Quantitative Insights for Communications and Marketing about Stigma and the Opioid Epidemic

Theoretical Background and research questions/hypothesis:

Stigma is a core issue in the opioid epidemic. Stigma affects seeking treatment for opioid use disorder (OUD), prescribing pain medications and treating OUD, supporting changes in public policies, and marshaling the resources necessary to implement programs to reduce opioid abuse, addiction and overdose deaths. The research questions included: To what degree does the general public hold stigmatizing attitudes toward people with an addiction to prescription opioids, people who are being treated or have been treated for opioid addiction, and the healthcare professionals who provide treatment for opioid addiction?

Methods:

A national survey used an online research panel. The sample included 997 adults (18-75 years old, median = 51 years), 49% female and 51% male, who identified as Caucasian (75%), African American (12%), Hispanic (10%), or Asian (6%). Respondents resided in urban (36%), suburban (34%) and rural (30%) areas. Education attainment of high school or less was 36%; 26% had some college or an associate degree; and 32% had a bachelor’s degree or higher. Median household income was $50,000-$74,999.

Results:

Most people agreed that opioid addiction affects all income groups (79%), people living in all areas of the country (79%), and all racial and ethnic groups (78%).

Almost 1/3 said they or someone they know had received treatment in the past 3 years for mental health problems - 18% for prescription opioid addiction, 21% for alcohol addiction, and 21% for addiction to heroin, cocaine or other illegal drugs. Sixty percent said that they had not heard of medication-assisted treatment (MAT) prior to taking the survey and, when described, MAT was considered less effective than either individual, group or residential treatment programs.

Respondents “agreed” or “strongly agreed” that people addicted to prescription opioids are more dangerous than the general population (36.4%) and should be able to stop using them on their own (64.1%). Half said employers should be allowed to deny employment, and 1/3 said landlords should be allowed to deny housing, to a person addicted to prescription opioids.

One in 3 respondents would feel uncomfortable seeing a doctor if they treated patients addicted to opioids; that a doctor should be able to refuse/stop seeing patients if they are addicted to prescription opioids; and would not want to see a doctor if they treat patients addicted to opioids.

Conclusions:

Understanding stigmatizing beliefs and behaviors can inform efforts to enhance prevention, treatment and recovery efforts at the national, state, and local level. Many adults do not have stereotypical views of opioid addiction, yet almost 67% view it through a moral failure frame – the individual chooses to start and continue taking an opioid.

Implications for research and/or practice:

The data lead to recommendations for communications about opioids, addiction and treatment: reduce support for discrimination of people addicted to prescription opioids in employment, healthcare, and housing; shift attitudes of “uncommitted” people toward supporting treatment and other services for people with an addiction to prescription opioids; and increase public acceptance of MAT and primary care physicians who treat patients with an opioid addiction.