For the most part, coverage about the opioid crisis in the U.S. focuses on rural communities and large urban centers as being primary areas of concentration. However, small and midsized cities like Reading have not been untouched by dramatic increases in drug use and corresponding overdose rates. In April 2022, Reading police responded to twelve overdoses in one day. This worsening of the opioid epidemic has been a trend nationwide.
And to add insult to injury, the COVID-19 pandemic has significantly worsened the toll of opioid use disorder across the country. In 2020 alone, 93,000 drug overdose deaths were recorded, nearly a 30% increase from 2019. The sheer number of U.S. citizens with past or current OUD — about 3 million — suggests that new tools need to be implemented to prevent development of OUD in our youth. And for those who are not detected in time, there is an urgent need to protect users from harm and encourage treatment seeking in this population, irrespective of the size or demographic of the afflicted region.
Public health experts advocate for preventative measures like safe injection sites and access to Narcan—a harm reduction approach shown to reduce some of the most serious consequences of OUD, including overdose. Harm reduction works to meet people “where they’re at” by accepting that not all drug use can be prevented and, thus, conditions under which drugs are used should, at a minimum, be made safer. Advocates emphasize the need to treat people suffering from substance use disorders with dignity and respect.
One harm reduction measure that is easy, cost effective, and, ironically, underappreciated is education. Education helps people understand that OUD is a chronic but treatable illness, not a moral failing, and that users are not inherently dangerous. Education will go a long way toward eliminating the stigma surrounding OUD that leads to shame, isolation, and treatment avoidance. Stigma reducing practices are, however, not widely accepted due largely to misunderstandings regarding people with OUD, despite a lengthy track record of research showing that they can be effective lifesaving measures for these individuals.
Stigma is particularly consequential when it is expressed by healthcare professionals who have preconceived notions about OUD that are unfounded and harmful. In fact, stigma in these settings is a major reason that people with OUD discontinue their medical care, resulting in poor physical and mental health outcomes.
Exposure to opioids during adolescence sensitizes the developing brain, increasing the risk for addiction into adulthood. Opioids highjack “reward pathways” in the brain that normally respond to natural pleasures but are now hyperactivated in the presence of these powerful substances. In effect, the quest for opioids supersedes natural drives and leads to intense craving and constant relapsing. During teenage years, opioids pack an even more powerful punch because the brain is still developing and, thus, more vulnerable to their addictive and harmful effects.
Although the loss of control over drug-taking behaviors occurs at the neurobiological level, around three-quarters of Americans believe that this condition is due to moral failing or lack of willpower. Living with a stigmatized condition can be detrimental. People with OUD face stigma throughout their lives which can, over time, cause internalized shame and guilt. Stigma is also considered a major social determinant of health, potentially adversely affecting health outcomes as well as opportunities to pursue education, relationships, and more.
Stigma is also a barrier to accessing and remaining in treatment services. Only one-quarter of physicians receive addiction education during their medical training, and one-quarter feel as though incorporating OUD treatment into their practice would attract “undesirable patients.” Individuals seeking treatment for OUD report being dehumanized, and healthcare professionals use phrases like “drug abuser,” “addict,” and “drug-seeker,” rather than viewing them as people in need of care. As a result, many individuals with OUD avoid healthcare situations or conceal their diagnosis.
Fortunately, the health outcomes of individuals with OUD can be vastly improved. Health care professionals can use patient-centered care and nonjudgmental language to promote stigma-free treatment for their patients. Healthcare professionals can also avoid value-laden words like “dirty” during drug testing. Emphasizing health and social risk factors for OUD reduces blame on people with the condition and increases support for large-scale public health programs addressing OUD. Reducing stigma promises to encourage people living with OUD to obtain necessary medical care. It’s a win-win for them and their families.
This is a call to action for healthcare providers to learn about the social determinants of OUD and create nonjudgmental environments in which people can seek affirming care. Medical boards should prioritize stigma-reducing communication by offering training and resources on compassionate care for people with OUD. Moreover, if individuals in influential positions make an intentional effort to provide accurate information to the public about the realities of OUD, misconceptions are likely to diminish, as will the stigmatization of individuals who are struggling. Policymakers are particularly well-situated to educate their constituents about OUD. It could save lives.
Madeline Jupina is a Master’s student in communication arts and sciences at Penn State University and an intern with the National Prevention Science Coalition to Improve Lives.
Diana Fishbein, Ph.D., is the founder and co-director of the National Prevention Science Coalition to Improve Lives. She is also director of translational neuro-prevention research in the FPG Child Development Institute at UNC Chapel Hill and serves on the part-time research faculty at Penn State.
