Unpacking The Associated Stigma Of The Opioid Crisis Response

I have spent the majority of my life working to understand addiction from both a personal and professional perspective. As someone who grew up in the beautiful state of West Virginia, where the opioid crisis is thick and prevalent in every system, I am often thankful opiates were not available when I was a kid.  I would likely be a statistic. West Virginia has a poverty rate of 17.9% and recently ranked in the bottom four states for household income. This does not surprise me one bit, because it was my reality. Poverty creates a desperation and also increases all sorts of trauma, I guess you can say poverty is trauma. All the stereotypes that you might have about the beautiful people from West Virginia, was in some part my reality. In addition to the struggles, there was a lot of beauty like childhood friends and families that believed in a village sense of care, mountain camping trips that still fill my dreams and make me smile, Friday night lights on the football field, and wild and wonderful journeys that filled me with hope—thanks to all the great WV teachers!

 My early experiences definitely continue to color my adult years, where my fight is about creating bridges for those struggling with addiction, mental health, and who come from socioeconomically disadvantaged homes. I’m mostly sending messages of hope and offering solutions for clinical intervention and community response because I know life can change, mine certainly has.  I know my past is why I have a deep drive to help with addiction community response and why I became an addiction and mental health counselor and researcher many moons ago because this fight was my fight in a roundabout way. I now fight for my kids’ future.  My pedigree has provided me with grit and resilience like no other—just ask my husband or anyone from my past. My clients have this same grit and resilience, this is why I always believed in their recovery even when very few people accepted their path of recovery or when the odds were stacked against them.  

I sat with clients who struggled with Opioid Use Disorder in Medicated Assisted Treatment (MAT), as a counselor, addiction specialist, and clinical supervisor and wondered why this treatment path felt so undercover? At that time (early 2003-2011), MAT had no wind in its sails, but clients were still coming by the hundreds and thousands and I was witnessing them get better and return to a life of recovery quickly.  The wind is starting to flow under the MAT sails and more doctors and health professionals are getting educated, providing and recommending care along a continuum. The day to day stigma that clients still have to face just to be in treatment or receive health care, in general, would be overwhelming to most people trying to navigate a system feeling deathly sick. My hat goes off to all those who are health care advocates for those struggling (mothers, fathers, aunts, siblings, recovery specialists).  I vowed to fight against this stigma and today as an addiction specialist, professor, and researcher I am doing just that with my work. The stigma associated with addiction was and still is the main barrier to individuals gaining access and feeling hopeful about their treatment choice. 

 Stigma has many different characteristics and target variants according to Pescosolido and Martin and it can be provider-based, policy-related, public practice, or self-induced. Below are some stigmas I have witnessed that I would like to begin to unpack: 

1. Medicated Assisted Treatment (i.e. Methadone, Buprenorphine, Vivitrol) is not treatment, it is just a replacement drug. 
2. Individuals struggling with Opioid Use disorder cannot and should not be treated for pain because of their addiction. 
3. Pregnant women with opioid use disorder on medicated assisted treatment and who deliver a baby and then get DSS called on them, even when they do not test positive for any other drugs. 
4. Drug courts operating on an abstinence-only policy for those struggling with opioid use disorder. 
5. Cops sitting outside of Medicated Assisted Treatment facilities or syringe exchange programs waiting to pull over the individuals when they leave care. 
6. DSS sitting in the lobby or parking lot of MAT facilities to see who is attending treatment there.
7. Community conversations that women who are struggling with Opioid Use Disorder should be sterilized and not allowed to have more kids. 
8. Individuals who have found recovery through a twelve-step philosophy (which is great) believing that this is the only recovery method and anyone else on a different path is not getting well, they are just continuing their addiction and manipulating providers. 
9. Calling people addicts, junkies, and not worth healthcare dollars. 
10. Considering death sentences for dealers.
11. The primary referral to treatment with individuals with OUD continues to be medical detox and inpatient treatment.  
12. Hospitals refusing to allow someone to dose on their methadone or other Medication used to treat OUD when hospitalized for other conditions. 
13. Very few treatment centers willing to help detox someone off of suboxone when someone is at a different stage of change and ready to move towards abstinence. 
14. Failure to recognize that people are at different stages of change, and a lack of an available continuum of care or usage of that continuum for each stage. Because we believe it is a one size fits all care model (abstinence-only). 
15. Someone overdosing and being triaged through the ER within 45 minutes or less in withdrawal and sent out to the street sick. 
16. Medical professionals not getting (or being mandated to receive) the necessary education and training to treat their patients with opioid use disorder even if this is a high majority of the cases they are seeing.  
17. Not thinking someone will ever get well based on their history. 
18. The tough love mentality for those struggling with opioid use disorder. 
19. Supporting incarceration instead of rehabilitation. 
20. Taking a lot of money from families for residential treatment and not offering them the evidence related to the percentage of people with this use disorder who get well from this treatment. Never discuss MAT or offer Naloxone training to parents that have kids who overdosed. 
21. Lack of regulations for addiction treatment
22. Health care providers who are in recovery only pushing their recovery path to patients. 
23. Not talking about safe injection facilities. 
24. Families disowning their kids for being in MAT or professionals losing their jobs for being in MAT. 
25. The belief that addiction is not a disease but a moral failing. 
26. Thinking that progress towards recovery happens overnight with the right pressure. 
27. Behavioral Health and Health Care professionals in school not getting sufficient addiction-related education. 
28. Not allowing opioid prevention programs in the schools because that problem does not exist in our community.
29. Not requiring (in some states) prescribing providers to use the Prescription Drug Monitoring program. 
30. The lack of affordability and availability of Naloxone. 

This list is not exhaustive or categorized but it is a quick list and everything on it I have sadly witnessed. I would welcome your conversations or stories about anything on this list. Or better yet, let me know any stigma that I missed or a counterargument.  This story is based on my own experience in the field of addiction treatment and does not represent any data-driven report. 

Let’s keep the list going so we can start tackling it one community at a time.