The Influence of Initiation Context on Attributions Towards Individuals with an Opioid Use Disorder Diagnosis

Opioid misuse can occur through two pathways of initiation: medical and nonmedical. This makes opioids unique relative to substances of misuse (e.g., nicotine, alcohol), where initial exposure starts with nonmedical experimentation. Differences in initiation may influence attributions toward individuals with Opioid Use Disorder (OUD). Those initiating use medically may be perceived as less personally responsible for their OUD diagnosis than those initiating nonmedically. Such differences may serve as a source of bias and, in turn, negatively impact treatment access and quality.

In a series of studies, participants reported the extent to which fictional patients were personally responsible for their OUD diagnosis. These patients differed only in their initiation pathways. These procedures were applied using both between-subjects (Study 1) and within-subjects (Study 2) designs, across samples of medical students, undergraduate students, and community members. Study 2 further investigated whether initiation context influenced treatment prioritization.

Results showed that patients described as having initiated medically were viewed as less personally responsible for the diagnosis than patients who initiated nonmedically. This pattern replicated across all designs and stakeholder groups. Additionally, Study 2a provided preliminary evidence that initiation context is influential in decisions regarding patient prioritization.

For individuals with an OUD diagnosis, initiation context represents an understudied source of bias that may impact treatment quality and access.