Where Opioid Use Disorder Stigma Comes From and How to Prevent It
Opioids, such as heroin and oxycodone, are pain-relieving medications that can sometimes lead to dependence and addiction.
Opioid use disorder (OUD), formerly known as opioid addiction, has become an increasing concern in the United States. This mental health condition involves a pattern of opioid use that may become difficult to manage or begin to interfere with daily life.
During the late 2010s, the national rates of OUD decreased, but the COVID-19 pandemic appears to have sharply reversed that trend. In 2020, 2.7 million people had OUD in the United States, making the condition more common than ever before.
Despite its prevalence, OUD carries a lot of stigma. In a nutshell, “stigma” means other people may view you negatively for having the condition.
OUD stigma can make it harder to get help for your mental health, and make it harder to get treatment.
Learn more about the origins of OUD stigma, how it harms people, and what you can do to support loved ones with OUD without stigma or judgement.
“Stigma” is an umbrella term for prejudice, discrimination, and other social burdens society places on certain groups of people. In a sense, it serves as a metaphorical “
OUD stigma can be many things.
Public stigma
Public stigma is the collection of negative beliefs about people with OUD, such as the idea that people with substance use disorder are somehow dangerous.
Stereotypes are still fairly common despite the fact that they are less common.
According to a 2018 national poll from The Associated Press-NORC Center for Public Affairs Research:
- A lack of will power was blamed by 44% of Americans.
- 32% of Americans thought OUD was a sign of poor upbringing.
Enacted stigma
People act on their negative beliefs about OUD.
This might involve overt discrimination, like a company illegally firing you for getting OUD treatment. It might also involve more subtle stigma, like your neighbors giving you the cold shoulder after you disclose your diagnosis.
Internalized stigma
It is considered to be stigmatized if you adopt OUD stereotypes into your own view.
For example, you may reject OUD treatment if you feel convinced you just need to have stronger willpower to handle opioid withdrawal. When that doesn’t work, you might (falsely) decide you’re simply incapable of change and give up on getting support and treatment.
Courtesy stigma
People who use drugs are not the only ones who experience stigma. It is possible for loved ones and colleagues to be stigmatized for not preventing opiate use.
For instance, a community may
Structural stigma
Structural stigma is the way in which negative attitudes can manifest. Some hospitals have a hard limit on the number of prescriptions you can get.
Even if you continue to experience pain, hospital medical professionals may label further requests for medication as drug-seeking behavior.
Stigma against OUD was not out of thin air. It is a result of cultural biases and propaganda.
Ableism
Unlike a rash or a broken bone, pain isn’t always obvious to an outside observer. There’s a
But pain isn’t merely a matter of comfort. Chronic pain can lower function in many areas, including:
“Doctors who fail to acknowledge the impact of chronic pain may consider someone’s desperation for treatment to be illogical.”
And when someone chooses to search elsewhere to get the pain relief they need, like by using heroin or off-label pills, for example? Society may then treat them as someone who failed to use the healthcare system properly, rather than someone whom the healthcare system failed.
It is not a good idea to buy drugs online.
Racism
In a 1994 Harper’s Magazine interview, one of former President Nixon’s aides admitted the administration’s “War on Drugs” was motivated more by politics than medical concern.
More specifically, Nixon’s administration focused on discrediting critics in Black communities by prosecuting heroin use in the 1970s.
In the 1990s,
Part of this stigma relates to the enduring myth that Black people feel less pain than white people.
One
Half of the participants endorsed at least one false belief. The endorsers rate pain for hypothetical Black patients as less than pain for white patients. They were less likely to prescribe pain-relief to black patients because of fear of drug misuse.
Disinformation
The Sackler family knew their prescription drugs had more addiction potential than they had thought. The Sacklers planned to shift blame for OUD to the people who were experiencing it.
According to lawsuit documents from the Minnesota attorney general’s office, Richard Sackler wrote in a 2001 corporate strategy email: “We have to hammer on the abusers in every way possible. They are the culprits and the problem.”
The company used a public relations campaign to make people think they were the victim.
Richard Sackler claimed that people with OUD get themselves addicted to products from Purdue at the expense of decent people.
The myths stemming from that campaign have had a lasting effect on OUD stigma.
There are serious effects on your mental health from OUD stigma.
If your community excludes or blames you for having a recognized health condition, you may have a harder time finding emotional support. Internalized stigma can also lower self-esteem and lead to feelings of shame and guilt.
Adults with OUD are
Having thoughts of suicide?
If you feel overwhelmed or depressed, you can get help from a crisis hotline.
Trained crisis counselors can listen to you, talk to you, and give you guidance when you need it.
- Text-based support: Text “HOME” to 741-741 to reach the Crisis Text Line.
- Phone support: Dial 988 to reach the National Suicide Prevention Lifeline.
- Support for LGBTQIA+ young adults: Call 866-488-7386 or text “START” to 678-678 to reach The Trevor Project. You can also chat online.
“Everyone deserves compassionate support during a crisis. You are not alone if you don’t know who to talk to.”
Stigma can damage your health by making it hard to get healthcare.
It can be difficult to deal with OUD stigma.
Seek treatment
OUD treatment is safe, effective, and legal. But in the United States,
If people in your community are heavily stigmatizing opiate use, you may avoid treatment.
- “It’s jeopardizing your employment.”
- harming your relationships
- Facing pity or disrespect from healthcare professionals.
- losing custody of your children
- Legal difficulties.
Find treatment
You may have trouble finding healthcare professionals who offer treatment near you if you are ready to get it.
Some doctors are reluctant to give medication for opiate treatment.
- fear of
being audited by the Drug Enforcement Administration - Considering people with OUD as difficult or dangerous.
- People who have OUD are not being avoided by choosing not to work with them.
Research from 2019 examined the attitudes about OUD held by Massachusetts emergency, family, and internal medicine professionals.
Nearly 1 in 4 professionals in this group believed their practice would attract “undesirable patients” if they treated OUD.
Receive healthcare unrelated to opioid use
Methadone and buprenorphine are medications for OUD (MOUDs). Despite overwhelming evidence that MOUDs have benefit in the treatment of OUD, some people believe treating OUD with medication is “trading one addiction for another.”
They believe that people who take these medications will develop an addiction to them instead, or eventually resume using opioids.
This can make it hard to access certain healthcare services, like organ transplants. Doctors may deem you ineligible for transplant for fear you may “waste” a donated organ by damaging it with opioid use. They may also suggest MOUDs could make your body reject the organ.
This discrimination can be dehumanizing, since it categorizes people who have used drugs as less deserving of treatment.
Furthermore, these so-called concerns have no supporting evidence. Existing research suggests people taking MOUDs have the same rates of transplant success as the general population.
According to a 2018 poll by the American Psychiatric Association, a third of the U.S. population knows someone with a history of OUD. If you’re one of these people, you may wonder how you can help your loved one recover from the disorder without stigmatizing them for it.
These tips can help.
Offer practical assistance
OUD treatment may involve a mix of medication, counseling, and support groups. It can be difficult to build a care team that can offer affordable services.
It is possible to help your loved one research their options and make the process of finding healthcare professionals and starting treatment simpler.
There are treatment programs for the drug Opioid.
Consider carrying naloxone
Naloxone is a medication that can reverse the effects of opioid overdose. In most U.S. states, you can get naloxone
You may never need naloxone, but in the event your loved one ever does experience an overdose, having this medication on hand may save their life.
Mind your language
People in OUD treatment sometimes use
Members of an OUD support group may call themselves “addicts” or “opioid abusers.” They can trust each other to understand the terms.
“It doesn’t mean that you can call your loved one an addiction. Throwing labels around is only reinforcing stigma.”
It is safest to use person-first language, like “They have OUD” or “They are in recovery from OUD.”
It is always a good idea to ask your loved one which terminology they would like you to use.
Respect their privacy
People with OUD have the same right to privacy as anyone else. The person with OUD needs to decide who they trust with their health information because of the risk of rejection.
You should not share what they told you without their permission.
“If you tell others behind your loved one’s back, it can derail the recovery process.”
Your loved one might be.
- Stop trusting you with information if you consider your disclosure a betrayal.
- They are unsure of who they know about their condition.
- Fear of becoming even more vulnerable makes people less motivated to seek treatment.
You and your loved one should establish who you want to inform before the event. If questions come up in the conversation, you should be prepared.
Get therapy yourself
Supporting someone through OUD treatment may often feel stressful. You may worry about their health or feel frustrated at the pace of recovery, just as you might when caring for a loved one with any other chronic health condition. You may also encounter stigma yourself for supporting your loved one unconditionally.
If you feel overwhelmed, know you don’t have to deal with this alone. Therapy offers a safe space to talk out your feelings unfiltered.
“Since therapy is confidential, you don’t have to worry about exposing your loved one’s health information to the local rumor mill, the way you would by talking with a friend or neighbor”
You might also consider free, confidential support groups. One of the most well-known support groups is NAR-ANON. It’s a 12-step program for family members of people with substance use disorders.
People with OUD can face stigma from friends, co-workers, and even doctors.
Much of this prejudice and discrimination against OUD stems from broader biases like racism and ableism. Regardless of the source, stigma can block your access to appropriate OUD treatment, reinforcing the very condition it punishes you for having. But with patience and support, recovery from OUD is absolutely possible.
“OUD is a diagnosis, not a flaw. You don’t need to feel guilty for seeking help.”
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.
