The Unique Nature of Public Stigma Toward Opioid Use Disorders: A National Study

Abstract

Background: Drug use stigma is associated with avoidance of health services and substance abuse treatment, lower odds of recovery, and susceptibility to mental and physical health conditions among people with opioid use disorder (OUD). In this study, we examine the nature and magnitude of public stigma toward OUD relative to other disorders. Methods: We examined data from the nationally-representative 2018 General Social Survey. Respondents (N=1,169) completed a vignette-based survey experiment to assess public stigma toward people with OUD compared to depression, schizophrenia, alcohol use disorder (AUD), or normal troubles using multiple regression. Findings: Adjusting for controls, Americans were significantly more likely to label symptoms of OUD a physical illness (73%, CI 66-80%; P<.001) relative to all other conditions, and less likely to label OUD a mental illness (40%, CI 32-48%; P<.001). Opioid use disorder was significantly less likely to be attributed to bad character (37%, CI 30-44%; P<.001) or poor upbringing (17%, CI 12-23%; P<.001) compared to AUD. Nonetheless, perceptions of competence associated with OUD (e.g., ability to manage money; 41%, CI 33-49%; P<.01) were lower than AUD, depression, and normal troubles. Moreover, willingness to socially exclude people with OUD was very high (e.g., 76% of Americans do not want to work with a person with OUD), paralleling findings on traditional targets of strong stigma (i.e., AUD and schizophrenia). Interpretation: In contrast to prior research on drug use stigma, Americans largely do not hold people with opioid use disorder responsible for their addiction. However, the public nonetheless endorses high levels of social exclusion and perceptions of incompetence. Reducing opioid use stigma will require strategies that differ from traditional anti-stigma campaigns, emphasizing the value of affected individuals and potential for recovery. Funding Statement: National Science Foundation, National Institute of Mental Health, Brain and Behavior Research Foundation, National Center for Advancing Translational Sciences. Declaration of Interests: Drs. Perry, Pescosolido, and Krendl have nothing to disclose. Ethics Approval Statement: IRB approval for the GSS is held at NORC (#93216) and exempt approval for the NSS module at Indiana University (#1703882292).