North America is currently in the midst of an unprecedented opioid epidemic. The number of opioid-related deaths is rising steadily across Canada, with the highest mortality rate occurring in British Columbia [1]. Many individuals with opioid use present with several comorbidities including co-occurring mental illness and polysubstance use [2]. These factors contribute to several cross-cutting health and social challenges, often limiting treatment initiation and increasing opioid-related harms [3]
Individuals with both psychiatric and substance use issues are at increased risk for drug-related death [4], especially following periods of abstinence and reduced tolerance, such as hospitalization [5]. Harm reduction interventions, such as take-home naloxone and supervised consumption sites, are important elements of care and are associated with a reduced risk of overdose death [6]. Despite a robust body of evidence supporting the public health benefit of harm reduction interventions [7], stigma and related barriers (e.g. discrimination, lack of knowledge) can limit their availability across the health system [8]. Existing research consistently reveals that health care professionals hold negative beliefs about people with substance use disorders [9], and these attitudes may worsen over time for dually diagnosed patients [10]. Unfortunately, these stigmatized perceptions, such as abuse of health system resources or failure to adhere to recommended care and treatment [11, 12], often contribute to inequitable and poor provision of care including reduced access to harm reduction resources [13]. For example, in acute psychiatric settings addiction-related stigma among clinicians has been associated with poor harm reduction integration [14, 15]. The acceptability of harm reduction approaches among clinicians is an important determinant of increased implementation of essential, evidence-based services to combat the ongoing opioid epidemic.
Given the disconnect between the scientific evidence for and the resistance to harm reduction among health care providers, it is critical to examine how clinician attitudes towards substance use influence the harm reduction best practices in psychiatric settings. The objective of our study was to explore mental health clinician attitudes towards substance use and associations with clinical experience and education level.