Opioids, such as heroin and oxycodone, are pain-relieving medications that can sometimes lead to dependence and addiction.
Opioid use disorder (OUD), formerly known as opioid addiction, has become an increasing concern in the United States. This mental health condition involves a pattern of opioid use that may become difficult to manage or begin to interfere with daily life.
During the late 2010s, the national rates of OUD decreased, but the COVID-19 pandemic appears to have sharply reversed that trend. In 2020, 2.7 million people had OUD in the United States, making the condition more common than ever before.
Despite its prevalence, OUD carries a lot of stigma. In a nutshell, “stigma” means other people may view you negatively for having the condition.
OUD stigma can further disrupt your mental health, discourage you from seeking help, and restrict your access to effective treatment.
Read on to learn more about the origins of OUD stigma, how it harms people, and what you can do to support loved ones with OUD without stigma or judgment.
“Stigma” is an umbrella term for prejudice, discrimination, and other social burdens society places on certain groups of people. In a sense, it serves as a metaphorical “
OUD stigma can take many forms:
Public stigma refers to the collection of negative beliefs society has about people with OUD, such as the idea that people with substance use disorder are somehow “dangerous” or “manipulative.”
Although such stereotypes are less common than in past decades, they remain fairly prevalent.
According to a 2018 national poll from The Associated Press-NORC Center for Public Affairs Research:
- 44% of Americans blamed OUD on “a lack of willpower”
- 32% of Americans considered OUD a character flaw or a sign of poor upbringing
Enacted stigma describes the way people act on their negative beliefs about OUD.
This might involve overt discrimination, like a company illegally firing you for getting OUD treatment. It might also involve more subtle stigma, like your neighbors giving you the cold shoulder after you disclose your diagnosis.
Adopting OUD stereotypes into your own worldview is considered internalized stigma.
For example, you may reject OUD treatment if you feel convinced you just need to have stronger willpower to handle opioid withdrawal. When that doesn’t work, you might (falsely) decide you’re simply incapable of change and give up on getting support and treatment.
People who use opioids aren’t the only ones who experience stigma. Loved ones and colleagues may also face courtesy stigma simply for associating with them or not preventing opioid use.
For instance, a community may
Structural stigma describes the way negative attitudes can manifest through cultural norms, laws, and policies. For example, some hospitals set a hard limit on the number of opioid prescriptions you can get.
When you reach this limit, even if you continue to experience severe pain, hospital medical professionals may label further requests for medication as “drug-seeking behavior.”
Stigma against OUD didn’t appear out of thin air. Much of it stems from preexisting cultural biases and deliberate propaganda.
Unlike a rash or a broken bone, pain isn’t always obvious to an outside observer. There’s a
But pain isn’t merely a matter of comfort. Chronic pain can lower function in many areas, including:
Doctors who fail to acknowledge this combined impact of chronic pain may then consider someone’s desperation for treatment illogical, even manipulative.
And when someone chooses to search elsewhere to get the pain relief they need, like by using heroin or off-label pills, for example? Society may then treat them as someone who failed to use the healthcare system properly, rather than someone whom the healthcare system failed.
In a 1994 Harper’s Magazine interview, one of former President Nixon’s aides admitted the administration’s “War on Drugs” was motivated more by politics than medical concern.
More specifically, Nixon’s administration focused on discrediting critics in Black communities by prosecuting heroin use in the 1970s.
In the 1990s,
Part of this stigma relates to the enduring myth that Black people feel less pain than white people.
Half the participants endorsed at least one of the false beliefs. The endorsers tended to rate hypothetical Black patients’ pain as lower than white patients’ pain. They were also less likely to prescribe Black patients appropriate pain-relief treatment, such as opioids, for fear of drug misuse.
As early as 1999, the owners of Purdue Pharmaceuticals, the Sackler family, knew their prescription opioid products had more addiction potential than anticipated. Rather than warn consumers and risk a hit to their reputation, the Sacklers planned to shift blame to the people experiencing OUD.
According to lawsuit documents from the Minnesota attorney general’s office, Richard Sackler wrote in a 2001 corporate strategy email: “We have to hammer on the abusers in every way possible. They are the culprits and the problem.”
Purdue Pharmaceuticals then used a public relations campaign to villainize people with OUD and cast the company as the victim.
Richard Sackler claimed people with OUD knowingly “get themselves addicted” to Purdue’s products at the expense of “decent people” like himself.
While his claims were eventually proven false, the myths stemming from that campaign have had a lasting effect on OUD stigma.
OUD stigma can have serious effects on your mental health.
If your community excludes or blames you for having a recognized health condition, you may have a harder time finding emotional support. Internalized stigma can also lower self-esteem and lead to feelings of shame and guilt.
Adults with OUD are
Having thoughts of suicide?
If you feel distressed and overwhelmed or have thoughts of hurting yourself, you can get free, confidential support from a crisis helpline.
Trained crisis counselors can listen to whatever you’re dealing with, talk you through a moment of crisis, and offer guidance with next steps to get more long-term support.
- Text-based support: Text “HOME” to 741-741 to reach the Crisis Text Line.
- Phone support: Dial 988 to reach the National Suicide Prevention Lifeline.
- Support for LGBTQIA+ young adults: Call 866-488-7386 or text “START” to 678-678 to reach The Trevor Project. You can also chat online.
Remember, everyone deserves compassionate support during a crisis. Even if you don’t know who to talk to, you’re not alone.
Stigma can damage your physical health, too, by creating an obstacle to healthcare.
OUD stigma can make it harder to:
OUD treatment is safe, effective, and legal. But in the United States,
If people in your community and social circle heavily stigmatize opioid use, you may avoid treatment for fear of:
- jeopardizing your employment
- harming your relationships
- facing pity or scorn from healthcare professionals
- losing custody of your children
- experiencing legal difficulties
Even if you feel ready to get treatment, you may have trouble finding healthcare professionals who offer treatment near you.
Some doctors are reluctant to offer medications for opioid treatment for a variety of reasons, such as:
- fear of
being auditedby the Drug Enforcement Administration
- considering people with OUD as “difficult” or “dangerous”
- avoiding courtesy stigma by choosing not to work with people who have OUD
Research from 2019 examined the attitudes about OUD held by Massachusetts emergency, family, and internal medicine professionals.
Nearly 1 in 4 professionals in this group believed their practice would attract “undesirable patients” if they treated OUD.
Receive healthcare unrelated to opioid use
Methadone and buprenorphine are medications for OUD (MOUDs). Despite overwhelming evidence that MOUDs have benefit in the treatment of OUD, some people believe treating OUD with medication is “trading one addiction for another.”
In other words, they believe people who take these medications will develop an addiction to them instead, or eventually resume using opioids.
This can make it hard to access certain healthcare services, like organ transplants. Doctors may deem you ineligible for transplant for fear you may “waste” a donated organ by damaging it with opioid use. They may also suggest MOUDs could make your body reject the organ.
This discrimination can be dehumanizing, since it classifies people who have used opioids or are trying to treat OUD as less worthy of lifesaving treatment.
Furthermore, these so-called concerns have no supporting evidence. Existing research suggests people taking MOUDs have the same rates of transplant success as the general population.
According to a 2018 poll by the American Psychiatric Association, a third of the U.S. population knows someone with a history of OUD. If you’re one of these people, you may wonder how you can help your loved one recover from the disorder without stigmatizing them for it.
These tips can help.
Offer practical assistance
OUD treatment may involve a mix of medication, counseling, and support groups. It can be difficult to build a care team that offers affordable services at compatible times.
But offering to help your loved one research their options can ease some of the overwhelm associated with finding healthcare professionals and starting treatment.
Consider carrying naloxone
Naloxone is a medication that can reverse the effects of opioid overdose. In most U.S. states, you can get naloxone
You may never need naloxone, but in the event your loved one ever does experience an overdose, having this medication on hand may save their life.
Mind your language
For example, members of an OUD support group may call themselves “addicts” or “opioid abusers.” They can trust each other to understand these terms describe substance use, not moral character or criminality.
However, just because your loved one sometimes calls themselves an addict doesn’t necessarily give you permission to call them that. Throwing labels around carelessly often only serves to reinforce stigma.
In general, it’s safest to rely on person-first language, like “They have OUD,” or “They’re in recovery from OUD.”
It also never hurts to ask your loved one which terminology they’d like you to use for them individually.
Respect their privacy
People with OUD have a right to privacy around their health status, just as they would with any other condition. Disclosure often comes with a risk of rejection and stigma, so the person with OUD needs to decide who they trust with their health information.
In short, you shouldn’t share what they disclosed to you without their permission.
Even if you’re sure the people you want to tell would offer acceptance and compassion, telling others behind your loved one’s back can seriously derail the recovery process.
Your loved one might:
- consider your disclosure a betrayal and stop trusting you with information
- isolate themselves, unsure of who does or doesn’t know about their condition
- become less motivated to pursue treatment for fear of becoming even more vulnerable
Ideally, you and your loved one will establish ahead of time who you want to inform. That way, if questions come up in conversation, you aren’t caught off guard.
Get therapy yourself
Supporting someone through OUD treatment may often feel stressful. You may worry about their health or feel frustrated at the pace of recovery, just as you might when caring for a loved one with any other chronic health condition. You may also encounter stigma yourself for supporting your loved one unconditionally.
If you feel overwhelmed, know you don’t have to deal with this alone. Therapy offers a safe space to talk out your feelings unfiltered.
Since therapy is confidential, you don’t have to worry about exposing your loved one’s health information to the local rumor mill, the way you would by talking with a friend or neighbor.
You might also consider free, confidential support groups. One of the most well-known support groups is NAR-ANON. It’s a 12-step program for family members of people with substance use disorders.
People with OUD can face stigma on all fronts: from friends, co-workers, and even doctors and other healthcare professionals.
Much of this prejudice and discrimination against OUD stems from broader biases like racism and ableism. Regardless of the source, stigma can block your access to appropriate OUD treatment, reinforcing the very condition it punishes you for having. But with patience and support, recovery from OUD is absolutely possible.
Remember: OUD is a diagnosis, not a character flaw. You never need to feel ashamed or guilty for seeking help.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.