Exploring the Roots of Stigma: A Qualitative Investigation of the American Public’s Attitudes Toward Individuals with Opioid Use Disorder

The ongoing opioid crisis underscores the urgent need to understand and address stigma toward individuals with opioid use disorder (OUD). Applying message framing theory, this study examines how different segments of the public conceptualize OUD. Through in-depth interviews with 26 U.S. adults, segmented by their OUD experiences (personal, family/friend, or none) and stigma scores (high or low), we explored the underlying reasons for stigmatizing attitudes toward individuals with OUD. Our analysis revealed three key themes that differentiate perspectives between participants with higher and lower stigma scores: varying views on personal responsibility versus societal causes, the impact of non-addictive personal opioid use experiences on perceptions of addiction, and the role of perceived proximity to the epidemic in shaping attitudes. Participants with higher stigma scores predominantly viewed OUD as a matter of personal choice, while those with lower stigma scores emphasized systemic factors and medical models. Personal experiences with non-addictive opioid use tended to reinforce rather than challenge existing frames, with participants with higher stigma scores interpreting such experiences through a personal responsibility lens. Our findings suggest that effective anti-stigma messaging will likely need to start within audience members' preferred frames before gradually introducing alternative perspectives, particularly for audiences with higher OUD stigma scores who strongly resist medical or societal responsibility frames. This study advances message framing theory by detailing how different audience segments frame and interpret OUD, offering insights for developing more effective communication strategies that can bridge opposing viewpoints while maintaining scientific accuracy.