Addressing Stigma

According to the American Psychiatric Association, fear of stigma can lead patients to forego getting treatment, leading to poor health outcomes. These resources focus on understanding and addressing the stigma of opioid use disorder and treatment to ensure that patients have the medications and support they need.

• The American Opioid Epidemic in Special Populations: Five Examples: This NAM Perspectives discussion paper identifies the unique needs of special populations including justice-involved populations, rural populations, adolescents, veterans, and people who inject drugs, and discusses promising approaches and critical research priorities needed to ensure improved care and reduced mortality for these populations. This is not an AHA-affiliated resource and may not reflect our views.
• New England Journal of Medicine. Perspective: Controlling the Swing of the Opioid Pendulum (Feb 2018). This perspective piece provides a case example of a patient who is negatively impacted by a clinic’s decision to implement a no-opioid policy, which means they would no longer prescribe any opioids. This piece goes into the reasons such policies exist and recommendations on how to overcome challenges which may result in clinics choosing to implement no-opioid policies.
• New England Journal of Medicine. Perspective: Caring for Ms. L. — Overcoming My Fear of Treating Opioid Use Disorder (Feb 2018). This perspective piece provides a case example of a patient who had come to a physician asking for buprenorphine treatment which is used to treat substance use disorders. The physician did not go through the training to get the licensure for buprenorphine treatment due to several reasons, including stigma that was associated with treating patients with substance use disorders. This piece provides insight into this physician going through the licensure process and experiencing providing treatment to patients in need.
• The Role of Shame in Opioid Use Disorders. (2016) Shame plays an important role in opioid use disorders (OUD) and can impede treatment if not addressed appropriately. In this module, participants will learn to recognize and appropriately address shame in patients with OUD. Participants will learn about particular groups of people with OUD who have specific concerns regarding shame, including people who inject heroin, and opioid-addicted pregnant women and mothers. In addition, treatment options that address shame in people with OUD are outlined. CME credit available.
• Follow-up Q and A Webinar: The Role of Shame in Opioid Use Disorders. (2016) This Q and A webinar further discussed Dr. Braun-Gabelman’s online module, “The Role of Shame in Opioid Use Disorders,” with questions from participants and a few cases related to this topic. CME credit available.
• Addiction, Stigma, and Discrimination: Implications for Treatment and Recovery. (2015) This presentation outlines the background and significance of stigma in relation to addictive disorders, highlights how stigma influences treatment access and treatment and recovery outcomes, and discusses what can be done to address and reduce stigma to enhance the quality of addiction care. CME credit available.
• Stigma in Methadone and Buprenorphine Maintenance Treatment. (2015) This module describes the history of methadone maintenance and the effectiveness and key myths of opioid agonist treatment. The module explores empathizing with patients taking methadone or buprenorphine and empowering clinicians to support patients and their significant others. CME credit available.
• SAMHSA Proposed Rule: Confidentiality of Substance Use Disorder Records. (April 5, 2016): The Substance Abuse and Mental Health Services Administration (SAMHSA) issued on February 9 proposed changes to the confidentiality rule for substance use disorder records to facilitate health information exchange while protecting patient privacy. “This proposal will help patients with substance use disorders fully participate and benefit from a health care delivery system that’s better, smarter and healthier, while protecting their privacy,” said Health and Human Services Secretary Sylvia Burwell. SAMHSA will accept comments on the proposed rule through April 11.

Case Examples

• Words Matter. (2017) Boston Medical Center created a list of stigmatizing and nonstigmatizing language in addition to a pledge that explains the importance of committing to using clinically appropriate and medically accurate terminology.
• Deconstructing Stigma: A Change in Thought Can Change a Life–McLean Hospital, Belmont, Mass. (2017) Stigma — a mark of disgrace associated with a particular circumstance, quality, or person — continues to be a significant barrier to access, treatment and coverage of psychiatric and substance use disorders. This webinar describes the steps that McLean Hospital took to deconstruct and eradicate stigma.
• The Value of Patient/Peer Advisory Groups: Improving Behavioral Health Services at Northern Kaiser Permanente, Oakland, Calif. (2017) Stuart Buttlaire, Ph.D., describes the selection, composition and qualifications of Kaiser’s advisory council, comprised primarily of individuals who have consumed behavioral health services at Kaiser (or have family members who have). Buttlaire shares how the council’s input has driven the modification of several elements in the Kaiser behavioral health service line, advancing the quality of care and patient satisfaction. Buttlaire also articulates how Kaiser works with council members to reduce stigma in the community.
• How Hospitals Are Fighting on the Frontlines of the Opioid Crisis. (2016) This article includes a discussion of how Gundersen Health System decreased stigma.
• Racism and discrimination in health care: Providers and patients. (2017) Doctors take an oath to treat all patients equally, and yet not all patients are treated equally well. The answer to why is complicated.