Assessment of Health Care Worker Stigma Toward Pregnant People With Opioid Use Disorder

Objectives: Stigma within health care can negatively affect pregnancy outcomes. Prior vignette studies suggest stigma varies by treatment status, but this has not been examined among pregnant people with opioid use disorder (OUD). We aimed to assess public stigma among health care workers toward pregnant people with OUD receiving medication for OUD (MOUD) versus actively using opioids and examine differences by clinical role and specialty. Methods: We conducted a cross-sectional survey of staff (residents/fellows, clinicians, nurses, clinical support staff, ancillary staff, and medical students) solicited through email and public postings at a tertiary care hospital from May to November 2023. Eligible participants were 18 years or older and worked in roles interacting with pregnant patients. Participants were randomized to 1 of 2 vignettes describing a pregnant patient with OUD receiving methadone or actively using heroin. Stigma was assessed using a modified Attribution Questionnaire (mAQ-11), including parenting confidence and custody items. Differences across vignettes, clinical roles, and specialties were analyzed using ANOVA, with P <0.05 considered significant. Results: Among 374 participants (MOUD n=183; heroin use n=191), stigma was significantly higher for active heroin use than the MOUD vignette (mean mAQ-11: 42.53 vs. 34.57, P <0.001). In the heroin-use vignette, clinicians endorsed less stigma than nurses and other medical professionals ( P <0.001). Pediatric/neonatal clinicians endorsed greater stigma than obstetric clinicians ( P =0.03). MOUD vignette participants expressed greater confidence in parenting ability and support for custody retention ( P <0.001). Conclusions: Health care worker stigma toward pregnant people with OUD was greatest in active opioid use vignettes. Differences across clinical roles and specialties identify important targets for antistigma interventions.