Addressing Stigma Around Opioid Abuse

Social stigma is a negative attitude, belief, or disapproval against a person or a group of people based on perceivable social characteristics. People affected by the opioid epidemic have to deal with the consequences of social stigma — directly or indirectly. 

Stigma Against Individuals With Opioid Abuse

According to the 2020 Nation Survey on Drug Use and Health, the majority of people who need treatment for opioid use disorder (OUD) aren’t getting it: only 278,000 people out of 2.5 million people received treatment for addiction.1 It’s tough to say whether stigma has affected this outcome, but the data is there to support it. For example, one study found that 78% of its respondents blamed individuals with opioid use disorder as the problem, with 72% feeling that some lacked the self-discipline to avoid addiction.2 Another study found that physicians largely had a lower regard for patients who had a substance use disorder.3 This research shows that many individuals with opioid abuse struggle with receiving empathy from the general public and their primary care providers.

Stigma Against Opioid Abuse Treatment

Medically Assisted Treatment (MAT) has been incorrectly stigmatized as substituting one drug for another, despite the fact that the program uses behavioral therapy in addition to medication to help curb withdrawals in patients. Even with multiple studies backing MAT as an effective option for individuals struggling with opioid abuse, access remains difficult for many people who don’t live near a certified opioid treatment program or have no means of transportation to one. 

Methadone, one of three drugs used for withdrawal treatment, has been under heavy restrictions for years. Until the COVID-19 pandemic, patients could only use methadone under strict supervision due to fears over potential misuse. These restrictions were lifted during the COVID-19 pandemic as state-wide lockdown measures prevented in-person visits, finally allowing individuals to take their medicine in the comfort of their own homes. Studies examining these new measures found that taking home methadone did not have negative outcomes for individuals undergoing treatment.45

Stigma Against Pain Treatment

Treatment of pain is treated differently now than it was when the opioid epidemic started in the late 90s. Before the release of Oxycontin, opioids were usually prescribed for cancer pain or short-term management after a surgery. With fears of addiction amidst a rising death toll, oncologists have been prescribing cancer less. One study found that opioid prescribing among oncologists declined 20% between 2013 – 2017, compared to 22% of non-oncologists.6 This decline also extended to cancer patients with a poor prognosis nearing the end of their life.7 Additionally, cancer patients reported negative interactions with their pharmacists that made it more difficult for them to obtain their prescriptions.8

Tips for Combating Stigma Around Opioid Abuse

Combating the stigma that people with OUD face is critical to ending the opioid epidemic so these patients can receive the care they need without feeling judged. Solutions could be as simple as not using certain words to describe OUD individuals, but policy changes could impact thousands and change the course of the opioid epidemic.

  • Verbiage: It is important for individuals with OUD to know that their addiction does not define or dehumanize them. Using words like “addict” or “drug abuser” has a negative connotation that ostracizes them from everyone else. They need to know that their providers and family have empathy for them.
  • Education: Incorrect assumptions about MAT programs can deter OUD individuals from this highly effective and proven method. Greater efforts need to be made to educate individuals about how MAT isn’t a crutch toward their progress.
  • Access: Many lack treatment options due to their location or the costs involved. Easing access to methadone during the COVID-19 pandemic is just one implementation that could help the millions of people with an OUD.

1 Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (pg. 41 – public domain)
2 Social Stigma Toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health–Oriented Policies | Psychiatric Services 
3 An Exploration of Emergency Physicians’ Attitudes Toward Patients With Substance Use Disorder
4 Full article: The impact of relaxation of methadone take-home protocols on treatment outcomes in the COVID-19 era 
5 Rural opioid treatment program patient perspectives on take-home methadone policy changes during COVID-19: a qualitative thematic analysis | Addiction Science & Clinical Practice | Full Text 
6 Temporal Trends in Opioid Prescribing Patterns Among Oncologists in the Medicare Population
7 US Trends in Opioid Access Among Patients With Poor Prognosis Cancer Near the End-of-Life
8 Cancer Patients’ Perceived Difficulties Filling Opioid Prescriptions After Receiving Outpatient Supportive Care