Opinion | Treating stigma to prevent opioid overdose deaths

Bassett and Brummett

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.

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Comments

Todd
Wed, 10/09/2019 - 12:47pm

This problem will be made worse if Representative John Bizon gets his way and bans Kratom. Senate Bill 433 is a death sentence for many in Michigan.

Nancy Finegood
Wed, 10/09/2019 - 7:12pm

Take the time to watch Brad Finegood’s TedX talk

Brad Finegood gets a little emotional when talking about the opioid epidemic—and with good reason. His brother, whom he describes as a “good kid” whose struggles with drug addiction started in college, died of an overdose several years ago. Finegood, an addiction counselor who started out working with clients in the criminal justice system, began to question the nation’s punitive approach to drug addiction after his brother’s death, and has since become one of the county’s leading advocates for harm reduction—policies that help people suffering from addiction lead better lives, and stay alive, even as they continue to actively use drugs or alcohol.

“People can’t get better when they’re dead,” Finegood says.

https://www.ted.com/talks/brad_finegood_unlocking_the_cure_to_substance_...

Matt
Thu, 10/10/2019 - 8:20am

So where's the line between self responsibility and saying someone "caught" heroin addiction like someone caught the flu? Stigma has some value, like telling your kids "you don't want to be that!". Sure some people's feelings are hurt but why shouldn't they? Seems like the only thing we can hold responsible is the drug company, the doctors and individuals themselves are nothing but helpless protoplasm.

Bones
Thu, 10/10/2019 - 11:27am

Perhaps because addiction is a medical condition and it was the goal of unscrupulous corporations to expose and addict as many people as possible to opioids while lying about the habit forming effects? You know, the benevolent forces of the market destroying lives in the pursuit of profit

Matt
Fri, 10/11/2019 - 4:53pm

Don't tell me you feel a case of herion addiction suddenly coming on? People are totally helpless to whether they become an addict or not? As someone who knows people who are addicts and others that come very close, the thing that stands out is how much they like it and whether they recognize it or not.

WRTolkas
Sun, 10/13/2019 - 11:13am

My cousin returned from Vietnam hooked. He died in prison of an overdose. Whose fault? He wasn't that way before he was shipped out. We enlisted together. He was drafted; me, I had a low number. Was I lucky or different?

middle of the mit
Sun, 10/13/2019 - 9:02pm

This is very complex problem. On the one hand, our nation has had this problem for decades it's only when it starts effecting white people that we decide that jail isn't the solution.

But why is it hitting white areas now? And why the rural areas the most? Could both situations be a result of low unemployment and people not having anything constructive to do? Seems to me that is the lowest common denominator.

As for the stigma, that is what people do, don't we? Stigmatize those who don't fit norms? Jail was never the proper solution to this particular problem, but...."perceptions" vs facts.

We don't throw drunks in jail unless they are drinking and driving or obnoxious and belligerent in public. We even allow them gathering places to go out in public and drink until they can no longer afford to. Our townships and counties even use alcohol to increase revenue at "family events". Seems to me we could find a way to fund treatment centers for those needing help if we wanted to.

The other problem I have is that there are legitimate pain patients who can no longer receive pain medication for documented physical problems. What are the supposed to do?
I have talked with people whose doctors won't prescribe them medicine that will help their problem and the only medicine they can get is time release pain medicine that isn't covered by insurance and their out of pocket costs went from $44/month to over $300.

I don't know what the answers are. All I know is that this the way America is heading. The wealthy get coddled, the workers get thrown out the door after their bodies are broken and no one wants to do anything about it because it will cost money.

Instead of asking why we have to pay for all the services and things that we are taxed for, maybe you should ask why these programs exist in the first place. I did, it was enlightening.

Just do some research. Find out why we have public schools. Find out why those public schools have free and reduced lunches. Did you know a Michigan Governor actually made law in the late 1800's and or early 1900's that each county have a poor house? You do now. Why?

We are a nation of individuals, linked together by a common bond. Just like a chain. And just like a chain, the chain is only as strong as it's weakest link.

Some of us would like to inspect the chain, find out where weak links are and fix them by welding them and reinforcing them. Others just want to cut the weak link out. But that makes the chain shorter. And now you may not be able to use it, especially if you cut all the weak links.

Addiction is not something you catch. Most people who have an addiction problem have a genetic marker that makes them more susceptible. The problem some of our citizens have is that they can not understand how something that hasn't happened to them could possibly happen to anyone as moral as they are. Your life experiences aren't the same. But you could have some compassion.

It's just easier to ridicule and make fun of those people. And it doesn't cost you any money.