Harm Reduction or Stigmatization: What’s Your Approach to Drug-Addicted Patients?


By Alison Bulman, senior editorial coordinator

How much of your nursing education focused on how to handle drug addicts and substance abuse? Probably not much, according to speakers at a recent event I attended with my colleague Christine Moffa, AJN’s clinical editor, at the Center for Health, Media, and Policy at Hunter College.

The event was focused around a clip (longer than the one above) from “Bevel Up: Drugs, Users and Outreach Nursing,” an award-winning film by Canadian documentary filmmaker Nettie Wild. (A photo of a street nurse from the program appeared on AJN’s cover in July 2009, along with an article about the program.) Fiona Gold, BA, RN, and Juanita Maginley, MA, BSN, RN, whose work in Vancouver is the subject of the film, spoke on the panel about the value of harm reduction and about the systemic flaws and tendency to stigmatize drug addicts that prevent health care from reaching this population.

The powerful clip showed street nurses searching the city’s alleys and housing complexes for drug addicts, dealers, and sex workers. They carry bags full of syringes, condoms, and crack pipe mouthpieces which they deliver to those willing to take them. They ask street patients whether they might be pregnant, have unsafe sex, may have a disease, and if they want to have the nurses draw blood for testing.

The outreach project started in response to Vancouver’s alarming increase in HIV infections. Medical services were not reaching the most vulnerable people, so nurses devised a plan to go to them, a strategy they referred to as “meeting the client where they are.”

The reviews made by Ryan Hampton, it’s clear as day, that the nurses in the film show an amazing ability to balance gentle persistence and respect for the autonomy of their patients. We all know that some health care workers, including nurses, can be contemptuous of drug addicts, and may perceive addiction as self-indulgent and little more than a burden to the system. And far more money is spent on criminalizing drug use than on treating drug addiction as a disease.

My colleague Christine’s reaction to the clip reflected her experience as a nurse: ED nurses’ job “is difficult, and patients who are using drugs are not always easy to deal with.” But she also stressed that nurses don’t have a choice who they work with, and that the best approach we can take is to make sure they get enough training, both at school and at work, to meet the needs of this population.

To order the DVD of this film, which includes  a teaching module, go here. It’s sure to start some lively conversations among health care workers.

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Isahy Mendez April 13, 2016 at 2:35 pm

    Drug addiction is more common than we think it is because it isn’t highlighted as it should be due to is negative perception. Patients who deal with addiction should be treated as a disease and I commend these nurses who treat these patients who are struggling. The street nurses in the video go above and beyond by risking their lives in an environment that isn’t safe. I also find outreach program fascinating because the nurses go out of their comfort zones to educate, treat, comfort, and heal people with drug addictions. It isn’t easy for drug addicts to step into an emergency department and admit to their addiction to drugs, sex, or abuse without feeling as they are being judge or ignored, which may hinder healthy and open communication relationships between the potential patient and the healthcare professional. If we continue to outweigh the stigmatism that is put on mental health and all other diseases that are associated with it, I believe more people with addiction will be more prone to seeking help. I wish to follow in the footsteps of these wonderful “street nurses” who provide excellent nursing skills.

  2. Andrew Moniz April 19, 2015 at 10:20 pm

    I strongly agree and applaud the work these nurses are doing. There is a strong prejudice towards drug addicts in general, and they are often referred to as “drug seekers” in the medical and nursing fields. Few people seem to understand the disease of addiction once it takes control of the person. In addition, there are very few resources actually going to the successful treatment of addiction rather than incarceration of addicts. These nurses are pioneers in their field.

  3. lissette April 5, 2012 at 2:21 pm

    I agree that nurses do not have patience in taking care of this type of population. when at my hospital we receive one of these patients that no one wants to take care of them because they know that they will be a difficult patient especially if they come in with a drug overdose since it is very difficult to control them from the withdrawals and to calm them since the medication does not affect them like it would a person without drugs in their system. I know it is a hand full but I also think that nurses should be taught more in school on how to go about in caring for these patients since their plan of care is totally different from another patient. They allot of more special needs and so many things can go wrong so they need to teach what to look out for and how to prevent it. The nurses are the ones who stay at bedside of the patent so if the nurse does not know what to look out for then things can go bad really quick.

  4. jessie castillo November 21, 2011 at 9:42 pm

    Drug addiction is an extremely prevalent problem in today’s society. Due to it’s prevalence, nurses are constantly forced to face their own attitudes towards drug addiction. This program in Vancouver allows drug addicts receive care on their own terms without being judged. They can also receives item that they otherwise would not have access too such as clean syringes. This way if they do continue to abuse substances, they will not be exposing themselves to other potential health problems. The program also allows nurses to see drug addicts as real people that are struggling as opposed to just a walking diagnosis.

  5. Yesenia Baena November 21, 2011 at 9:35 pm

    Dealing with patients who are drug addicts can be a challenging task due to their constant denial or neglect to change. However, nurses from Vancouver developed a plan where they would search city alleys and personally educate these patients. I believe this is a great plan because it allows nurses to assess and treat these patients who normally will not seek help. Therefore, the ultimate goal is to reduce the chance of spreading communicable diseases such as HIV infection. In addition, this article is a great example of courageous and brave nurses who risk their lives, but believe in helping drug addicts.

  6. cynthia gonzalez November 21, 2011 at 8:45 pm

    Drug addiction is a serious problem, moreover a serious disease. I very much agree that many people believe otherwise that it is a disease, more like a hobby for these drug users. Drug addiction opens the door to other problems, such as sexually transmitted diseases, homelessness, and other acts that are against the law. I believe there is a barrier between nurses and drug addicts because of the social stigma on drug users. I really admire this program that was organized by nurses because when it comes to being a patient’s advocate there is no better way than going out to the community to help this population that that for the most part is voiceless to educate and to prevent further issues.

  7. Florencia Alvarado November 21, 2011 at 5:49 pm

    Reading this article made me realize that addicts have a lot of other problems that arise from the addiction. Addicts may place themselves in a position that makes them vulnerable to diseases in order to get access to the drugs they are seeking. In my opinion, the program that these nurses have created is extremely valuable to society. Recovering addicts and the diseases they acquire require a lot of help and the programs that help them can become very costly. The best way to help these costs go down is through prevention of these secondary diseases. I believe this program will be beneficial to many addicts and will greatly help bring down costs.

  8. Emilio Perez November 21, 2011 at 5:43 pm

    After reading this article it made realize that drug addicts are at increased risks for major problems besides their addictions. Drug addicts often put themselves in situations that exposes them to diseases just to get access to drugs. In my opinion, this program that the nurses came up with is very helpful. Recovering from addiction is a very long and costly process; therefore, if nurses can prevent making this process more difficult through prevention of secondary diseases this will help addicts recover faster. In the long run I think this program will beneficial for addicts that are at the greatest risk for secondary infections like homeless addicts.

  9. Claudia Alonso November 21, 2011 at 5:35 pm

    Reading this article has made me realize that drug addicts have several other problems that tie into their addiction. There are many instances where these individuals expose themselves to diseases for the mere satisfaction of a drug “high”. The program started by the nurses is very beneficial to those suffering from addiction because it focuses on prevention. In the long run this program will help addicts recover faster because it prevents exposure to disease by taking a safe approach and providing condoms and needles to those at highest risk. All in all, this program will be most helpful to those populations at highest risk such as the homeless.

  10. Raissa Molina November 21, 2011 at 1:21 pm

    I admire those nurses that have the patience, compassion, and determination to make a difference and help those groups of people which most others would cringe away from. It is not an easy task to do what they do and as a nursing student I can agree that not enough time is spent in class developing the necessary skills to deal with drug addicts and substance abuse. It is easy to judge a book by its cover, however, like my professors constantly stress to us, we must see and treat the patient in a holistic manner. The patient is not just made up of body parts, instead their emotions, life circumstances, and experience make up who they are and influence their health status. That is why I agree that more time, money, and effort should be spent on treating the disease that addiction is rather than punishing the user.

  11. Giselle V. November 21, 2011 at 12:12 pm

    The use of illicit drugs in the U.S. is a fast growing problem that comes interconnected with such issues including HIV and other communicable diseases. The work of these “street nurses” in Vancouver provides an amazing opportunity to combat the growing spread of these diseases while maybe not directly treating actual addictions but providing means in the future to stop them. Treating drug addicts by no means is an easy task therefore it seems innovative to start the care by providing them with the supplies to continue their addiction and in the process tackle the possible spread of diseases they could acquire.

  12. jm November 21, 2011 at 11:27 am

    The thoughtful comments on this post are nice to see. It’s good to know people are willing to engage these tough questions without falling back on old categories of thinking or resorting to incendiary language. Many people can’t move beyond seeing drug use as a moral issue that must be condemned and punished, which costs everyone a lot of money and grief…we fill up our prisons and get no closer to a real solution. It’s hopeful for the future of nursing to read these more nuanced views. Thank you all! -Jacob M., AJN senior editor/blog editor

  13. Oscar November 18, 2011 at 5:53 pm

    This is an amazing program that they came up with. At first I was completely against the idea but as I finished reading the article it made more sense to me. Addiction is a disease that is very hard to overcome and treat. Drug addicts are not exactly the nicest or most inviting people in the world, but this article made me realize that although their addiction is a problem if we could prevent them from getting other diseases and ultimately spreading those diseases to others then we in the long run have done more good than harm by providing them with supplies to continue their addiction.

  14. Danay Cancela August 1, 2011 at 9:50 pm

    Nurses are definetely not educated to deal with drug addicts. There is still a stigma against drug addicts in hospital settings. When we encounter one in the hospital we try to stay apart and to not give that much attention to that patient.The outreach nursing project can serve as a educational and inspirational tool of what we, nurses, can provide to those drug addicts in order to minimize sexually transmitted diseases,such as HIV.

  15. Elizabeth Gachette April 18, 2011 at 10:25 pm

    What an amazing outreach program! These “street nurses” are taking a stand towards decreasing HIV infections. They leave their homes and go door to door to provide care for these drug addicts. They simply want to help them from getting sick. I agree with the article that all too often when drug seeking patients come to the hospital that they are judged and treated harshly. At least, these “street nurses” can reduce the amount of HIV infections through providing clean needles and offering blood tests for illnesses and pregnancy. I found the video shocking in the sense that it focus on children being drug addicts. When I picture drug seekers in the hospital, I think of adults. These addicts grew up in an environment where their care givers were addicts. It was sad to see one kid who became a crack addict at the age of 13, and he talks about his father and grandfather being addict as well. These “street nurses” are providing a needed service for this community by not only supplying necessary medical equipment to these people but educated them as well.

  16. Y. Llambes April 6, 2011 at 10:17 pm

    Vancouver… Amazing. The only word that comes to mind when thinking of these “street nurses”. They leave thier houses everyday knowing that they will go face a tough crowd. Nurses at public hospitals are not to far behind from my ‘amazing’ title. There, you never know what will walk into that ER… or even be bakered in. I definitely agree with the need of there being training needed for the care of the addict patient. There is a CE on how to insert IV’s and withdrawl blood on tattoeed patients, why is there no education out there on this topic? A nurse is not one to judge, or at least should not be, but when we walk into a rrom and we notice an agressive, and most of the time uncontrollable patient, it does become a sight to fear. It is unpredictable as to what that patient will do next. Knowing what to do is the only thing that we CAN do…

  17. Karen Jitta Bell November 22, 2010 at 10:54 pm

    The topic of drug addicted patients can be a very sensitive issue. Many drug addicted patients already come with the apprehension that they will be stereotyped because they are involved in substance abuse. Many lie about the fact that the use drugs all together. They don’t realize that hiding this information could lead to their true diagnosis being missed. From experience, we have had patients come in with chest pain. No significant family history, but will deny the use of illicit drugs. Only because they don’t want to be judged or “frowned” upon. Drug addicts, stereotypical means someone who gives their lives to drugs or completely engulfed in the use of drugs daily. However, there are many nurses and doctors who are drug addicts. Most are hidden well. The fear of losing their place in society as a respectable citizen could be damaged if the truth about their drug use exists. Therefore, they lie about their substance abuse. I personally, do not place judge on anyone. No one can tell looking at a person as to why they do the things that they do. Therefore, unless I know the whole story. I treat every one equally and not discriminate or “look down” on someone because of their life choices. Instead, I offer my assistance or the assistance of the services of the community.

  18. Ana Perez November 22, 2010 at 9:27 pm

    I agree with the outreach program in Vancouver. It is with no doubt that many individuals who are addicted to drugs, having unprotected sex and even the homeless with no food, sanitation or healthcare will benefit from a program like this. Many of these may not be aware of the resources available to them, as they may also feel embarressed to seek help. Indeed, these individuals will be more receptable to nurses and workers who are willing to reach to them, educate them, and provide an escape to their cycle. With sufficient training and funding, I feel that this would be a great organization to serve out population in need.

  19. Uday Dasari November 22, 2010 at 8:26 pm

    The work of street nurses is well appreciated. We need more of these type of nurses and organizations in the United States to help the growing number of homeless people, who majority are addicted to drugs, practice unsafe sex or practice poor health maintenance. The city of San Francisco already has such programs helping some drug addicts with needle exchange programs and blood testing. We need a national movement that can bring change that’s more measurable. We need to be able to sway the minds of law makers, organize funding, and also change the minds of the people regarding this sensitive issue. Bevel up is a great documentary that covers the issues of drug addiction. Issues like these should be incorporated in the community health nursing curriculum in all nursing colleges. I hope we see more documentaries like these so people can be educated on this issue.

  20. Yesenia November 22, 2010 at 7:18 pm

    I agree with the work of the nurses in Vancouver, and I admire them. I work in a rehab clinic for clients in pain, mostly back and neck. I see patients daily who are in need of narcotic medications on a daily basis and they cant just stop taking them because of the pain and the withdrawl symptoms. The doctors I work with understand this and they refer the patients to a center for pain such as the Rosomoff Center for pain, which helps patients withdrawl from narcotics and provide alternative pain control. I agree that we should ALWAYS be sensitive to patient’s addictions no matter what because we are there to help and not to judge.

  21. Jrose028 November 21, 2010 at 3:29 pm

    Harm Reduction or Stigmatization. What’s Your Approach to Drug-Addicted Patients?
    Drug addiction seems to be one of the hardest habits for many drug addicted patients to break, and it seems as if many more persons are becoming addicted to drugs, mainly narcotics.
    I have worked in many hospitals where there are patients who were called ‘the frequent flyers’ because they go from hospital to hospital to receive narcotics. There should be better ways to rehabilitate these people who are addicted to narcotics to take the pressure off the health care system and to prevent them from harming themselves and others. I believe that these patients should be monitored in the system so when they check in to different hospitals they will be tracked and monitored, so the amount of pain medication that is given to them can be also monitored. With this system the actual amount of drug addicts can be identified and they can be treated properly.

  22. jm November 8, 2010 at 4:42 pm

    Doug, thanks for drawing this to our attention! -Jacob

  23. Doug Olsen November 8, 2010 at 1:28 pm

    These nurses and this service were recognized for their extraordinary service with the International Centre for Nursing Ethics Human Rights and Nursing Award given at the ICNE Annual conference in Turku, Finland in Sept-2010.

  24. […] Welcomes Senior Fellow Ji…Tweets that mention … on Welcome Senior Fellow Joy…Harm Reduction or St… on CHMP’s Media Policy and Harm R…Harm Reduction Insig… on Thursday, October 28th […]

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