In early 2006, health officials first learned of the growing opioid crisis when top US scientists, the National Institute on Drug Abuse (NIDA) and the National Institutes of Health warned government officials of the imminent health crisis and called for urgent action – But no action came. The Opioid Epidemic was allowed to rage unchecked for nearly 10 years, killing scores of loved ones, friends, co-workers & neighbors, leaving families & communities in ruin across the nation. Between 2001 and 2016, there were 335,123 opioid-related overdose deaths in the United States. 0ver the 15- years, total opioid overdose deaths grew from 9,489 in 2001 to 42,245 deaths in 2016, a 345% increase. It wasn’t until 2015 when President Obama finally prevailed upon Congress for legislation to address the Opioid Epidemic until 2015. Alarmed by the Opioid Epidemic death toll, the Surgeon General released two reports, Facing Addiction in America, The Surgeon General’s Report on Alcohol, Drugs and The Surgeon General’s Spotlight on Opioids. These landmark studies concluded that drug dependency can happen to anyone and redefined substance use disorder (SUD) as a chronic relapsing brain disease, and not a moral failing or character flaw. The reports also provided various strategies to combat the health crisis.
Why did it take the United States so long to respond to the Opioid Epidemic? Did stigma contribute to America’s slow response? A study conducted by the World Health Organization (WHO) determined the most stigmatizing socially-disapproved-of medical condition that exists is drug addiction, and alcohol addiction was #2. A second study sponsored by WHO study determined that stigma was a major cause of discrimination and exclusion, stigma contributes to the abuse of human rights, and stigma is a public health issue because it contributes to high rates of death, incarceration, and mental health concerns. Throughout history, Americans held negative thoughts, feelings, and labels about drug users, and considered people who used drugs as bad, reckless, irresponsible junkies and crackheads. Negative public opinion and strong social stigma could have influenced decisionmakers and may have stymied action, support and funding necessary to combat the opioid epidemic.
Stigma is rarely based on facts but rather on assumptions, preconceptions but the harmful consequences of stigma affects all of us – and nearly everyone has felt stigmatized or has stigmatized others at some point in their lives. Stigma is found everywhere, even in the healthcare setting.
Stigma and the Healthcare Setting
Several studies exposed that negative perceptions of people with substance use disorders were rampant and all too common among primary care physicians, medical specialists, pharmacists and dentists. Studies also revealed that healthcare professionals feel uncomfortable working with people dependent on drugs and often believe patients with substance use disorders misuse treatment resources, do not care about their health, fail to follow recommended care, and abuse the system through drug-seeking and diversion. Another study of nurses showed most had negative attitudes and views about people who used drugs. When health professionals carry unhealthy stigma towards people with drug dependence, it affects their willingness to assess or treat the patient for substance abuse, creates misconceptions that contribute to inequitable treatment and is a crucial barrier to treatment. This type of prejudice and intolerance among healthcare professionals is called provider stigma.
Historically, individuals with substance use disorders have received treatment only in “addiction treatment programs” that were designed in the 1960s to treat addictions as personality or character disorders or mitigated by incarceration. This separation of substance use disorder treatment from the rest of health care has contributed to the lack of understanding of the medical nature of these conditions, lack of awareness among affected individuals about a significant health problem, and slow adoption of scientifically supported treatments.
The primary care settings have been identified as untapped opportunities to engage individuals with substance use disorders and to offer evidence-based addiction treatment. The Surgeon General believes integrating substance use disorder in the mainstream health care will improve the quality of treatment services, patient health and quality of life. Integrated treatment with comprehensive continuing care will dramatically reduce fatalities, address health disparities, reduce societal costs and allow recovery to be an achievable outcome. But because substance use treatment is separated from the mainstream health systems, health providers are inadequately prepared to address the substance misuse or related problems in a clinical setting resulting in incorrect diagnoses, inappropriate treatment plans, poor adherence to treatment plans by patients, and high rates of emergency department and hospital admissions.
To improve patient care, healthcare professionals must change their personal attitude towards substance use disorders and appraise the role stigma is playing in shaping their practices. The medical community needs to examine to understand any negative mindset involving substance use disorder treatment, and transform all unhealthy stigmas contributing to substandard care into one more beneficial and in alignment with how other chronic conditions are successfully treated in primary care. Healthcare needs understand the goals of substance use treatment and value them the same as the treatment goals for other chronic illnesses namely, to eliminate or reduce the primary symptoms (substance use), improve general health and function, and increase the motivation and skills of patients and their families to manage threats of relapse.
Everyone Can Fight Back Against Stigma
People with substance use disorders report perceived stigma from loved ones, friends and community. No matter the situation, no one likes to feel judged or devalued and in order to encourage people to reach out for help and get on the path to recovery, stigma needs to be eliminated. It’s important to keep in mind that everyone can all do a better job of eliminating stigma around drug use. Educational programs and modeling of non-stigmatizing behavior can help people provide nonjudgmental, empathic support.
Effective ways for individuals to help reduce stigma include:
- Offering compassionate support.
- Displaying kindness to people in vulnerable situations.
- Listening while withholding judgment.
- Seeing a person for who they are, not what drugs they use.
- Doing your research; learning about drug dependency and how it works.
- Treating people with drug dependency with dignity and respect.
- Avoiding hurtful labels.
- Replacing negative attitudes with evidence-based facts.
- Speaking up when you see someone mistreated because of their drug use.
- Sharing your own stories of stigma.