A call to action on addressing opioids stigma
Most media coverage about the opioid crisis in the U.S. focuses on rural communities and large urban centers. Small and midsized cities also have been affected by dramatic increases in drug use and overdose rates. In April, Reading police responded to 12 overdoses in one day.
A worsening opioid epidemic has been a trend nationwide, especially during the COVID-19 pandemic. In 2020 alone, 93,000 drug overdose deaths were recorded — 30% higher than 2019. The sheer number of U.S. citizens with past or current opioid use disorder — about 3 million — suggests that preventing OUD from developing in the first place is crucial. When people are already using drugs, there is an urgent need to protect them and others from harm, irrespective of where they live.
Public health experts support measures such as safe injection sites and access to Narcan — harm reduction approaches that reduce some of the worst consequences of OUD. They accept that not all drug use can be prevented, thus conditions under which drugs are used should be made safer. Advocates emphasize the need to treat people with substance use disorders with dignity and respect.
One harm reduction measure that is easy and cost-effective, yet underappreciated, is education. Education helps people understand that OUD is a chronic but treatable illness, and that users are not inherently dangerous. Increased education will go a long way toward eliminating shame and isolation caused by such stigma. Stigmatizing medical experiences are a major reason that people with OUD discontinue necessary medical care. Stigmareducing practices, however, are not widely used, despite a lengthy track record of research showing they can be effective lifesaving measures.
Exposure to opioids during adolescence sensitizes the developing brain, increasing risk for addiction into adulthood. Opioids hijack “reward pathways” in the brain that normally respond to natural pleasures but are hyperactivated in the presence of these powerful substances. In effect, the quest for opioids supersedes natural drives and leads to intense craving and constant relapsing.
Though the loss of control over drug-taking behaviors occurs at the neurobiological level, around three-quarters of Americans believe this condition is due to moral failing or lack of willpower. This attitude is detrimental to people with OUD, causing lifelong shame and guilt. Stigma is a major social determinant of health, potentially adversely affecting health outcomes as well as opportunities to pursue employment and healthy relationships.
Stigma is also a barrier to accessing and remaining in treatment services. Only onequarter of physicians receive addiction education during their medical training, and one-quarter feel that incorporating treatment into their practice would attract “undesirable patients.” Individuals seeking treatment for OUD report being dehumanized. As a result, many with OUD avoid health care situations or conceal their diagnosis.
Fortunately, the health outcomes of individuals with OUD can be vastly improved. Health care professionals can use patient-centered care and nonjudgmental language, including avoiding value-laden words like “dirty” during drug testing. Emphasizing health and social risk factors for OUD reduces blame on people with the condition and increases support for largescale public health programs addressing OUD. Reducing stigma promises to encourage people living with OUD to obtain necessary medical care.
This is a call to action for health care providers to learn about the social determinants of OUD and create nonjudgmental medical environments. Medical boards should prioritize stigma-reducing communication by offering training on compassionate care for this population.
Moreover, if individuals in influential positions, such as policymakers, provide accurate information to the public about the realities of OUD, misconceptions are likely to diminish, as will the corresponding stigma. It could save lives.
Madeline Jupina is a Master’s student at Penn State University and an intern with the National Prevention Science Coalition to Improve Lives. Diana Fishbein, Ph.D. is the founder and co-director of the National Prevention Science Coalition to Improve Lives.