Beyond High Versus Low: Differentiating Levels of Stigma Toward Opioid Use Disorder and Criminal Legal Involvement

This study aimed to identify distinct profiles of the level of stigma held toward individuals with opioid use disorder and those with criminal legal involvement (CLI) and to examine the demographic characteristics, lived experience, and support for opioid-related policies associated with these profiles.

The authors analyzed cross-sectional data from a representative survey of 6,543 U.S. adults (December 2023-January 2024). A latent class analysis was performed with six stigma subscales (perceived risk, distrust, and social distance with regard to people with opioid use disorder and people with CLI). Associations between the level of stigma held and attitudes toward public health policies were examined with survey-weighted regression.

Four classes of stigma were identified: low (8.3% of respondents [weighted]), moderate (52.5%), high (32.5%), and extreme (6.6%). The extreme group had the highest stigma scores, particularly for CLI-related perceived risk and social distance subscales, and was associated with older age and lack of personal history with opioid use disorder or the legal system. More severe stigma predicted greater support for punitive policies and lower support for harm reduction policies, with the extreme stigma group holding significantly more punitive attitudes than the high stigma group.

The degree of stigma regarding opioid use disorder and CLI is not monolithic. The identification of an extreme stigma group, characterized by pronounced CLI-related stigma and lack of personal lived experience, suggests that one-size-fits-all public health messaging may be ineffective. Understanding this segmentation in the population is crucial for developing targeted interventions to build support for evidence-based policies.