TL/DR –
The stigma among U.S. healthcare providers towards patients with substance use disorders (SUD) is widespread and varies across substances, according to a new national study from Columbia University Mailman School of Public Health and several other universities. The study found that the stigma score was highest for stimulant use disorders, followed by opioid use disorders and alcohol use disorders. The research also identified key institutional barriers that reinforce stigma including time constraints, lack of training, limited referral resources, discomfort discussing SUD with patients, legal concerns, and minimal privacy in clinical settings.
Healthcare Provider Stigma Towards Substance Use Disorders Revealed in National Study
A comprehensive national study reveals widespread stigma among U.S healthcare providers towards patients with substance use disorders (SUDs). The collaborative study involving Columbia University Mailman School of Public Health, University of Miami Miller School of Medicine, and others, published in the journal Addiction, uncovers significant variances in stigma across opioid, stimulant, and alcohol use disorders.
This analysis is the first of its kind to compare stigma across these disorders with stigmatized chronic conditions like depression, HIV, and Type II diabetes. It also explores how stigma impacts healthcare providers’ tendency to screen for SUDs, offer referrals, or deliver treatment.
Carrigan Parish, assistant professor at Columbia Mailman School of Public Health, emphasizes that the study results underscore the need to seize opportunities to treat SUDs, especially in emergency departments.
Surveying over 1,700 healthcare professionals, including primary care and emergency medicine providers, as well as dentists, the study utilized a nationally representative sample. Participants shared their views on stigma and reported their practices towards six conditions, three SUDs, and three comparison conditions.
Key Findings of The Stigma Study
Stigma was highest for stimulant use disorders, followed by opioid and alcohol use disorders. Stigma scores were significantly lower for depression, HIV, and Type II diabetes, with higher levels of compassion and treatment reported for these conditions. Notably, over 30% of providers preferred not to work with patients with opioid or stimulant use disorders.
Emergency medicine physicians exhibited the highest stigma levels towards SUDs, yet were the most active in providing clinical care. Despite the high stigma levels, dentists reported the lowest stigma levels towards all conditions queried. Interestingly, these attitudes did not significantly differ by demographic or geographical factors.
Professor Daniel Feaster at the University of Miami noted that providers were less confident in their ability to help patients with stimulant or opioid use disorders. He stressed that this not only reflects attitudes but also affects access to care, potentially leading to system failures.
The study also highlighted several institutional barriers reinforcing stigma, including time constraints, inadequate training, limited referral resources, and discomfort discussing SUDs with patients, among others.
Senior author Lisa R. Metsch, Professor at Columbia Mailman School, emphasized the need to equip and support providers dealing with SUDs. She highlighted the daily challenges in primary care settings, where time pressure and limited resources are constant barriers.
Dentists, despite not being typically involved in treating SUDs, can recognize oral signs of substance use and refer patients to appropriate care. However, they too face challenges in training and systemic support.
Parish concluded that future efforts should focus on understanding the variations in treatment and provider roles to build smarter, tailored interventions.
The study was supported by the National Institute on Drug Abuse Treatment Clinical Trials Network, under grant number 5UG1DA013.
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