ to indicate groups who are marginalized according to race as a part of their identity.
 

Lineup

In this episode, you’ll hear:

• 4:31 – Dr. Siu Ming Kwok – Academic Director, University of Calgary School of Public Policy, and President, Alberta College of Social workers
• 19:00 – Paul Choisil – Harm reduction advocate, and member of the People with Lived and Living Experience Council (Health Canada), and the PEEP Consultation and Advisory Board (BCCDC)

 
Pearls

Here’s what listeners can take away from this episode:

1. In caring for people who use drugs, recognize the history and context that shapes the lives, choices available and opportunities of our patients. This includes the relationship between racism and drug prohibition and the ongoing impact of drug prohibitionist policies that have—and continue to—enact disproportionate harm on racialized and Indigenous communities.
2. We have all been socialized in a society that is racist. As a result, we carry unconscious bias that can impact the way care is delivered. Critically reflecting on biases that we carry and the policies and services we offer can be an important way to improve the way we offer care for racialized people who use drugs.
3. Racism is systemic and personal and is not something our patients can turn off or not experience. Without changing our systems, we may still work in contexts that perpetuate racism and racist policies, even in progressive settings. People in leadership positions need to be mindful of reviewing and changing policies and practices that are rooted within racist system.
4. Seeking out opportunities to learn about anti-racism and sharing them with colleagues can help create a clinic space that is more accessible and inviting for racialized patients. Taking a truly anti-racist approach involves a process of continual learning.
5. Remember that many racialized people who use drugs will have already experienced stigma and discrimination in healthcare settings. In addition to other aspects of cultural competence, Indigenous harm reduction and trauma informed practice can help in developing cultural safety in the clinic.

 
Resources

De-centring western colonial approaches

• Policy brief: Indigenous harm reduction = reducing the harms of colonization. 2019. [Online].
• Downtown Eastside Women’s Centre. Red Women Rising. [Online].

Articles

• Burgess, D.J., van Ryn, M., Crowley-Matoka M., Malat, J. Understanding the provider contribution to race/ethnicity disparities in pain treatment: insights from dual process models of stereotyping. Pain Med. 2006;7(2):119- 134. https://doi.org/10.1111/j.1526- 4637.2006.00105.x PMID:16634725
• Farahmand, P., Arshed, A., Bradley, M.,V. Systemic racism and substance use disorders. 2020. Charles B. Slack, etc. doi:10.3928/00485713-20201008-01
• Hall, W.J., Chapman, M.V., Lee, K.M., et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105(12):e60-e76. https:// doi.org/10.2105/AJPH.2015.302903 PMID:26469668
• Khenti, A. The Canadian war on drugs: structural violence and unequal treatment of Black Canadians. Int J Drug Policy. 2014 Mar;25(2):190-5. doi: 10.1016/j.drugpo.2013.12.001. Epub 2013 Dec 18. PMID: 24418631.
• Kwok, S. Exploring the Experiences of Chinese in Drugs Treatment Programs in Vancouver. 2000. The British Journal of Social Work, 30(5), 663–672. http://www.jstor.org/stable/23716175
• Matsuzaka, S., Knapp, M. Anti-racism and substance use treatment: Addiction does not discriminate, but do we?, 2020. Journal of Ethnicity in Substance Abuse, 19:4, 567-593, DOI: 10.1080/15332640.2018.1548323

Additional resources

• Canadian Drug Policy Coalition. History of drug policy in Canada, summarized from Busted: An Illustrated History of Drug Prohibition in Canada by Dr. Susan Boyd
• Fraser Health. Considering culture in our care for immigrants and refugees. 2016. [YouTube video].
• Indigenous Corporate Training Inc. A Look at First Nations Prohibition of Alcohol. 2016 [online].
• In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care. 2020. [online].

 

Photo by National Cancer Institute on Unsplash