Majority of Philadelphians Say People Bring Opioid Dependence on Themselves

Most experts see a chronic condition that needs effective treatment

Dr Vittorio
The Pew Charitable Trusts

The broad consensus among clinicians and researchers is that people with problematic opioid use generally suffer from a complex, chronic brain condition known as opioid use disorder (OUD). Many Philadelphians, however, don’t see it that way.

In The Pew Charitable Trusts’ Philadelphia Poll this spring, a majority said that being “addicted” to opioids is something that people bring on themselves; only about 2 in 5 said it is like getting a disease.  Nonetheless, 70 percent said they had sympathy for individuals addicted to opioids.

Most medical experts agree that the most effective way to treat OUD is with medication-assisted treatment (MAT), a combination of certain Food and Drug Administration-approved medications and counseling.

The view that people who become dependent on opioids are somehow to blame has proved to be a barrier to expanding such care, according to a March report by The National Academies of Sciences, Engineering, and Medicine. Pew recognizes that the word “addicted,” which was used in the poll questions, may be seen by some as stigmatizing as well. The term was used because it is widely understood by the public.

The Pew survey, which covered other topics as well, was conducted in two parts this year. The first surveyed 600 Philadelphians by telephone—402 by cellphones and 198 by landlines—from March 18-31. In the second, city residential addresses were selected at random and contacted by mail in April. This resulted in 490 people answering the questions online and another 213 filling out paper versions; the last responses were received May 15. The margin of error for the total of 1,303 responses is plus or minus 3.7 percentage points.

Philadelphia’s perceptions of opioid use disorder

The survey asked Philadelphians: “Do you think being addicted to opioids is like getting a disease such as diabetes or heart problems, or do you think this is something people bring on themselves?” Among those who chose one option or the other, 58 percent said people bring the condition on themselves, while 42 percent said it is like a disease.

Those perceptions varied by geography and demographics. The share saying people bring the condition on themselves was highest among respondents in the River Wards (73 percent)—which includes Kensington, Fishtown, Port Richmond, and Bridesburg and has seen the highest number of deaths in Philadelphia in recent years—and in North Philadelphia (68 percent). Looking at demographics, 65 percent of African-Americans and 63 percent of Hispanics shared this view. On the other hand, college graduates (44 percent) and those with household incomes over $100,000 (47 percent) were the least likely to say people bring this problem on themselves.

Respondents with personal connections to people involved with opioids were more likely to see the condition as a disease—but not much more. Among those who said they knew someone who was addicted, 49 percent said they saw it as a disease, more than the 42 percent overall. Among those who said they knew someone who had died from drug use, a comparable 48 percent called the condition a disease.

The percentage of respondents who offered no opinion on this question differed in the two parts of the survey, largely because of the way each was structured. In the telephone sample, 13 percent told interviewers they had no firm opinion on the issue—or that being addicted could be a disease and something people bring on themselves—and were recorded as such. Mail and web participants did not have the opportunity to provide such answers on the questionnaire. In both segments of the poll, however, the ratio between “bring it on oneself” and “disease” was the same.

The degree to which Philadelphians’ attitudes on this topic are different from those of the nation as a whole is hard to determine, in large part because responses are often influenced by how the questions are posed.

For instance, in a nationwide poll conducted by The Associated Press in 2018, 53 percent said that people misusing opioid pills were extremely or very likely to be experiencing a medical problem that requires treatment, while 44 percent attributed this behavior to a lack of willpower or discipline. In that survey, heroin and illegally sourced fentanyl were not included in the definition of opioids. In Pew’s Philadelphia poll, heroin and illegally sourced fentanyl were included in the definition. Respondents also could select both medical and willpower responses.

The results of the Pew survey don’t mean that most Philadelphians are indifferent to the impact of the opioid problem. In the survey, 70 percent said they had at least some sympathy for individuals addicted to opioids, with 26 percent saying they had a lot.

The highest percentage expressing at least some sympathy were those with family members who were addicted (80 percent), college educations (80 percent), or incomes of at least $100,000 (78 percent).

Efforts to change local attitudes

As part of a push to expand the availability and acceptance of MAT, several groups in Philadelphia are promoting the idea that OUD is a treatable disease and not something people bring on themselves.

“Every step of the opioid crisis is seeping with stigma,” said Dr. Priya Mammen, director of public health programs at Philadelphia’s Thomas Jefferson University.

In 2018, the Independence Blue Cross Foundation launched its Someone You Know campaign focused on reducing the stigma of opioid misuse. In addition, Independence Blue Cross, the region’s largest health insurance company, is working to make it easier for those with OUD to find health care providers who can meet their needs.

Dr. David Barclay, a primary care provider who treats people with OUD in Philadelphia, has applauded the company for asking to list him as a MAT provider on its website along with his other specialties. In Barclay’s view, doing so helps “normalize the diagnosis” and aligns it with other chronic conditions.

In 2019, the  Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services launched a campaign called Bupe Works, aimed at increasing awareness about and decreasing any stigma associated with the use of buprenorphine, one of the three FDA-approved medications for OUD. Broader acceptance of the idea that the condition can be addressed through medication-assisted treatment may increase the sense that it is a disease, although there is little research assessing whether such campaigns can change attitudes about substance use disorders.

Larry Eichel is the project director and Meagan Pharis is a senior associate with The Pew Charitable Trusts’ Philadelphia research initiative.

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