Mattering Matters: Identifying what influences people who use drugs to access emergency healthcare services

Abstract

People are dying on sidewalks, behind dumpsters, and in abandoned buildings. These are individuals living precariously with severe, long-term substance use disorders. They ingest, inhale, and inject toxic, contaminated substances, and their lives are shaped by overdoses, chronic illness, and poverty. This dissertation examines a cohort of individuals who use drugs and delay or avoid emergency hospital care, often resulting in severe health complications, including death.

People who use drugs (PWUD) experience complex, often tenuous relationships with healthcare systems. While they do access care, they face systemic barriers such as discrimination, long wait times, and the risk of withdrawal symptoms, however, there is a cohort who do not. Hospitals are frequently perceived as unsafe and stigmatizing environments, leading to delays or avoidance of emergency services. These patterns contribute to lower health outcomes, prolonged hospitalizations, and increased mortality. Although the literature extensively documents these barriers, little is known about their motivations, the why, how, when, and with whom that influence PWUD to access emergency healthcare.

This study used a mixed methods sequential explanatory design to explore, “What influences and motivates PWUD to access emergency healthcare services?” Conducted in Saint John, New Brunswick, the study involved two phases: Social Network Analysis (2022, n = 4) and Interpretive Description (2024, n = 40). The study examined PWUD with complex substance use and healthcare experiences, including individuals who delay, avoid, reluctantly access, or repeatedly use emergency services under conditions of extreme need. Data analysis supported by UCINET© and NetDraw© revealed that participants had dense, insular networks with limited access to external resources, constraining their healthcare-seeking behaviour.

Interpretive analysis identified four key concepts. Pain emerged as a primary motivator for seeking emergency care. In addition, connection, understood as meaningful social bonds, and perceived self-worth, defined as belief in one’s value and significance, contribute to an overall sense of mattering. Mattering, in this context, is essential for PWUD to engage with emergency healthcare services.

This study argues that mattering emerged as an important facilitator for emergency healthcare engagement among PWUD. These findings offer theoretical, clinical, educational, and policy implications for improving care for this marginalized population.