Forgoing healthcare among high‑risk drug users from Porto: reasons and determinants

Background/Objectives: High-risk drug use is a major public health problem. Drug users have a worst health profile than the gen¬eral population and several reports suggest they have difficulty in obtaining needed healthcare. Little is known about healthcare utili-zation and/or the number of people who report forgoing treatment or care among drug users in Portugal, a pioneer country on drug use decriminalization and harm reduction strategies. Forgoing health¬care is associated with unfavorable health-related outcomes and higher medical costs. This study aimed to assess the levels of forgoing healthcare, and its reasons and determinants, among high-risk drug users from Porto (Northern Portugal). Methods: A convenience street-based sample of drug users from Porto municipality was assembled in April 2017. People aged 18 years or older who have used any type of drug at least once in the previous 12 months were included. A structured questionnaire covering socio-demographics, patterns of drug use, health status, healthcare utiliza¬tion and related barriers was applied. Age and sex adjusted logistic regression models were fitted to assess associations (Odds ratio, OR, and 95% Confidence Intervals, CI). Results: On total 321 drug users were evaluated. The majority were men and half were more than 55 years. 76% used drugs every day, mostly crack/cocaine, heroin and cannabis. The majority of the par¬ticipants, 85.4%, visited a healthcare service during the past year. The prevalence of forgoing or delaying care was 25.2%. The most common reasons to forgoing or delaying healthcare utilization were ’long wait¬ing times’, ‘neglect’, ‘not having money’, ‘bureaucracy’ and ‘discrimi-nation’. Other reasons for forgoing healthcare were ‘shame’, ‘long waiting lists’ and ‘the need to make appointments’. Forgoing health care was positively associated with poly drug use (more than two types of drugs in the last 12 months) (OR 2.258, 95%CI 0.973-5.241), discrimination by health professionals (3.059, 1.557-6.012), having psychiatric comorbidity (3.549, 1.624-7.755) and being a sex worker (2.544, 1.125-5.754). Conclusions/Recommendations: Although high-risk drug users from Porto reported high levels of healthcare utilization, many re¬ported forgoing healthcare. Poly drug use, discrimination and mental health problems were significantly associated with forgoing health¬care. Interventions should target these specific groups and should eliminate barriers to help increase access to and utilization of health services.