Reducing Stigma Education Tools (ReSET) > 01. Stigma and Opioid Use Disorder

01. Stigma and Opioid Use Disorder

MODULE 1 | SECTION 1 OF 5

Stigma and Opioid Use Disorder

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Learning objective


Explain how stigma may contribute to
decreased access to evidence-based care.

Stories from People in Recovery

Opioid Use Disorder is the Public Health Crisis of Our Time

Opioid use that places individuals at risk of overdose is the public health crisis of our time. Over 20 million adults in the United States have a substance use disorder including alcohol and illicit drugs such as cocaine, methamphetamine, and opioids.1

 

In 2017, more than half of all drug overdose deaths were related to opioids.2 While the following presentation is focused on opioid use disorder (OUD), it is important to recognize that our healthcare system was not designed to treat substance use disorders as a whole

and instead perpetuates harmful beliefs that addiction is a moral failing and not a medical disease. This results in decreased quality of care and access to care for substance use disorders including OUD.

 

Many of these clinical and policy issues are rooted in bias and stigma and will be further described in the following modules. As we begin to explore the relationship between stigma and the care of patients with OUD, let’s discuss what stigma is and how it comes to manifest in the minds of individuals, including healthcare professionals.

How does the mortality rate for drug overdoses compare to other causes of death in the United States?

In this interactive exercise, you will be presented with four partially completed mortality charts. Use your cursor to draw the remaining annual mortality values for Drug Related Deaths, HIV, Guns, and Motor Vehicle Accidents (MVA). Once you’ve completed the four charts, you will be able to see how your responses compare to each other and to the actual values.

Drugs Guns HIV MVA

Use your cursor to draw what you think are the remaining annual mortality values for Drug-Related Deaths.

The Number Who Die each Year From Drug-Related Deaths

Use your cursor to draw what you think are the remaining annual mortality values for Guns Deaths.

The Number Who Die each Year From Guns

Use your cursor to draw what you think are the remaining annual mortality values for HIV Deaths.

The Number Who Die each Year From HIV

Use your cursor to draw what you think are the remaining annual mortality values for Motor Vehicle Accidents(MVA) Deaths.

The Number Who Die each Year From Motor Vehicle Accidents

How do your responses for each cause of death compare to each other? How do you think your answers will compare to the actual values?

More adults die each year from drug-related deaths than from guns, HIV, and motor vehicle accidents. Continue reading below to learn how stigma associated with drug addiction contributes to it's higher mortality rate.

Adapted from New York Times

The modern word “stigma” comes from the term “stizein”, which was a mark burned onto the skin of slaves to signify their low place in the social hierarchy in ancient Greece.3 There are several definitions for stigma. Some describe stigma as a social construct whereby a mark of disgrace, similar to a stizein, is applied to a specific population in order to easily identify and devalue them.3

Others refer to stigma as “an attribute that links a person to an undesirable stereotype, leading other people to reduce the bearer from a whole and usual person to a tainted, discounted one.”4

To make meaningful steps forward in eliminating stigma, we need to distinguish it from stereotypes, prejudice, and discrimination.5 Let’s review how these terms connect to one another:

Patients with OUD often attempt to avoid the “mark”, or label, that may associate them with negative stereotypes.5 This label avoidance, and resulting stigma avoidance, is a consistent barrier for many patients who desire the ability to seek help and treatment.

 

Once patients experience societal stigma and discrimination, they often experience feelings of self-stigma.5 Patients may begin to agree with the societal stereotypes, such as believing they are “bad” people, and as a result they may feel unworthy of receiving care. This cycle can continue until patients with substance use disorders feel as though there is no point in even trying to interact with the healthcare system.6-8

Development of Provider Stigma

Among medical students and resident physicians, stigmatizing attitudes towards patients with substance use disorders often increases during training.9–11 Opioid use disorder is viewed more negatively and harshly compared to other disorders involving substances such as alcohol.9

 

This stigma lingers into post-training practice.12

 

Only 20% of general internists feel prepared to screen individuals for substance use disorders, 1 in 3 internists view substance use disorders as being dierent from other chronic diseases, and 1 in 10 believe that those who use substances inappropriately should be punished.12 In the emergency department, working with patients who have substance use disorders may be seen as unsatisfying and those patients may be seen as irritating.13

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  1. Englander H, Collins D, Perry SP, Rabinowitz M, Phoutrides E, Nicolaidis C. “We’ve Learned It’s a Medical Illness, Not a Moral Choice”: Qualitative Study of the Effects of a Multicomponent Addiction Intervention on Hospital Providers’ Attitudes and Experiences. J Hosp Med. 2018;13(11):752-758. doi:10.12788/jhm.2993
  2. Finnell DS. A call to action: Managing the neural pathway of disgust, bias, prejudice, and discrimination that fuels stigma. Substance Abuse. 2018;39(4):399-403. doi:10.1080/08897077.2019.1576091

REFERENCES

  1. 1-Lipari R, Van Horn S. The SBHSQ Report: Trends in substance use disorders among adults aged 18 or older. June 2017. https://www.samhsa.gov/data/sites/default/files/report_2790/ShortReport-2790.html.

 

  1. 2-National Institute on Drug Abuse. Overdose Death Rates. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Published January 29, 2019. Accessed December 14, 2019.

 

  1. 3-Link BG, Phelan JC. Conceptualizing Stigma. Annual Review of Sociology. 2001;27:363. doi:10.1146/annurev.soc.27.1.363

 

  1. 4-Goffman E. Stigma: Notes on the Management of Spoiled Identity. 2nd ed. New York: Simon & Schuster; 1963.

 

  1. 5-Corrigan PW, Nieweglowski K. Stigma and the public health agenda for the opioid crisis in America. International Journal of Drug Policy. 2018;59:44-49. doi:10.1016/j.drugpo.2018.06.015

 

  1. 6-Crapanzano K, Hammarlund R, Ahmad B, Hunsinger N, Kullar R. The association between perceived stigma and substance use disorder treatment outcomes: a review. SAR. 2018;Volume 10:1-12. doi:10.2147/SAR.S183252

 

  1. 7-Akdağ EM, Kotan VO, Kose S, et al. The relationship between internalized stigma and treatment motivation, perceived social support, depression and anxiety levels in opioid use disorder. Psychiatry and Clinical Psychopharmacology. 2018;28(4):394-401. doi:10.1080/24750573.2018.1478190

 

  1. 8-Corrigan PW, Bink AB, Schmidt A, Jones N, Rüsch N. What is the impact of self-stigma? Loss of self-respect and the “why try” effect. Journal of Mental Health. 2016;25(1):10-15. doi:10.3109/09638237.2015.1021902

 

  1. 9-Avery J, Knoepflmacher D, Mauer E, et al. Improvement in Residents’ Attitudes Toward Individuals with Substance Use Disorders Following an Online Training Module on Stigma. HSS Jrnl. 2019;15(1):31-36. doi:10.1007/s11420-018-9643-3

 

  1. 10-Lindberg M, Vergara C, Wild-Wesley R, Gruman C. Physicians-in-training Attitudes Toward Caring For and Working with Patients with Alcohol and Drug Abuse Diagnoses: Southern Medical Journal. 2006;99(1):28-35. doi:10.1097/01.smj.0000197514.83606.95

 

  1. 11-Avery J, Han BH, Zerbo E, et al. Changes in psychiatry residents’ attitudes towards individuals with substance use disorders over the course of residency training: Attitudes Towards Substance Use Disorders. Am J Addict. 2017;26(1):75-79. doi:10.1111/ajad.12406

 

  1. 12-Wakeman SE, Pham-Kanter G, Donelan K. Attitudes, practices, and preparedness to care for patients with substance use disorder: Results from a survey of general internists. Substance Abuse. 2016;37(4):635-641. doi:10.1080/08897077.2016.1187240

 

  1. 13-Mendiola CK, Galetto G, Fingerhood M. An Exploration of Emergency Physicians’ Attitudes Toward Patients With Substance Use Disorder: Journal of Addiction Medicine. 2018;12(2):132-135. doi:10.1097/ADM.0000000000000377

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