Reducing the stigma associated with addiction – the word itself now tagged with a degree of stigma – is a priority in drugs policy. Stigmatising attitudes contribute to drug harms and deaths through delaying access to treatment, leaving treatment early and increased risk-taking behaviour.
Brea Perry and her colleagues at Indiana University took a look at the scale of the problem of stigma for non-medical prescription opioid use and dependence in a representative sample of over a thousand adults in the USA.
They used case scenarios to test out attitudes to opioid use and compared this condition to attitudes to depression, alcohol use disorder, schizophrenia and subclinical distress.
They found that the public were much more likely to label opioid use disorder a physical illness rather than a mental illness and that, compared to alcohol use disorder, it was less likely to be associated with ‘bad character’ and ‘poor upbringing’. However, there was a very strong tendency to want to socially exclude those with opioid use disorder.
They found evidence that the public ‘hold negative stereotypes about individuals after they have become dependent on opioids and may be pessimistic about their ability to function normally and successfully perform social roles’.
Taken together, our results suggest that public stigma and resulting discrimination will continue to profoundly shape the lives of people with OUD, adversely affecting physical and mental health and quality of life
So what are the solutions? Dr Perry and her colleagues said:
The most effective strategy for combating opioid use disorder stigma may be to avoid a rhetoric of hopelessness, and instead emphasize the recovery potential of affected individuals and communities
They suggest a reframe: ‘Along these lines, public health campaigns might focus on creating an image of persons with opiate use disorder as fighting against a serious condition with real prospect for remission, similar to cancer. Public attention could then be directed toward strengthening the formal and informal safety net required to support successful recovery.’
Commenting on this research, Patrick Corrigan, who researchers and writes on stigma in mental health and addictions, makes some pertinent points.
He says that unlike something like skin colour, there is no obvious mark associated with substance use disorder. Instead, “stigma is elicited by labels and labels occur by association: ‘Hey; that’s Mike coming out of the methadone clinic. He must be a druggie’. People with opiate use disorder or other substance use disorders will avoid stigmatizing labels by avoiding treatments associated with the label”.
He points out that unlike stigma in mental illness, the stigma of addiction is ‘socially, politically and/or legally sanctioned around the world’.
According to Corrigan, there are three agendas to be considered in order to erase the stigma.
- Service engagement agenda
- Rights agenda
- Self-worth agenda
In the last of the three, peer support by people in recovery is key in reducing shame which is created as a result of self-stigma. In all approaches though, Corrigan emphasises that people with lived experience of opiate use disorders must have central roles in development and implementation. In many addiction treatment and support settings this is already happening, although sometimes with hesitancy or resistance.
While the telling our own stories of addiction and recovery is not without risk, if done well our narratives have the power to humanise, to span chasms, to elicit empathy and connection and to tackle shame. When access to such experiences sits alongside formal treatment, the impact on retention in treatment and treatment outcomes is likely to be significant. As is the impact on stigma.
Personal histories can help with the reframing Perry and colleagues call for – to emphasise that those with opioid dependence can gain remission, just like those with cancer. Perhaps most importantly, the voice of lived experience can instil hope – something fundamental for recovery from the stigma and other harms of addiction.
Join the discussion on Twitter: @DocDavidM
 Perry BL, Pescosolido BA, Krendl AC. The unique nature of public stigma toward non-medical prescription opioid use and dependence: a national study. Addiction. 2020 Dec;115(12):2317-2326. doi: 10.1111/add.15069. Epub 2020 Apr 20. PMID: 32219910.
 Corrigan PW. Commentary on Perry et al. (2020): Erasing the stigma of opioid use disorder. Addiction. 2020 Dec;115(12):2327-2328. doi: 10.1111/add.15145. Epub 2020 Jun 21. PMID: 32567106.