Stigma in Healthcare Settings

Maryland Department of Health: Words Matter
The Maryland Department of Health emphasizes using understanding and respectful language around substance use disorders to reduce stigma. It provides alternatives to common stigmatizing terms, promoting person-first language and highlighting the impact of word choice on perceptions.

Addressing Stigma
Maryland's Office of Overdose Response has created a public awareness toolkit to help dispel negative attitudes toward people who use substances or have mental health conditions.

"Don't Label Us" Campaign 
Queen Anne’s County Health Department has developed an award-winning education and stigma-reducing campaign about recovery from substance use disorder.

How to talk with your patients about substance use disorders 
Talking with patients about potential substance misuse can be challenging. This overview from the American Medical Association demonstrates how one physician approaches this conversation during his addiction consultations with patients while avoiding stigma in the process.

"Overcoming Addiction, Ending Stigma" Resource Guide
The Substance Abuse and Mental Health Services Administration has developed a list of resources about the language of substance use disorder recovery and treatment.

Addiction and Substance Use Disorders: Tips for Communicating without Stigma
A social media strategist at the National Institute on Drug Abuse shares the strategies her organization employs when it comes to avoiding stigmatizing language.

Words Matter - Terms to Use and Avoid When Talking About Addiction 
NIDA has created a page of tips for providers to keep in mind when using person-first language. It also contains terms to avoid in order to reduce stigma and negative bias when discussing addiction.

First Responder Substance Use Stigma Measures Toolkit
The First Responder Substance Use Stigma Measures Toolkit, developed by the National Association of County and City Health Officials in collaboration with Dr. Lawrence Yang, aims to assess and address stigma towards individuals with opioid use disorders among first responders.

Stigma: Beyond the Numbers
Get tips from the Centers for Disease Control and Prevention on how to talk about substance use disorders and learn about other direct actions you can take to reduce stigma to support recovery.

Remove Stigma: Talk With Your Patients About SUD
This sheet from the CDC provides techniques for talking with patients and their families about substance use disorder.

Changing the Narrative
Changing The Narrative is a network of reporters, researchers, academics, and advocates concerned about the way the media represents drug use and addiction. Its mission is to help journalists and opinion leaders provide accurate, humane, and scientifically-grounded information in this contested terrain. It offers expert sources – including people with lived experience of the issues – and up-to-date, fact-checked, and evidence-based information on news and controversies.

NIDAMED: Clinical Resources
The webpage provides science-based resources for health professionals and those in training about screening, addressing and treating addiction. It offers resources on vaping, marijuana, other drugs, the opioid crisis, safe opioid prescribing and overdose prevention. It also includes information on opioid overdose practice guides, screening tools to identify substance use, and free CME activities on combatting stigma and opioid use.

Addiction Medicine Toolkit
This Addiction Medicine Toolkit from the CDC helps clinicians understand and treat substance use disorders. It includes training on communication, patient cases and American Society of Addiction Medicine resources. A significant part of the toolkit focuses on addressing stigma by offering guidance on respectful language and empathetic communication to improve patient engagement.

Anti-Stigma Toolkit
A toolkit for behavioral health prevention and treatment providers, recovery community organizations, and individuals in recovery with practical information and tools to enhance their capacity to engage in effective stigma reduction efforts.

Reduce Stigma Against Substance Use Disorders
This resource, developed by the Reduce Stigma Against Substance Use Disorders Action Team, focuses on reducing the significant stigma associated with substance use disorders. Recognizing that stigma prevents individuals from seeking necessary help and support, the team undertook a process of assessment to understand the scope of the problem. Following this, they launched a comprehensive public education campaign designed to challenge negative perceptions and promote understanding. The resources created as part of this campaign include engaging content for social media platforms, informative videos addressing various aspects of stigma, specialized toolkits tailored for key groups (such as law enforcement or healthcare providers), and a community-wide challenge aimed at encouraging individual and collective action against stigma. The overarching goal of this initiative is to create a more supportive and less judgmental environment for individuals affected by SUDs, ultimately facilitating greater access to care and improved outcomes.

Stigma as a fundamental hindrance to the United States opioid overdose crisis response
This research article examines the role of stigma in responses to the opioid crisis in the United States. It shows how several dimensions of stigma play a role in hindering a response to the crisis.

Different forms of stigma and rural primary care professionals' willingness to prescribe buprenorphine
This qualitative study identified three distinct forms of stigma influencing rural primary care providers' willingness to prescribe buprenorphine: stigma towards patients, stigma towards providers and stigma towards buprenorphine itself. These findings underscore the complex nature of stigma as a barrier to buprenorphine access in rural areas and suggest that implementation strategies must address these different forms of stigma to improve prescribing rates.

Confronting Inadvertent Stigma and Pejorative Language in Addiction Scholarship: A Recognition and Response
This editorial dives into the importance of appropriate use of language in the field of addiction. Inappropriate use of language can negatively impact the way society perceives substance use and the people who are affected by it.

Stigma Against Addiction Medication Limits Our Ability to End the Opioid Epidemic
This article focuses on the negative impact of stigma surrounding the use of medication for opioid use disorder on efforts to end the opioid epidemic. It highlights how stigma, often based on misconceptions, leads to the underutilization of an effective treatment and contributes to preventable overdose deaths.

Stigma: how it affects the substance use disorder patient
This study underscores the pervasive and detrimental effects of stigma, particularly perpetuated by language, on individuals with substance use disorders and various aspects of their lives, including treatment and societal integration. It emphasizes the urgent need to adopt destigmatized language in daily conversations and across systems to foster a more accepting and supportive environment for recovery.

Addressing Stigma to Provide Quality Care to People Who Use Drugs
This commentary argues that stigma is a major obstacle to providing quality healthcare for people who use drugs. It highlights how negative experiences with healthcare providers discourage individuals from seeking care and can have dire consequences, even in overdose situations. The author contends that lasting change requires addressing the larger societal and legal structures that criminalize drug use and fuel harmful biases within the healthcare system. Therefore, efforts to improve care must target both individual attitudes and these systemic issues.

“They look at us like junkies”: influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City
This study in New York City found that many self-identified people who inject drugs experienced stigma in healthcare settings, leading to distrust and reluctance to seek care. However, they reported positive experiences at syringe service programs. The researchers suggest that SSPs offer a non-stigmatizing alternative for medical care and recommend further exploring how people who inject drugs make healthcare decisions in stigmatizing environments and expanding medical services within SSPs.

Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review
This review analyzed the extent to which healthcare professionals hold negative views about people with substance use disorders, impacting their care. Lack of training and experience contribute to this stigma, which is worse for certain groups. Addressing negative beliefs and improving addiction education could help reduce stigma.

Healthcare Worker’s Feelings About People With Substance Use Disorders
A review of studies revealed that healthcare professionals often hold negative attitudes towards people with substance use disorder, viewing them more negatively than those with other illnesses. These negative views are linked to beliefs about their character and a perception that SUD is self-controlled. However, experience and training can improve these attitudes. Importantly, perceived discrimination can hinder treatment. The review emphasizes the need to address these negative attitudes in healthcare to reduce stigma and improve care.

Lifesaving opioid addiction meds are rarely started after emergency visits for overdose
A study of Medicaid data revealed that only 6% of overdose patients in emergency departments started medication for opioid use disorder within 30 days. Significant racial disparities exist, with white patients more likely to receive medication than Black, Hispanic, Asian, and American Indian/Alaska Native patients. This gap is widening for Black patients despite increasing overdose rates. Researchers emphasize ED visits as a critical point for starting treatment to reduce the risk of future fatal overdoses and urge healthcare providers to address these disparities and increase MOUD initiation.

Past Webinars from MACS and MACS for MOMs

Words Matter: Decreasing Stigma While Caring For Pregnant People with Substance Use 
Katrina Mark, MD
August 31, 2023
Webinar Slides - August 31, 2023

Fight Stigma in the Pharmacy: Using the Right Words to Support Patients with Opioid Use Disorder
Bethany DiPaula, PharmD 
October 3, 2022
Webinar Slides - October 3, 2022

Fight Stigma: Using the Right Words to Support Patients with Opioid Use Disorder 
Bethany DiPaula, PharmD
January 25, 2021
Webinar Slides - January 25, 2021

NIDAMED CME/CE Activities

Words Matter - Terms to Use and Avoid When Talking About Addiction
This CME/CE activity informs clinicians on how language can destigmatize substance use disorders and addiction. It focuses on using person-first language and on terms to avoid to reduce stigma and negative bias when discussing addiction.

Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder
This CME/CE activity highlights clinicians' role in helping destigmatize substance use disorders and reduce negative bias among pregnant women and mothers. The activity has background information and tips for providers on language to use or avoid.

SAMHSA Webcast Series

The Power of Perceptions & Understanding: Changing How We Deliver Treatment & Recovery Services 
This four-part webcast series from SAMHSA educates healthcare professionals about the importance of using approaches that are free of discriminatory attitudes and behaviors in treating individuals with substance use disorders and related conditions, as well as patients in recovery.

Maryland Harm Reduction Training Institute

Stigma, Trauma, and People Who Use Drugs
In this free, asynchronous, online course, examine the historical roots of drug-related stigma, the role of trauma for people who use drugs and strategies for challenging stigma at multiple levels.