Categorizing Stigma as a Barrier to Support Following Nonfatal Overdose: A Qualitative Study

Objectives: Stigma is known to be a major barrier to treatment for people who use drugs (PWUD). This study uses the Stigma and Health Discrimination Framework to analyze how different forms of stigma shape experiences in the wake of an overdose incident, and perceptions of the efficacy and utility of postoverdose interventions among a sample of PWUD in Dayton, Ohio-a location with a high overdose rate.

Methods: Interviews were conducted with 23 individuals who self-reported past-month illicit opioid, crack/cocaine, or methamphetamine use who had experienced or witnessed a drug overdose in the past 6 months. Interviews were recorded, transcribed, and thematically analyzed using Taguette software.

Results: Discrete forms of stigma were identified as barriers to postoverdose interventions intended to link PWUD with support and services to help them access treatment. Individuals identified experiences of enacted stigma through medical mistreatment, exploitation, and judgment. They identified anticipated stigma through mistrust and unsustainable treatment. Internalized stigma was identified through the effect of loss on mental health, feeling "stuck," and the role of race on support-seeking behaviors. Experiences of structural stigma included desensitization of addiction as a disease and lack of feasible, long-term treatment options.

Conclusions: The results suggest that enacted, anticipated, internalized, and structural forms of stigma act as barriers to the efficacy of postoverdose outreach programs, and the initiation and sustainability of treatment. Understanding how each form of stigma adversely impacts PWUD can improve public health and clinical interventions to reduce stigma and overdose death.

Keywords: health disparities; opioid overdose; opioid-related disorders; stigmatization.