Healthcare provider stigma toward patients with substance use disorders

The overdose epidemic accounts for more than 89 000 deaths across the United States annually. Despite the availability of medications and therapies to treat substance use disorders (SUD), most people remain untreated. Stigma towards treating patients with SUD has been identified as a potential barrier to SUD treatment. This study aimed to quantify the prevalence and intensity of provider stigma towards patients with SUD, by substance use type and compared with other conditions, and its relationship to providers' clinical practices.

National probability sample survey (October 2020-October 2022).

USA; online/paper questionnaire.

Primary care (PCPs) and emergency medicine physicians (EMPs) and dentists randomly selected from the American Medical and Dental Associations. Data were collected from 1240 participants (Council of American Survey Research Organizations response rate 53.6%).

The main outcome was self-reported provider stigma towards people with SUD, assessed by the Medical Condition Regard Scale. Providers indicated their agreement with 11 statements concerning three SUD categories [opioids (OUD), stimulants, alcohol (AUD)], Type II diabetes, depressive disorder and HIV. Mixed models compared stigma levels across conditions and by clinician group. Clinicians were assessed about their screening, referral and treatment practices.

The lowest stigma rating was for diabetes (mean = 23.2; standard deviation = 6.5) and the highest for stimulant use disorders (mean = 36.3; standard deviation = 10.7). Stigma towards OUD was statistically significantly higher than AUD [effect size (ES) = 0.49, 95% confidence interval (CI) = (0.42-0.57), P < 0.001], while stigma towards stimulant use disorders was statistically significantly higher than OUD [ES = 0.11, 95% CI = (-0.04 to 0.19), P < 0.004]. EMPs had statistically significantly higher stigma scores than PCPs (P < 0.001), while PCPs reported significantly higher stigma scores than did dentists (P < 0.014). Lower stigma scores were associated with provision of SUD referrals [ES = -0.37, 95% CI = (-0.66 to -0.07)], providing medications for OUD [stigma scores: AUD (ES = -0.44, 95% CI = [-0.73 to -0.15]), OUD (ES = -1.26, 95% CI = [-1.55 to -0.97]) and stimulant use disorder (ES = -0.73, 95% CI = [-1.02 to -0.44])] and having available SUD consultation [stigma scores: AUD (ES = -0.48, 95% CI = [-0.67 to -0.28]), OUD (ES = -0.51, 95% CI = [-0.86 to -0.37]) and stimulant use disorder (ES = -0.59, 95% CI = [-0.78 to -0.39])].

Among US primary care and emergency medicine physician workforces, provider stigma towards substance use disorders appears to be higher than for opioid, stimulant and alcohol use disorders and negatively associated with providers' clinical practices.