Data shows that opioid overdoses — and opioid overdose deaths — are spiking during the COVID-19 pandemic. At the same time, only about 18% of the 1.6 million people in the U.S. with opioid use disorder receive medications proved to help them recover.
One barrier to care is the stigmatization of people with this disorder. Medical professionals agree that addiction is a disease, but many people — including some health care providers — continue to consider it a moral or personal weakness. This stigma may play a role in discouraging people from seeking treatment, and some doctors from offering it.
Focus group findings
In 2018, the Pew Charitable Trusts held focus groups in Indiana and Wisconsin to understand why people with the disorder, also known as OUD, don’t always seek treatment — even when it can save their lives.
Many participants who misused opioids had internalized stigma, believing they lacked the discipline or character to stop using opioids. They also feared judgment. One person said of attending a support group, “What if I saw one of my daughter’s teachers? I’m walking into this place and now they know that my daughter has a father who’s an addict?”
And some people who were already in treatment said that family members, caregivers, employers, law enforcement and even health care providers stigmatized their addiction. "I think a lot of doctors around here judge you," said one participant. Another added, "You get treated differently at the pharmacy than someone filling (blood pressure pills)."
In fact, some stigma surrounds the three OUD medications that have been proven safe and effective: buprenorphine, methadone and naltrexone. These medications do not provide a “high” when used as prescribed and are no different from medicines that treat other long-term illnesses.
But many focus-group participants said the medications can be seen as just a substitute of one drug for another. One man said, “it’s shameful to say that you’re on (medications).”
Changing attitudes and policy
Against this backdrop, Indiana and other states can provide successful approaches for reducing or eliminating stigma. For example, Indiana’s Next Level Recovery initiative calls for eliminating stigmatizing language as a first step to removing barriers to treatment. Anti-stigma campaigns can show that people with OUD are fighting a serious condition and have real prospects for remission, highlighting their value to their loved ones and communities.
In July, Pennsylvania announced a partnership with the national nonprofit organization Shatterproof to reduce stigma in the systems with the largest impact on people with substance use disorders: employers, health care, government, criminal justice, media and entertainment, and local communities.
The partnership will provide educational content that shows how to reduce stigma in everyday language while also working to eliminate policies that are barriers to treatment.
Dell Medical School at the University of Texas at Austin recently launched a free, self-directed anti-stigma online training for health care providers, pharmacists and social workers. The training explains how stigma manifests in health care settings and can lead to negative health outcomes, explores the delivery of compassionate, recovery-oriented care and addresses common misconceptions about OUD medications.
In addition, lawmakers can help shift public opinion about OUD by addressing policies that limit the use of effective medications. Federal legislation could ease burdensome training and licensure requirements for clinicians who prescribe buprenorphine for OUD, and exempt them from random office record inspections that can currently be conducted. Buprenorphine is approved by FDA, and no other prescription drug —including opioid pain medications — faces such enormous barriers to use in treatment.
Federal policymakers should also expand access to methadone by directing the Drug Enforcement Administration to expedite the approval of additional mobile methadone vans. Methadone programs in six states and Puerto Rico use these vans, which can be especially helpful in rural areas where there are few treatment options.
But the DEA has not approved any new mobile methadone vans since 2007. The agency should act quickly so that people with OUD — no matter where they live — can get the treatment they need close to home and with less risk of coronavirus exposure.
Top-down policy change and grassroots education efforts are simultaneously needed to change perceptions about OUD and treatment. Before, during and after the pandemic, no individual should feel shame about pursuing care to seek a healthy life in recovery, and no health care worker should feel hesitant to provide that care.
Beth Connolly is the director of, and Alex Duncan a senior officer with, the Pew Charitable Trusts’ substance use prevention and treatment initiative.
This article was originally published in Indy Star.