Types of Opioid-Related Stigma

Opioid-related stigma is an unfortunate development of the opioid epidemic, especially for individuals who are prescribed opioids to treat their chronic pain. Stigma is defined as a set of negative beliefs about others with a specific characteristic or trait. Unfortunately, opioid-related stigma can prevent individuals with chronic pain from seeking or receiving adequate treatment.

The five main types of opioid-related stigma include the following:

Public stigma

Public stigma is a set of negative beliefs or prejudices held by society that lead people to discriminate against individuals with certain characteristics, traits or conditions.

Examples of opioid-related public stigma:

• The assumption that individuals who have valid opioid prescriptions and take them as prescribed are addicts
• The assumption that individuals who have valid opioid prescriptions and take them as prescribed are morally weak or dangerous

Enacted stigma

Enacted stigma consists of the behaviors that develop from public stigma, such as discrimination.

Examples of opioid-related enacted stigma:

• A physician’s personal beliefs about opioids or the individuals who take them prevents the physician from prescribing adequate pain relief to those who need it
• An individual who is prescribed opioids for a valid reason is passed over for a promotion

Structural stigma

When public stigma and enacted stigma become part of cultural norms, institutions, or laws, they become structural stigma.

Examples of opioid-related structural stigma:

• Prior authorization requirements for opioid prescriptions
• Arbitrary lifetime treatment limits
• Ineligibility for organ transplantation due to continued opioid therapy
• Denial of third-party payments for prescription opioids

Anticipated stigma

With this type of stigma, an individual who takes opioids is aware of the negative perceptions surrounding opioid use and develops the expectation of being rejected because of them.

Examples of opioid-related anticipated stigma:

• Fear of rejection from friends or family who believe all individuals on opioids are addicted to them
• Fear of loss of employment

Internalized stigma

Internalized stigma occurs when an individual who experiences public stigma accepts and adopts the stigmatized values applied to them. Internalized stigma can lead to anxiety, depression, or other behavioral health concerns.

Examples of opioid-related internalized stigma:

• An individual who takes opioids as prescribed for pain relief believes they are inherently weak
• An individual who takes opioids may see medication tolerance or physical withdrawal as signs they are an addict

The bottom line

Reducing or eliminating opioid-related stigma is possible. Educating physicians, law enforcement, and others; eliminating the media’s use of stigmatizing language; and providing treatment for individuals who experience anticipated or internalized stigma can help.

Additional resources used to create this article include the U.S. Department of Health and Human Services.