Dr. Mary T. Bassett is director of the Harvard University FXB Center for Health and Human Rights and a professor at the Harvard T.H. Chan School of Public Health.
Dr. Chad Brummett is an associate professor of anesthesiology and director of pain research and
director of clinical anesthesia research at the University of Michigan. He is also the co-director of the Michigan Opioid Prescribing Engagement Network (Michigan OPEN).
Pernicious pharmaceutical marketing practices have led to an explosion in opioid use over the last two decades. The social costs have reverberated across families and communities. Heroin, long a scourge of black and brown communities, recently crossed the color line as white opioid users sought lower cost replacements for prescription opioids. More Americans than ever before are now opioid dependent, and far too many lives have been cut short by opioid overdoses. The current overdose crisis is a driving factor in the United States’ life expectancy declining for a third year in a row.
In response, cities and states across the country have launched aggressive responses to prevent overdose deaths. Efforts include better data tracking, increased access to naloxone, which reverses opioid overdoses, and improved access to treatment. Michigan has started to see a decline in overdose deaths -– proof that strong action can help save lives. However, one critical barrier remains: stigma.
Racial stigma played a role in our country’s response to the previous opioid overdose epidemic in the 1970s and '80s. Earlier waves of heroin use, primarily among people of color, led to punitive measures instead of treatment. The response to today’s overdose crisis humanizes the drug user, who now often is white, opening the door to help instead of handcuffs. But the door is only partially ajar.
The lasting effects of the War on Drugs taint current efforts to curb overdose deaths. Even if inappropriate prescribing of painkillers were to stop, opioid dependence will remain a major threat to life. But only 11 percent of people who could benefit from substance use treatment received treatment at a specialty facility in the past year. Why?
Part of the reason is that stigma has greatly limited treatment options for people living with opioid use disorder. Methadone treatment, for example, is often referred to by those in recovery as “liquid handcuffs” due to the daily, in-person check-ins required for treatment. Other methods of treatment, like buprenorphine, can only be prescribed by a growing, but limited, number of health care providers due to the requirement of a full day course and a special waiver process. Stigma of addiction and myths about buprenorphine have created a barrier to engaging primary care physicians in addressing our greatest public health problem.
Developing a substance use disorder is not the result of a moral failure –- anyone can develop opioid use disorder (opioid addiction). That’s why it’s up to all of us to eliminate the stigma that, for far too long, has led to people living with addiction struggling alone.
As part of a commitment to confront real-world problems, our universities – Harvard University and the University of Michigan –- have teamed up to address the opioid overdose crisis. On Thursday, Harvard will host the second joint summit, “Stigma and Access to Treatment,” where we aim to shine a light on the role stigma plays and develop actionable steps to address it.
Stigma makes people who use drugs feel ashamed about their drug use and people who love them reluctant to talk about it. Health care providers continue to feel uneasy about taking care of someone with a substance use disorder, and policy makers and payers must facilitate better treatment options. We need people to understand that this is a disorder that people need help with, about which none of us should be ashamed. Tackling stigma is essential to saving lives and communities.