Stigmatization for opioid use from service providers—a community-based qualitative study

Stigma is a primary barrier to opioid use disorder (OUD) intervention implementation, undermining treatment outcomes. Some scholars have argued that stigma from service providers is the greatest barrier to recovery. Strategies to address service provider stigma are undertheorized and typically focus on one-time individual education, despite evidence that a long-term approach that engages macro, meso and micro social levels is necessary for effective stigma mitigation. We qualitatively analyze 170 interviews with community coalition members participating in the Healing Communities Study (HCS), conducted from May to June 2022, to identify perceptions of service provider OUD and OUD intervention stigma, and strategies to mitigate stigma. HCS was a longitudinal, cluster randomized wait-listed controlled trial that aimed to reduce opioid overdose deaths in four states. Our analysis included deductive and inductive components, framed by the Health Stigma Discrimination Framework to leverage the multi-level structure of the HCS. Participants shared perceptions of blame and burnout as key service provider OUD stigma drivers. Drivers of OUD intervention stigma included perceptions that OUD medications enable drug use, providers’ preference for abstinence only treatment, and refusal to consider OUD treatment (distancing). Strategies identified to reduce stigma included formal and informal education opportunities over extended timeframes, education from expert peers, and cross-sector collaboration. OUD stigma drivers cooccur and may influence the development of OUD intervention stigma, diminishing treatment outcomes. Anti-stigma approaches should take a multi-level, intersectional, longitudinal approach. Strategies must also recognize the importance of varied, ongoing educational opportunities, providing service providers adequate time and opportunity for meaningful learning and reassessment of stigmatized attitudes and beliefs. Community coalitions may be effective leaders in designing and implementing cross-sector strategies across social levels to promote community cohesion and reduce service provider OUD and intervention stigma.