Stigma affects everyone. Ending the stigma toward people with addiction is more important now than ever, as the rates of substance use disorder and mental health concerns have risen dramatically during the COVID-19 pandemic (1). Social distancing measures have introduced additional barriers to receiving care for substance use and mental health concerns.
OPEN is dedicated to reducing stigma in our community, focusing on the health care setting. Addressing stigma is a critical aspect of each OPEN initiative. OPEN is excited to collaborate with Shatterproof, a leading stigma reduction nonprofit, in delivering programming that spreads awareness to the importance of patient-centered care and person-first language.
The partnership between OPEN and Shatterproof aims to start conversations on the issue of structural stigma and provides stigma-reduction resources and programming to health care professionals. In collaboration with Shatterproof, OPEN offers access to Just Five – an online workplace training about addiction. Just Five has short educational modules designed to deliver facts and information about substance use disorders, people who use substances, and recovery. Spend Just Five minutes learning today!
What is Stigma?
What does “stigma” mean?
A stigma is a negative assumption about a person, or a group of people, based on a specific belief or behavior2. A stigma can affect how someone is treated by society. Patients with opioid use disorder, or OUD, are often stigmatized, despite OUD being a medical disease that patients do not choose to have. Stigma may also be compounded by other types of bias, such racial, gender, religious, age, and economic biases, further worsening experience and access to care.
How does stigma affect healthcare?
Due to the stigma surrounding opioid use, there are negative assumptions about patients with opioid use disorder (2). Consequently, it can be difficult for people, including healthcare workers, to recognize OUD as a medical condition that requires treatment just like high blood pressure, heart disease, or diabetes. It is important for healthcare providers to recognize risk factors for OUD and symptoms of OUD so patients can receive appropriate medical treatment.
Did you know OUD is a disease?
OUD is a chronic medical disease that is listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and requires ongoing medical treatment from a physician (3,4). There are genetic and environmental risks to developing OUD, just like with heart disease, cancer, and diabetes. Similarly, OUD, like many other medical conditions, can be treated with medications, therapies, and lifestyle changes.
What can we do to reduce the stigma related to opioid use?
- Be kind and compassionate toward patients with OUD. OUD is just like any other chronic medical disease requiring lifelong treatment.
- If you have OUD, be kind and compassionate toward yourself.
- Do your part to reduce stigma toward OUD:
- Be an advocate and use language to minimize stigma
- Use the right words to minimize stigma
- Provide support and encouragement
- Be empathetic
- Learn more about OUD.
How we talk about opioid misuse and substance use can add to the stigma surrounding OUD (5,6). It’s important to use language that emphasizes that OUD is a medical disease, not a life choice (4). While there are many examples of words to use and words to avoid when talking about OUD, here are some common words and phrases to consider:
Use these words:
- Opioid use disorder (OUD)
- Substance use disorder (SUD)
- Negative test
- Positive test
- Substance-free test
- Opioid misuse
- Substance use
- Patient with opioid use disorder
- Recovering patient
Avoid these words:
- Drug user
- Former addict
- Reformed addict
- Drug abuse
How to talk to your doctor about OUD
How do I start the conversation with my doctor?
Your doctor cares about you and wants to help you. While it can be scary to talk to your doctor, know that your doctor is experienced in discussing sensitive topics. Your doctor can help you access treatment for substance use. Your doctor also understands that substance use disorder is a chronic disease and that it is not your fault. Something simple, like, “I’m worried about the effects of taking opioids” or “I don’t like how opioids have influenced my life” can start the conversation with your doctor.
What can I do if I am concerned about a loved one having opioid use disorder?
Provide support for them. Encourage them to start a conversation with their doctor about risk factors for OUD. Help connect them with medical care; you can do this by providing transportation to appointments, reminding them to pick up prescriptions from the pharmacy, sharing useful phone numbers and websites with them, and regularly asking them how they are doing. It is important to support them how they wish to be supported, so be sure to ask questions like, “how can I support you?” or “what can I do to help you?” When in doubt, you can reach out to your doctor or a local substance use treatment center to ask for guidance. Do not attempt to hide or dispose of someone else’s medications. Opioid withdrawal can be fatal (7), so do not limit someone else’s substance use without specific instructions from their doctor to do so.
Substance Abuse and Mental Health Services Administration
- Website: https://www.samhsa.gov/find-help/national-helpline
- Confidential 24/7 Hotline: 1-800-662-HELP (4357)
988 Suicide & Crisis Lifeline
- Website: https://988lifeline.org/
- Confidential 24/7 Hotline: Dial 988 or dial 1-800-273-TALK (8255)
- 24/7 Lifeline Online Chat: https://988lifeline.org/chat/?_ga=2.233643422.1814246273.1664466067-1203270125.1664466067
- Website: https://www.help.org/
- Information about calling a hotline: https://www.help.org/drug-abuse-hotline/
National Institute of Mental Health: https://www.nimh.nih.gov/health/find-help
Veterans Affairs Resources
- Substance Use Disorder Website: https://www.va.gov/health-care/health-needs-conditions/substance-use-problems/
- Find a SUD program near you: https://www.va.gov/directory/guide/SUD.asp
- Mental Health Services Website: https://www.va.gov/health-care/health-needs-conditions/mental-health/
Wellbeing for healthcare professionals
- American Psychiatric Association Website: https://www.psychiatry.org/psychiatrists/practice/well-being-and-burnout/well-being-resources
- American College of Emergency Physicians Website: https://www.acep.org/emwellness/resources/suicide-prevention/mental-health-resources-for-physicians/
- National Alliance on Mental Illness Website: https://www.nami.org/Your-Journey/Frontline-Professionals/Health-Care-Professionals
Michigan Department of Health resources
- Mental Health Resources: https://www.michigan.gov/coronavirus/resources/mental-health-resources
- Teen Resources: https://www.michigan.gov/coronavirus/resources/mental-health-resources/teen-resources
- Resources for Schools: https://www.michigan.gov/coronavirus/resources/mental-health-resources/resources-for-schools
- Understand more about opioid use disorder: https://youtu.be/NDVV_M__CSI
- Learn about opioid use disorder from a patient’s perspective: https://youtu.be/WhpAYw9kCt8
- Dell medical school: reducing stigma education tools (ReSET)
- Providers clinical support system: Challenging patient conversations
- Recovery Research Institute: Addictionary
- Language to destigmatize addiction
- USDHHS: Substance abuse and mental health services administration: Talking with your adult patients about alcohol, drug, and/or mental health problems
- Useful to exploration of patient centered language and questions from the US department of health and human services
- Addiction Technology Transfer Network: Anti-Stigma Toolkit
- AMA: Addressing patient shame, stigma when treating opioid misuse
- PowerPoint presentation: The role of shame in opioid use disorders
- Discusses guilt vs shame, how to identify it, and how these factors relate to different populations (people who inject heroin, families: mothers and pregnant women with history of use)
- NIH: Principles of Drug Addiction Treatment: A Research Based Guide
- NEJM article: Other victims of the Opioid epidemic
- Discusses a patient with a remote history of use though sober while inpatient
- PCSS module: Special Aspects of Stigma in Methadone and Buprenorphine Maintenance Treatment
- Considerations for healthcare providers treating patients with substance use disorder
- JAMA Article: Confronting the Stigma of opioid use disorder— and its treatment
- American Society of addiction medicine: Patients with addiction need treatment, not stigma
- Stigma in health facilities: why it matters and how we can change it
- Forty-two study meta analysis examining inclusion criteria and providing insight on interventions to reduce HIV, mental illness, or substance abuse stigma.
- Johns Hopkins Medicine: Stigma of Addiction
1- Wu, T., Jia, X., Shi, H., Niu, J., Yin, X., Xie, J., & Wang, X. (2021). Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Affective Disorders, 281, 91-98. https://dx.doi.org/10.1016/j.jad.2020.11.117
2- Tsai, A.C., Kiang, M.V., Barnett, M.L., Beletsky, L., Keyes, K.M., McGinty, E.E., Smith, L.R., Strathdee, S.A., Wakeman, S.E., & Venkataramani, A.S. (2019). Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Medicine, 16(11), 1-18. https://dx.doi.org/10.1371/journal.pmed.1002969
3- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
4- Murphy, B. (2018, September 13). 4 factors that add to stigma surrounding opioid-use disorder. American Medical Association. https://www.ama-assn.org/delivering-care/overdose-epidemic/4-factors-add-stigma-surrounding-opioid-use-disorder
5- National Institutes of Health. (2021, November 29). Words matter – Terms to use and avoid when talking about addiction. National Institute on Drug Abuse: Advancing Addiction Science. https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction
6- Northwest Portland Area Indian Health Board. (n.d.). Words matter when we talk about addiction. Tribal Opioid Response: Healing our Nations Together. https://www.npaihb.org/wp-content/uploads/2020/07/Words-Matter-When-We-Talk-About-Addiction-For-Patients-Fact-Sheet-21.pdf
7- Torres-Lockhart, K.E., Lu, T.Y., Weimer, M.B., Stein, M.R., & Cunningham, C.O. (2022). Clinical management of opioid withdrawal. Addiction, 117, 2540-2550. https://dx.doi.org/10.1111/add.15818