This is so tricky. I work in a chronic pain clinic and we have this outlined in our Narcotic Agreement Contracts which are required by our College. I don’t think it’s a lack of empathy, I think it comes from prevention. Due to the fact that Narcotics are in itself very high risk, adding a street substance with unknown amounts of the drug and/or other chemicals on top of that puts the patient at an incredibly high risk for death from overdose. If the College were to find out out that a Physician continued to prescribe a controlled substance after discovering their patient recently used an illegally obtained controlled substance (street drugs) you can be prosecuted by your governing authority for Medical Negligence and Malpractice. This standard policy is to protect Prescribers, but it is also to deter patients from acquiring street drugs and succumbing to a fatal overdose.

When we urine test a patient and they are found to have a Cocaine metabolite in their urine, for example, we are not aware of where the drug came from, how much they have ingested or whether or not they are in danger of injury. The Physician will immediately inform the pharmacy and cancel the prescription, and ask the patient if they need an urgent referral to an addiction centre. We are not stigmatizing them because they used drugs. We are protecting ourselves legally, and more importantly, protecting the welfare of the patient.

I agree with the aspect of the stigma though. Many Doctors will outright refuse to treat you if they find out you have a drug history, which is inappropriately discriminatory and wrong. It should absolutely affect whether or not you are qualified to take Opioids, and how your Physician should care for you, but not used against you to deny treatment.