Blog 2- The Stigma Around Addiction

 What is stigma?

    Stigma is the negative beliefs, attitudes, or perceptions that can lead to discrimination and separate one group or person from the rest of society (Judd et al., 2021).  Unfortunately, opioid use addiction is the most stigmatized health condition in the world (Cheetham et al., 2022).  Society often views opioid addiction as a personal choice rather than a disease (Cheetham et al., 2022).  The public views those with opioid use addiction as dangerous, manipulative, and undeserving of health care benefits, housing, and resources for food (Cheetham et al., 2022).

 (Substance Use Services Blog Series, 2020).

Why Does Stigma Exist?

Stigma exists because of the lack of knowledge the public has on the disease of addiction (Cheetham et al., 2022).  The public often hears the negative aspects of addiction through the media, such as the news (Cheetham et al., 2022).  The news is known for portraying the negative side of stories for a more dramatic reaction from the public.  How often do we hear the positive aspects of improvement in opioid treatment facilities on the news? Never. Usually the news talks about the number of overdoses and deaths that follow addiction. 

          Stigma can also exist because of the policies and regulations around treatment (Cheetham et al., 2022).  Methadone and suboxone clinics have strict rules for treatment, including drug testing, amounts of doses that can be filled at once, where the medication can be picked up, and who is allowed to prescribe the medication (Cheetham et al., 2022). The public forms a negative stigma around treatment because of all the rules that exist.   

What Are The Effects of Stigma?

    Stigma makes it difficult for those with opioid addiction to find quality health care.  Many providers refuse to care for patients who suffer from addiction because of the monitoring, regulations, and rules around treatment plans (Cheetham et al., 2022). Providers have a fear that their reputations will be ruined (Cheetham et al., 2022). Providers also feel that these patients are difficult to manage because they have a difficult time achieving pain control and are often looked at as "drug seeking" (Cheetham, et al., 2022).  I am ashamed to admit this, but I hear the "drug-seeking" comment at least once a shift from providers and healthcare workers caring for those with opioid use addiction.  I can understand the frustration providers feel when their patients state their pain is a 10/10 while they are relaxing on their phones, texting, and smiling.  Believe me, I get it.  It is not our job to treat these patients with any lack of respect, judgment, or slang language including "drug-seeker".  It is never acceptable. 

Confronting the Stigma of Opioid Addiction in Nassau County FL. (n.d.)

  Stigma can also cause a patient to lose social support and go into isolation (Christie, 2021).  The shame from the stigma of opioid use addiction can lead to weaker relationships among friends and families (Christie, 2021). This isolation also leads to a lower desire to seek treatment opportunities which ultimately can lead to overdoses and mortality (Christie, 2021).   

How Can We Avoid Stigma?

    To avoid stigma, it is important to educate the public on addiction (Cheetham et al., 2022).  The public needs to see that addiction is a disease and not a choice and that it can be treated successfully (Cheetham et al., 2022).  The public needs to see videos such as Andrew Allen's interview from Husson University ( linked below). 

 

https://husson.instructure.com/courses/2029948/files/164206902?module_item_id=39648104

In this interview, Andrew does an amazing job explaining how his addiction started, how it impacted his life, and how he never lost hope in finding treatment.  Stories like Andrew's will speak to the public in a positive light.

    Stigma can also be avoided by using destigmatizing language when discussing cases of patients with opioid use disorder (Cheetham et al., 2022). The words we choose to use are influential on the attitudes and beliefs of those around us (Cheetham et al., 2022).  For example, using the term "druggie" should be replaced with "a person who suffers from opioid use addiction" (Cheetham, et al., 2022). The healthcare community as a whole needs to educate all staff about destigmatizing language in hopes of decreasing the stigma around addiction.

References

Cheetham, A., Picco, L., Barnett, A., Lubman, D. I., & Nielsen, S. (2022). The impact of stigma on people with opioid use disorder, opioid treatment, and policy. Substance Abuse and Rehabilitation, 13(13), 1–12. https://doi.org/10.2147/SAR.S304566

Christie, N. (2021). The role of social isolation in opioid addiction. Social Cognitive and Affective Neuroscience, 16(7), 645–656. https://doi.org/10.1093/scan/nsab029

Confronting the Stigma of Opioid Addiction in Nassau County FL. (n.d.). https://www.nassaufldrugprevention.org/what-is-stigma

Judd, H., Meier, C. L., Yaugher, A. C., Campbell, E., & Atismé-Bevins, K. (2021). Opioid use disorder stigma reduction through story telling narrative and sharing: A qualitative review and lessons learned. International Journal of Mental Health and Addiction, 21(1). https://doi.org/10.1007/s11469-021-00606-y

Substance Use Services Blog Series: Different Kinds of Stigma, Shame, and Self-Compassion. (2020, June 18). Deltassist Family and Community Services Society. https://deltassist.com/substance-use-services-blog-series-different-kinds-of-stigma-shame-and-self-compassion

Blog 2- Opioid Use Treatment

 

Pharmacological

The most widely prescribed pharmacological opioid treatment medication is methadone and buprenorphine, or Suboxone (Patel et al., 2021).  Methadone can help neuropathic pain and opioid intolerance and mimics the effects of both morphine and heroin (Patel et al., 2021).  Suboxone also can be used to treat pain but has a less withdrawal effects than methadone (Patel et al., 2021).  Methadone and suboxone both involve regulations for prescribing, including only being dispensed through certified treatment programs (Patel et al., 2021).

(What Is Methadone And How Does It Really Work? , n.d.).

Barriers to pharmacological treatment

                When first starting methadone, it must be taken every 8 to 12 hours (Patel et al., 2021).  This is difficult for patients because it can only be dispensed at a certified treatment center.  These treatment centers may not always be at a close distance to patients.  Especially if patients can’t drive, transportation to the treatment centers may be very difficult and stressful (Patel et al., 2021). Lifting regulations around dispensary rules will allow patients to fill these medications like the rest of their medications and allow them to take their medications at home (Patel et al., 2021).

                Only 6% of physicians have received the authorization waiver to prescribe suboxone, which leaves many counties in the United States without a physician who can prescribe suboxone for treatment.  This number is concerning, especially regarding the lack of care those with opioid use addiction receive.  Many physicians admit to lacking knowledge, education, and experience in prescribing suboxone and have little interest in participating in the training to be certified in prescribing suboxone (Patel et al., 2021).  Education around addiction, treatment, and prescribing suboxone and methadone needs to be done at a graduate level.  Mandated training and certification can help increase access to physicians able to prescribe these medications (Patel et al., 2021).

Contingency Management

Contingency management is proven to be one of the most effective treatments for opioid addiction, but it is rarely used in healthcare (Patel et al., 2021).  It uses positive reinforcement to reward those who submit negative drug tests (Patel et al., 2021). Rewards such as vouchers for money, food, and gift cards are given to those who continuously provide negative drug screens (Patel et al., 2021).  This seems like a great system to provide positive reinforcement to those struggling with opioid abuse, but I honestly have never heard of this!  I have taken care of hundreds of patients who have a substance use disorder and have never heard them mention contingency management before.   

(Stock, 2024).

     Barriers to contingency management of course include funding (Patel et al., 2021). Who would fund all of these prizes?   An idea for funding could be through donations of treatment centers and rehabilitation centers.

References

Patel, K., Bunachita, S., Agarwal, A. A., Lyon, A., & Patel, U. K. (2021). Opioid use disorder: Treatments and barriers. Cureus, 13(2). https://doi.org/10.7759/cureus.13173

Stock, P. (2024). Prizes Stock Illustrations – 7,636 Prizes Stock Illustrations, Vectors & Clipart - Dreamstime. Dreamstime. https://www.dreamstime.com/illustration/prizes.html

What Is Methadone And How Does It Really Work? (n.d.). Methadone.org. https://www.methadone.org/