Non-disclosure of drug use in outpatient health care settings: Findings from a prospective cohort study in Vancouver, Canada

•Many people do not tell their health care providers about their drug use.•Indigenous people were half as likely to disclose drug use as their non-Indigenous counterparts.•Disclosure of drug use was associated with lower quality of care.•There is a need for culturally safe and non-stigmatizing care to address pervasive stereotyping in the health care system towards Indigenous people and people who use drugs.•Routine culturally safe screening and brief intervention for substance use disorders should be applied in outpatient health care services.