Opioid Stigma Research Articles

Sociodemographic Characteristics and the Stigmatization of Prescription Opioid Addiction.

The aim of this study was to investigate the relationship between participants' sociodemographic characteristics and the degree to which they stigmatize people with an opioid addiction. A randomized, between-subjects case vignette study (n = 2605) was conducted with a nationwide online survey. We investigated how the stigmatization toward a hypothetical individual who misused prescription opioids differed across participants' sociodemographic factors (ie, age, gender, education, race, and income). Our results showed that study participants who were male, white, low-income, college graduates, and younger rated the hypothetical individual with an opioid addiction with lower stigma. In addition, we showed that participant gender moderated the relationship between information given about initiation of opioid use (received prescription opioids from a doctor vs took prescription opioids from a friend) and opioid stigma perceptions. Our results support previous findings that stigmatizing attitudes towards drug use vary across participant sociodemographic characteristics. The findings from our study provide a better understanding of how stigmatizing attitudes towards prescription opioid use differ across sociodemographic characteristics and can serve to improve negative perceptions of those with an opioid addiction.

Ambiguous identities of drugs and people: A scoping review of opioid-related stigma

BackgroundHuman beings have long consumed opiates and opioids for pleasure and as a treatment for numerous ailments, most notably pain. North America is currently in the grips of a crisis of opioid-related overdoses, and stigma is considered a major driver of the harms. While it is well established that substance use in general is highly stigmatized, stigma is a complex concept and opioid-related stigma is not well understood. A lack of clarity on opioid-related stigma has practice and policy implications in terms of understanding the sources of opioid stigma, how it manifests in various contexts, its impact on affected groups, and the development of effective strategies to redress it. MethodsWe performed a scoping review of the academic literature to develop a typology of opioid-related stigma. A charting process identified the type, agent, and recipient of stigma as well as the methodology and substances considered. ResultsOur search yielded 8,543 articles, from which 49 were included in the analysis. Based on the findings, we developed a typology of four main themes: (1) interpersonal and structural stigma toward people accessing opioid agonist therapy (OAT); (2) stigma related to opioids for the treatment of chronic pain; (3) stigma in healthcare settings; and (4) self-stigma. ConclusionHow opioid-stigma is (re)produced depends on the context of opioid use, the social identity and networks of the person who is consuming the opioid, and what type of opioid is being consumed, including medically-sanctioned forms of treatment. Opioid-related stigma permeates intrapersonal, interpersonal, structural, and societal levels, and people who consume opioids are marginalized at all levels. Our review describes our typology of stigma and illuminates multi-level considerations for reducing opioid-related stigma in healthcare settings.

Cancer and Opioids: Patient Experiences With Stigma (COPES)—A Pilot Study

ContextCancer-related pain is a common symptom that is often treated with opioids. However, legislation aimed at containing the opioid crisis, coupled with public fears about opioid risks, may contribute to opioid stigma in cancer patients. To our knowledge, no prior research has examined opioid stigma and stigma-related behavior in this population. ObjectiveThe objectives of this study were to describe opioid use, including reasons for use and overuse and underuse behavior; characterize opioid stigma; and identify potentially maladaptive stigma-related behaviors. MethodsParticipants were 125 adults undergoing active cancer treatment seen at the Moffitt Supportive Care Medicine Clinic. Patients completed a brief, anonymous questionnaire evaluating opioid use, opioid stigma, and stigma-related behaviors. ResultsPatients were primarily women (65%) aged 45-64 years (49%), most commonly diagnosed with breast (23%) and hematologic (15%) cancer. Among patients who reported opioid use (n = 109), the most common reason for use was pain relief (94%), followed by improved sleep (25%). A subset of patients reported using less (13%) or more (8%) opioid medication than advised. Opioid stigma was endorsed by 59/97 patients prescribed opioids (61%), including fear of addiction (36%), difficulty filling prescriptions (22%), and awkwardness communicating with providers (15%). Stigma-related behaviors were endorsed by 28 (29%) respondents prescribed opioids, with “taking less opioid medication than needed” as the most commonly endorsed behavior (20%). ConclusionTo our knowledge, this study provides the first evidence of opioid stigma and its consequences in cancer patients and offers potential targets for interventions aimed at reducing stigma and encouraging safe, effective opioid use.

A new brief opioid stigma scale to assess perceived public attitudes and internalized stigma: Evidence for construct validity

One key strategy to improve treatment access for persons with opioid use disorder (OUD) is overcoming stigma that is internalized by such individuals. Because few theoretically-derived, multidimensional measures of substance abuse stigma exist, we contribute a brief, theoretically-based measure of opioid-related stigma (adapted from Corrigan's Self-Stigma of Mental Illness Scale) to assess perceived stigma and internalized stigma among individuals with OUD. This study presents initial validation of the newly-developed Brief Opioid Stigma Scale among 387 adults who entered an inpatient opioid managed-withdrawal program. The scale assesses: (1) Stereotype awareness (“Aware”), or the extent to which individuals who use opioids perceive community members to believe OUD-related stereotypes; (2) Stereotype agreement (“Agree”), or the endorsement of stigmatizing beliefs by individuals who use opioids; (3) Self-esteem decrement (“Harm”), or the diminution of self-esteem due to these negative stereotypes' impacts on self-worth. Psychosocial measures including self-esteem, depressive symptoms, mental and physical functioning, and desire for aftercare OUD medication treatment, were administered to assess construct validity. Results showed that greater endorsement of the “harm” stigma subscale was associated with greater depressive symptoms, lower self-esteem, and poorer mental and physical functioning. The “aware” stigma subscale displayed similar overall patterns of associations with self-esteem and depression but to a lesser magnitude. The “aware” stigma subscale was positively associated with desire for aftercare methadone and naltrexone treatment, and the “harm” subscale was positively associated with desire for aftercare buprenorphine treatment. Results indicated good initial construct validity. Tailored stigma interventions are recommended for specific aftercare OUD medication treatments.

Can Screening, Brief Intervention, and Referral to Treatment Education and Clinical Exposure Affect Nursing Students' Stigma Perception Toward Alcohol and Opioid Use?

BACKGROUND: Alcohol and/or opioid stigma perceptions are barriers to screening, brief intervention, and referral to treatment (SBIRT) implementation. AIM: To examine SBIRT education and clinical exposure efficacy at decreasing nursing students' stigma perceptions toward caring for patients affected by alcohol and/or opioid use problems. METHOD: A single-sample, pretest-posttest design with N = 124 nursing students. The students had a 1.5-hour SBIRT education session and a 12-week clinical experience with some patients who had alcohol and/or opioid use problems. RESULTS: The participants' stigma perceptions improved toward patients who had alcohol and/or opioid use problems. CONCLUSIONS: SBIRT education and clinical exposure may provide a basis for promoting understanding of alcohol and/or opioid use-related stigma and can be used as an intervention to decrease some of stigma's negative effects.

Stigma and the public health agenda for the opioid crisis in America

The current opioid crisis in the U.S. is unprecedented and calling for a nationwide reorganization of the public health prevention program. Stigma is a persistent barrier to this agenda, unfortunately with a limited body of research on substance use disorder (SUD) available to inform it. We review the broader research literature on the stigma of behavioral health (i.e., mental illness and SUD) to identify strategies to address the opioid crisis and harmful stigma. A major difference between mental illness and SUD stigma is that the latter is legally and socially sanctioned. In making sense of the behavioral strategies for stigma change, we consider three agendas for stigma prevention (prevention, rights, and self-worth). We suggest that incorporating the rights and the self-worth agendas with an in vivo focused contact model, might be most effective for an integrative strategy aimed at targeting opioid stigma. Involving people in recovery as key drivers of this agenda and evaluating the detrimental impact of using stigma as a health tool (social sanction), will bring new horizons to solving this deadly epidemic.

Assessing Opioid Stigma in Oncology Outpatients Receiving Palliative Care for Cancer-Related Pain (S714)

Assessing Opioid Stigma in Oncology Outpatients Receiving Palliative Care for Cancer-Related Pain (S714)

The Epidemic as Stigma: The Bioethics of Opioids

In this paper, we claim that we can only seek to eradicate the stigma associated with the contemporary opioid overdose epidemic when we understand how opioid stigma and the epidemic have co-evolved. Rather than conceptualizing stigma as a parallel social process alongside the epidemiologically and physiologically defined harms of the epidemic, we argue that the stigmatized history of opioids and their use defines the epidemic. We conclude by offering recommendations for disrupting the burden of opioid stigma.

Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries.

In order to implement more effective policies for cancer pain management, a better understanding of current practices is needed. Physicians managing cancer pain and patients experiencing cancer pain were randomly surveyed across 10 Asian countries to assess attitudes and perceptions toward cancer pain management. A total of 463 physicians (77.3% oncologists) with a median experience of 13 years were included. Medical school training on opioid use was considered inadequate by 30.5% of physicians and 55.9% indicated ≤10 h of continuing medical education (CME). Of the 1190 patients included, 1026 reported moderate-to-severe pain (median duration, 12 months). Discordance was observed between physician and patient outcomes on pain assessment with 88.3% of physicians reporting pain quantification, while 49.5% of patients claimed that no scale was used. Inadequate assessment of pain was recognized as a barrier to therapy optimization by 49.7% of physicians. Additional barriers identified were patients’ reluctance owing to fear of addiction (67.2%) and adverse events (65.0%), patients’ reluctance to report pain (52.5%), excessive regulations (48.0%) and reluctance to prescribe opioids (42.8%). Opioid use was confirmed only in 53.2% (286/538) of patients remembering their medication. Pain affected the activities of daily living for 81.3% of patients. These findings highlight the need for better training and CME opportunities for cancer pain management in Asia. Collaborative efforts between physicians, patients, policy makers, and related parties may assist in overcoming the barriers identified. Addressing the opioid stigma and enhancing awareness is vital to improving current standards of patient care.