Reducing stigma in primary care toward people who use drugs: A pilot study exploring the promise and limits of stigma training

Primary care can improve health for people who use drugs (PWUD), but stigma among healthcare professionals impedes patient engagement. Past research suggests training reduces stigmatizing professional attitudes, but effects on other aspects of healthcare stigma are largely unknown. This pilot study tests whether stigma reduction training changes three stigma processes toward PWUD in primary care: attitudes, intentions to provide care, and workplace culture.

The study delivered a two-hour substance use stigma training to clinical (e.g., physicians) and non-clinical (e.g., reception staff) primary care professionals in Michigan. Pre- and post-training survey data were collected, and a one-hour qualitative focus group was conducted with a subset of respondents. Cohen's d and paired t-tests assessed changes in stigma. The study analyzed qualitative data using thematic analysis.

Fifty-one professionals completed surveys, and five professionals participated in the focus group. Training reduced stigmatizing attitudes toward PWUD (e.g., improvement in the Medical Condition Regard Scale d = 0.499, p = 0.007), but did not change intention to enact stigma or workplace culture. Qualitative data suggested training promoted empathy toward PWUD and explained best practices, but training also revealed gaps between evidence and current clinic practices. Participants noted that external factors that training does not alter, e.g. controlled substance prescribing regulations, may disincentivize professional engagement with PWUD.

This pilot study explores the promise and limits of training for altering professional stigma toward PWUD in primary care. Although training readily reduces attitudinal forms of stigma, other interventions are likely needed to reduce stigmatizing professional behaviors and primary care environments.