Substance Use Terminology

Individual, interpersonal, and neighborhood measures associated with opioid use stigma: Evidence from a nationally representative survey

Despite growing awareness of opioid use disorder (OUD), fatal overdoses and downstream health conditions (e.g., hepatitis C and HIV) continue to rise in some populations. Various interrelated structural forces, together with social and economic determinants, contribute to this ongoing crisis; among these, access to medications for opioid use disorder (MOUD) and stigma towards people with OUD remain understudied. We combined data on methadone, buprenorphine, and naltrexone providers from SAMHSA's 2019 directory, additional naltrexone providers from Vivitrol's location finder service, with a nationally representative survey called "The AmeriSpeak survey on stigma toward people with OUD." Integrating the social-ecological framework, we focus on individual characteristics, personal and family members' experience with OUD, and spatial access to MOUD at the community level. We use nationally representative survey data from 3008 respondents who completed their survey in 2020. Recognizing that stigma is a multifaceted construct, we also examine how the process varies for different types of stigma, specifically perceived dangerousness and untrustworthiness, as well as social distancing measures under different scenarios. We found a significant association between stigma and spatial access to MOUD - more resources are related to weaker stigma. Respondents had a stronger stigma towards people experiencing current OUD (versus past OUD), and they were more concerned about OUD if the person would marry into their family (versus being their coworkers). Additionally, respondents' age, sex, education, and personal experience with OUD were also associated with their stigma, and the association can vary depending on the specific type of stigma. Overall, stigma towards people with OUD was associated with both personal experiences and environmental measures.

Addressing Stigma in Medication Treatment of Adolescents With Opioid Use Disorder

: In September 2016, the American Academic of Pediatrics released a policy statement that adolescents with opioid use disorder should be offered pharmacotherapy with buprenorphine/naloxone, methadone, or naltrexone. In our clinical practice, however, we have encountered the perception among patients, families, and clinicians alike that medications should be used as a last resort. That we should wait until things get worse is a discarded approach. As addiction specialists, it is imperative that we prevent and identify risky use and use disorders, then intervene early and offer timely, evidence-based treatment. We suggest that adolescents deserve special attention and that specific efforts should be made to reduce the stigma associated with treating adolescents with opioid use disorder with medications to optimize those efforts.