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Stigma in healthcare is widespread and may be harmful. Stigma is created from stereotypes, prejudiced ideas, and discrimination. Stigma may result in negative perceptions about people with opioid use disorder (OUD) which may result in barriers to accessing services,1 and inequitable or suboptimal care.2 Reducing stigma is essential to elevating the public health response. In 2021, The National Institute of Health stated that 75% of primary care physicians appeared to hold high levels of stigmatizing beliefs about people with OUD.3 There are several leading harm reduction principles, which can be found here. The learning material on this page is focused on addressing and helping to reduce provider stigma towards patients with OUD.
Stigma in healthcare is widespread and may be harmful. Stigma is created from stereotypes, prejudiced ideas, and discrimination. Stigma may result in negative perceptions about people with opioid use disorder (OUD) which may result in barriers to accessing services,1 and inequitable or suboptimal care.2 Reducing stigma is essential to elevating the public health response. In 2021, The National Institute of Health stated that 75% of primary care physicians appeared to hold high levels of stigmatizing beliefs about people with OUD.3 There are several leading harm reduction principles, which can be found here. The learning material on this page is focused on addressing and helping to reduce provider stigma towards patients with OUD.
Table of Contents
Table of Contents
Bias and stigma towards those who use Opioids
Bias and stigma towards those who use Opioids
Examining Our Biases About People Who Misuse Opioids
Examining Our Biases About People Who Misuse Opioids
For information on how discrimination and bias affect people who use drugs see below:
For information on how discrimination and bias affect people who use drugs see below:
Bias and Stigma of Medication-Assisted Treatment and Treatment for Opioid Use Disorder
Bias and Stigma of Medication-Assisted Treatment and Treatment for Opioid Use Disorder
Example: Examining Bias and Practicing Cultural Humility
Example: Examining Bias and Practicing Cultural Humility
This video shows how to correctly approach and address bias and practice cultural humility to help reduce stigma in the workplace.
This video shows how to correctly approach and address bias and practice cultural humility to help reduce stigma in the workplace.
Put this example into practice:
Put this example into practice:
Overcoming stigma to start Buprenorphine during hospitalization
Overcoming stigma to start Buprenorphine during hospitalization
How does language perpetuate stigma?
How does language perpetuate stigma?
Stigma and Gender
Stigma and Gender
Addressing the Unique Challenges of Opioid Use Disorder in Women
Addressing the Unique Challenges of Opioid Use Disorder in Women
Recommended Further Reading: Opioid Use and Stigma: The Role of Gender, Language and Precipitating Events
Recommended Further Reading: Opioid Use and Stigma: The Role of Gender, Language and Precipitating Events
Harm Reduction
Harm Reduction
Finding the hook: Changing Perceptions of Harm Reduction Strategies
Finding the hook: Changing Perceptions of Harm Reduction Strategies
HIV and Hepatitis C Harm Reduction Resources
HIV and Hepatitis C Harm Reduction Resources
HIV and Hepatitis C Resources
HIV and Hepatitis C Resources
Harm Reduction in Rural and Indigenous Populations
Harm Reduction in Rural and Indigenous Populations
Decolonizing Substance Use and Addiction
Decolonizing Substance Use and Addiction
Prevention in Rural Communities: Tekoa's Takeback Program
Prevention in Rural Communities: Tekoa's Takeback Program
My Journey to Understand Pain, Opioids and Trauma in my Community
My Journey to Understand Pain, Opioids and Trauma in my Community
More Resources on Prevention in Indigenous Communities
More Resources on Prevention in Indigenous Communities
Reference List
Reference List
Stone EM, Kennedy-Hendricks A, Barry CL, Bachhuber MA, McGinty EE. The role of stigma in U.S. Primary Care Physicians’ treatment of opioid use disorder. Drug Alcohol Depend. 2021;221:108627. doi:10.1016/j.drugalcdep.2021.108627
Harm Reduction Principles. National Harm Reduction Coalition. https://harmreduction.org/about-us/principles-of-harm-reduction/. Published May 23, 2021. Accessed July 18, 2022.
Examining our biases about people who misuse opioids. SAMHSA. https://www.youtube.com/watch?v=4wc_esR_g5s. Published March 15, 2018. Accessed July 11, 2022.
Meyerson BE, Russell DM, Kichler M, Atkin T, Fox G, Coles HB. I don't even want to go to the doctor when I get sick now: Healthcare experiences and discrimination reported by People Who Use Drugs, Arizona 2019. Int J Drug Policy. 2021;93:103112. doi:10.1016/j.drugpo.2021.103112
Tyndall M, Dodd Z. How structural violence, prohibition, and stigma have paralyzed North American responses to opioid overdose. AMA J Ethics. https://journalofethics.ama-assn.org/article/how-structural-violence-prohibition-and-stigma-have-paralyzed-north-american-responses-opioid/2020-08. Published August 1, 2020. Accessed July 11, 2022.
Do people stigmatize individuals with opioid use disorder even when their addiction arose from opioids prescribed for pain? Recovery Research Institute. https://www.recoveryanswers.org/research-post/people-stigmatize-individuals-opioid-use-disorder-opioids-prescribed-for-pain/. Published July 25, 2022. Accessed August 5, 2022.
Examining Bias and practicing cultural humility. Think Cultural Health. https://www.youtube.com/watch?v=Jze6Hil5SyI. Published May 1, 2019. Accessed July 11, 2022.
Overcoming stigma to start buprenorphine during hospitalization. NIHOD. https://www.youtube.com/watch?v=KmiBgVXELBA. Published July 26, 2021. Accessed July 11, 2022.
Schneider JP. Opioid addiction is not opioid dependence. practicalpainmanagment.com. https://www.practicalpainmanagement.com/treatments/addiction-medicine/opioid-use-disorder/what-name-case-which-we-call-addiction-not. Published 2019. Accessed July 11, 2022.
Addictionary. Recovery Research Institute. https://www.recoveryanswers.org/addiction-ary/. Published May 9, 2022. Accessed July 11, 2022.
Beyond the data - addressing the unique challenges of opioid use disorder in women. https://www.youtube.com/watch?v=jGxbodrkRWo. Published January 24, 2017. Accessed July 18, 2022.
Goodyear K, Haass-Koffler CL, Chavanne D. Opioid use and stigma: The role of gender, language and precipitating events. Drug Alcohol Depend. 2018;185:339-346. doi:10.1016/j.drugalcdep.2017.12.037
Finding the hook: Changing perceptions of harm reduction strategies. SAMHSA. https://www.youtube.com/watch?v=tMF9Cfn_SRk. Published March 15, 2018. Accessed July 11, 2022.
Seaman A, Leichtling G, Stack E, et al. Harm reduction and adaptations among PWUD in rural Oregon during COVID-19. AIDS Behav. 2021;25(5):1331-1339. doi:10.1007/s10461-020-03141-4
Hepatitis C overview guide. National Harm Reduction Coalition. https://harmreduction.org/issues/hepatitis-c/overview/what-is-hepatitis/. Published August 30, 2020. Accessed August 17, 2022.
Hepatitis C basics for people who use drugs. CLOUD. https://www.opioidlibrary.org/document/hepatitis-c-basics-for-people-who-use-drugs/. Accessed August 24, 2022.
CDC recommendations for hepatitis C screening among adults - United States, 2020. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm. Published April 9, 2020. Accessed August 17, 2022.
HIV among people who inject drugs. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/hiv-idu.html. Published June 28, 2022. Accessed August 17, 2022.
Brunner M. Prevalence and medication treatment of opioid use disorder among patients with HCV or HIV. Addiction Technology Transfer Center (ATTC) Network. https://attcnetwork.org/asme/prevalence-and-medication-treatment-opioid-use-disorder-among-patients-hcv-or-hiv. Published March 1, 2021. Accessed August 29, 2022.
Hepatitis C Screening in the Behavioral Health Setting. SAMHSA. https://store.samhsa.gov/product/Advisory-Hepatitis-C-Screening-in-the-Behavioral-Healthcare-Setting/sma15-4917. Accessed August 17, 2022.
Murdock, R.M., Brizzi, M.B., Perez, O. et al. Public Health Considerations among People who Inject Drugs with HIV/HCV Co-Infection: A Review. Infect Dis Ther 8, 23–32 (2019). https://doi.org/10.1007/s40121-018-0228-8
Giroir BP. Substance misuse, infectious disease, and the powerful potential of syringe service programs. HIV.gov. https://www.hiv.gov/blog/substance-misuse-infectious-disease-and-powerful-potential-syringe-service-programs. Published August 9, 2022. Accessed August 17, 2022.
Dan, C. The important role of substance use disorder treatment providers in ending the HCV and HIV epidemics. HIV.gov. https://www.hiv.gov/blog/important-role-substance-use-disorder-treatment-providers-ending-hcv-and-hiv-epidemics. Published April 8, 2021. Accessed August 17, 2022.
Syringe Services Programs (ssps). Centers for Disease Control and Prevention. https://www.cdc.gov/ssp/index.html. Published May 23, 2019. Accessed August 18, 2022.
Pierre L. Decolonizing Substance Use & Addiction. YouTube. https://www.youtube.com/watch?v=j95ayhyadNE. Published April 8, 2020. Accessed July 11, 2022.
Prevention in rural communities: Tekoa's Takeback Program. YouTube. https://www.youtube.com/watch?v=fPX0g-3dlbU. Published August 17, 2017. Accessed July 11, 2022.
Choo J. My journey to understand pain, opioids, and trauma in my community. YouTube. https://www.youtube.com/watch?v=K5L1pnuCW_E. Published October 24, 2019. Accessed July 11, 2022.
Opioid misuse and overdose prevention in Native Communities. samhsa.gov. https://www.samhsa.gov/sites/default/files/opioidfactsheet_final_2017-12-06.pdf. Published 2017. Accessed August 15, 2022.
Models of tribal promising practices: Tribal opioid overdose prevention care coordination and Data Systems. nnphi.org. https://nnphi.org/resource/models-of-tribal-promising-practices-tribal-opioid-overdose-prevention-care-coordination-and-data-systems/. Published February 2, 2021. Accessed August 15, 2022.
Whelshula, M., Hill, M., Galaitsi, S.E. et al. Native populations and the opioid crisis: forging a path to recovery. Environ Syst Decis 41, 334–340 (2021). https://doi.org/10.1007/s10669-021-09813-3
Winters, E., Harris, N. The Impact of Indigenous Identity and Treatment Seeking Intention on the Stigmatization of Substance Use. Int J Ment Health Addiction 18, 1403–1415 (2020). https://doi.org/10.1007/s11469-019-00162-6
Lopez I. Tribal Mental Health gets new focus, but equity barriers remain. Bloomberg Law. https://news.bloomberglaw.com/health-law-and-business/tribal-mental-health-gets-new-focus-but-equity-barriers-remain. Published June 13, 2022. Accessed August 17, 2022.
Stringer H. The Healing Power of Heritage. American Psychological Association . https://www.apa.org/monitor/2018/02/cover-healing-heritage. Published February 2018. Accessed August 17, 2022.
Culturally-informed programs to reduce substance misuse and promote mental health in American Indian and Alaska native populations. Prevention Solutions . https://preventionsolutions.edc.org/services/resources/culturally-informed-programs-reduce-substance-misuse-and-promote-mental-health. Published 2018. Accessed August 17, 2022.
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