Ambiguous identities of drugs and people: A scoping review of opioid-related stigma

Melissa D McCradden; Denitsa Vasileva; Ani Orchanian-Cheff; Daniel Z Buchman

doi:10.1016/j.drugpo.2019.10.005

Ambiguous identities of drugs and people: A scoping review of opioid-related stigma

Int J Drug Policy. 2019 Dec:74:205-215. doi: 10.1016/j.drugpo.2019.10.005. Epub 2019 Oct 28.

Authors

Melissa D McCradden¹, Denitsa Vasileva², Ani Orchanian-Cheff³, Daniel Z Buchman⁴

Affiliations

¹ St. Michael's Hospital, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, 399 Bathurst Street, 8th Floor, McLaughlin Pavilion, Room 443, Toronto, ON M5T 2S8, Canada; University of Toronto Joint Centre for Bioethics, Canada.
² Toronto Western Hospital, University Health Network, 399 Bathurst Street, 8th Floor, McLaughlin Pavilion, Room 443, Toronto, ON M5T 2S8, Canada; University of Toronto, Canada.
³ Toronto Western Hospital, University Health Network, 399 Bathurst Street, 8th Floor, McLaughlin Pavilion, Room 443, Toronto, ON M5T 2S8, Canada.
⁴ Toronto Western Hospital, University Health Network, 399 Bathurst Street, 8th Floor, McLaughlin Pavilion, Room 443, Toronto, ON M5T 2S8, Canada; University of Toronto Joint Centre for Bioethics, Canada; Dalla Lana School of Public Health, University of Toronto, Canada. Electronic address: daniel.buchman@utoronto.ca.

PMID: 31671303
DOI: 10.1016/j.drugpo.2019.10.005

Abstract

Background: Human beings have long consumed opiates and opioids for pleasure and as a treatment for numerous ailments, most notably pain. North America is currently in the grips of a crisis of opioid-related overdoses, and stigma is considered a major driver of the harms. While it is well established that substance use in general is highly stigmatized, stigma is a complex concept and opioid-related stigma is not well understood. A lack of clarity on opioid-related stigma has practice and policy implications in terms of understanding the sources of opioid stigma, how it manifests in various contexts, its impact on affected groups, and the development of effective strategies to redress it.

Methods: We performed a scoping review of the academic literature to develop a typology of opioid-related stigma. A charting process identified the type, agent, and recipient of stigma as well as the methodology and substances considered.

Results: Our search yielded 8,543 articles, from which 49 were included in the analysis. Based on the findings, we developed a typology of four main themes: (1) interpersonal and structural stigma toward people accessing opioid agonist therapy (OAT); (2) stigma related to opioids for the treatment of chronic pain; (3) stigma in healthcare settings; and (4) self-stigma.

Conclusion: How opioid-stigma is (re)produced depends on the context of opioid use, the social identity and networks of the person who is consuming the opioid, and what type of opioid is being consumed, including medically-sanctioned forms of treatment. Opioid-related stigma permeates intrapersonal, interpersonal, structural, and societal levels, and people who consume opioids are marginalized at all levels. Our review describes our typology of stigma and illuminates multi-level considerations for reducing opioid-related stigma in healthcare settings.

Keywords: Addiction; Opioids; Pain; Policy; Stigma.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Analgesics, Opioid / administration & dosage*
Chronic Pain / drug therapy
Delivery of Health Care / organization & administration
Humans
Opioid Epidemic
Opioid-Related Disorders / epidemiology
Opioid-Related Disorders / psychology*
Social Identification
Social Stigma*

Substances

Analgesics, Opioid