Categorizing Stigma as a Barrier to Support Following Nonfatal Overdose: A Qualitative Study

Area of Science:

• Public Health
• Sociology
• Addiction Medicine

Background:

• Stigma presents a major obstacle to treatment access for individuals who use drugs (PWUD).
• Understanding the multifaceted nature of stigma is critical for improving health outcomes and reducing overdose mortality.

Purpose of the Study:

• To analyze how various forms of stigma influence the experiences of PWUD following an overdose.
• To assess perceptions of postoverdose intervention efficacy and utility among PWUD.
• To apply the Stigma and Health Discrimination Framework to a high-overdose rate location.

Main Methods:

• Conducted semi-structured interviews with 23 individuals reporting recent illicit opioid, crack/cocaine, or methamphetamine use.
• Participants had experienced or witnessed an overdose within the past six months.
• Employed thematic analysis of transcribed interviews using Taguette software.

Main Results:

• Identified enacted stigma (medical mistreatment, exploitation, judgment) as a barrier to accessing postoverdose support services.
• Anticipated stigma (mistrust, unsustainable treatment) and internalized stigma (mental health impacts, racial disparities in help-seeking) were significant.
• Structural stigma, including the medicalization of addiction and lack of long-term treatment options, also emerged as a key challenge.

Conclusions:

• Enacted, anticipated, internalized, and structural stigma impede the effectiveness of postoverdose outreach and treatment initiation/sustainability.
• Tailoring interventions to address specific forms of stigma can enhance public health efforts.
• Reducing stigma is essential for decreasing overdose deaths and improving care for PWUD.