Blog: We must better understand stigma toward patients with substance use disorders

With COVID-19 ravaging communities across the nation, many providers are understandably exhausted – mentally, physically and emotionally. Because of actions outside of their control, including varied policy responses at different levels of government and some of the public ignoring known infection control practices, clinicians are often asked to risk their health and bear the brunt of this pandemic, all while continuing to provide quality, empathetic care to an ever-flowing stream of patients.

Even before the COVID-19 pandemic, advocates working to end substance use disorder (SUD) stigma asked a similar question: How do you support and encourage providers to offer compassionate, evidence-based care to individuals who are often rebuked by their own families and communities as weak or having bad character? Rather than discuss SUD as a chronic disease that changes the brain, there is a tendency to raise nonfactual tropes about the effectiveness of medication or focus on the perceived lack of effort from their patients to “get better.”

For example, a Massachusetts study found 24% of emergency, family and internal medicine providers believe their practice would attract undesirable patients if they treated opioid use disorders (OUDs).

Beyond distrust towards patients, there is rampant skepticism of evidence-based treatment. Nearly one-third of U.S. primary care physicians do not think treating substance use disorder with medication is any more effective than treatment without it, despite clear evidence that buprenorphine and methadone are highly effective treatments for OUD and other SUDs and save lives.

The perceived ineffectiveness of treatment could result from physicians repeatedly seeing individuals who were previously offered medication or referrals to treatment providers. For example, in Washtenaw County, Mich., 16% of patients diagnosed with opioid-related poisoning had multiple emergency department visits over 42 months. This can leave a lasting impression on some providers. 

This perceived ineffectiveness may also reflect the need for increased and improved addiction education. In a survey of physicians and nurse practitioners, only one in four respondents had received addiction training during their medical education, a startling statistic relative to other chronic medical conditions.

This lack of education – and the material challenges present in providing dignified, effective care to individuals with substance use disorders – combine to spread stigma across the provider community. Unfortunately, we know very little about addressing this stigma, and how to ensure clinicians can overcome these headwinds to continue providing the highest quality care.

While there are a handful of trailblazing academics in this area, it nonetheless remains a nascent field of study, deserving of increased attention and funding. Beyond such support for this type of research, there also exists a real need to understand how clinicians’ mental health is impacted by treating individuals with behavioral health issues. Without an evidence-based path forward, advocates and physicians will continue to fumble when trying to reduce physician burnout and stigma towards individuals with substance use disorders. That’s one of the reasons Shatterproof recently partnered with the AHA, who also works to reduce stigma, to develop and disseminate materials for clinicians to tackle this enormous problem.

The addiction epidemic continues to worsen, and the rise in drug deaths this year will likely be the sharpest percentage increase in annual drug deaths since 2016 – when fentanyl became widely distributed and led to an approximately 22% increase in overall drug overdose deaths. Advocates will once again turn to providers to help in this effort.

We must approach those with substance use disorders in a compassionate and destigmatizing way to lives are saved in what will likely be the next wave of the addiction crisis – and make sure that the providers treating them have the educational foundation and resources they need to do so.

Matthew Stefanko is the director of National Stigma Initiative for Shatterproof, a national nonprofit dedicated to reversing the addiction crisis in the U.S.