Words matter: A campaign to reduce stigmatizing substance use language at an urban health system

Stigmatizing language describing substance use is common in clinical settings and contributes to healthcare mistrust, diminished self-worth, and increased barriers among people with substance use disorders (SUD). This study evaluated the effectiveness of a multipronged stigma-reduction campaign ("Words Matter") in decreasing stigmatizing language in electronic health records (EHR) within a large health system.

This study was conducted at Denver Health, an integrated safety-net health system in Denver, Colorado. The Words Matter campaign launched system-wide in Spring 2024 and reached 1521 employees across 26 departments. The intervention consisted of a 20-min targeted staff presentation, a language guide, a data dashboard, a system-wide pledge, and revisions to EHR note templates. Natural language processing (NLP) was used to identify stigmatizing terms in clinical notes, and an observational time-series analysis (January 2022-March 2025) examined trends in stigmatizing language across approximately 15 million clinical notes for patients aged 10 years and older. The primary measurement was weekly change in the proportion of notes containing stigmatizing language related to substance use. Secondary measurements included pledge participation and changes in self-reported knowledge among staff who attended the educational presentation.

Accounting for preexisting trends, there was a 34.6% reduction in stigmatizing language in clinical notes (estimated to be 1381 fewer notes) 12 months after campaign launch, though this change did not reach statistical significance. Pre-campaign, 2.8% of clinical notes and 15.9% of patient records contained stigmatizing language; among patients with SUD, 36.4% had such language in their notes. Twenty-one percent of stigmatizing terms originated from EHR templates rather than clinician word choice. Among survey respondents (n = 345), knowledge scores increased by an average of 1.0 points on a 5-point scale, and 763 staff members signed the Words Matter pledge.

This is the first known evaluation of a targeted, data-informed stigma-reduction campaign addressing substance use within a large integrated health system, which demonstrated meaningful reductions of stigmatizing language in clinical notes. Removing stigmatizing terms from EHR templates produced the largest reduction and represents an efficient, scalable strategy. Concise, evidence-based education also effectively increased staff awareness and commitment to using nonjudgmental language.