Latent profiles of change in opioid-related stigma and predictors of profile membership within a nationally representative, weighted sample in the United States

Background Stigma is a well-established barrier to opioid use disorder (OUD) treatment initiation and outcomes. However, research has yet to fully describe if and how national public OUD stigma changes over time in the absence of formal intervention. Utilizing a longitudinal, nationally representative sample, this study aimed to: 1) describe changes in stigma over time, 2) identify distinct subgroups of individuals characterized by different patterns of change in stigma over time, and 3) assess predictors of subgroup membership. Methods Data were drawn from a two-wave national survey (late 2021- early 2024). Measures included public OUD stigma, perceptions of OUD criminality, supportive OUD public policy endorsement, and personal/familial OUD experience. Weighted analysis included descriptive statistics for mean-level changes, latent profile analysis (LPA) for change profiles, and ordinal regressions to identify predictors of profile membership. Results Descriptively, stigma scores remained relatively stable between waves (range: -0.09–0.15). LPA supported a three-profile solution: no change, increased stigma, and decreased stigma. Several factors were associated with increased likelihood of membership in the decreased stigma profile (e.g., personal OUD experience, greater public policy support) and increased stigma profile (e.g., Republican political party, higher educational attainment, stronger perceptions of OUD criminality). Conclusions Although OUD stigma was largely stable descriptively, latent profiles showed distinct increases or decreases, predicted by several factors, including (but not limited to) personal experience, policy support, political party, and perceptions of criminality. Understanding these natural longitudinal changes is critical for designing targeted interventions to reduce stigma and improve health outcomes for individuals with OUD.