Episode 2: Stigma, Addiction, and Health Care

Thursday, July 1, 2021

 

 

Countering the Opioid Crisis: Time for Action Podcast

Click here if you are interested in listening to the full episode hosted by the National Academy of Medicine.

In this episode the guest speakers are Dr. Charlene Dewey, a professor at Vanderbilt University Medical Center and Edna Boone, a health information technology expert. Both speakers discuss the stigma of having a substance use disorder (SUD), getting treatment for a SUD, and even being in recovery from a SUD. They also discuss how stigma negatively impacts individuals from seeking treatment and what we can do to move forward.  Below are some of the highlights that I took away from the podcast:

  • Dr. Dewey defines stigma as a mark or stain of shame that one person assigns to another person.
  • Dr. Dewey wanted to clarify that SUD is not a choice, a moral failing, or a criminal act; people have a pre-disposed risk to addiction and it is a disease.
  • Language is one of components of stigma but there are also stigmatized behaviors. An example is when a healthcare provider does not think that a person is capable of making medical decisions for themselves because they use substances, not just in the moment where they might be high, but anytime.
  • Healthcare providers are regular people too that grew up in society next to you and me. They are going to have their own experiences with SUD and people with addiction. They might already have preconceived notions before they even start practicing medicine.
  • Other diseases have stigma too. For example when family members tell others that their loved one was diagnosed with "the big C" and not actually say the word cancer. 
  • Edna discusses how even the way we provide care is stigmatized in the medical community. You need special training and waivers to prescribe medications to treat SUD or opioid use disorder (OUD), but you don't need special training or waivers to prescribe opioids. SUD treatment and even more broadly, mental health treatment, is separated from regular healthcare which by itself is stigmatizing.
  • Dr. Dewey made an important statement that historically minorities have been criminalized at a harsher rate than white people; this is where the opioid epidemic started but it wasn't viewed that way yet. It wasn't until white people started having the same issues with opioids that people of color did that the opioid epidemic began being viewed as it is today. As a crisis that these people need help with and not a crime or moral failing.
  • Edna talks about adolescents and how they are at a higher risk to try substances and then in turn develop a substance use disorder. They could be pre-disposed genetically or being influenced by their peers around them. They also find it harder to ask for help because they can't get help without their parents or are afraid to talk to their doctors in case the doctor tells their parents.
  • Another component of stigma in healthcare is that a lot of treatments are not covered by insurance.
  • A historical example of stigma related to a disease was the HIV/AIDS crisis. Doctors were afraid to touch patients with HIV and even when the science proved that wasn't possible - the facts were not enough to change public opinion. It took mass media campaigns, celebrities to admit that they had the disease, and public health organizations to open to help these people. It didn't happen overnight but now the stigma with having HIV is not the same as it once was decades ago.
  • Edna suggests that to move past stigma people can speak up about any experiences they have had with SUD. Whether it be their own story, or families/friends. Also, to use person centered language when addressing people with SUD. Change the language you use, be kind, and be thoughtful with your words.
  • Dr. Dewey speaks to the healthcare providers and suggests that when they are treating patients with SUD they should think about what they can do that is different to help that person. They should also be conscious of not placing judgment on people with SUD. Doctors should be part of the solution and not part of the problem.

 

Annette Perrino
Program Manager
Macomb Partnership for Overdose Prevention