IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v268y2021ics0277953620306894.html
   My bibliography  Save this article

Stigmatize the use, not the user? Attitudes on opioid use, drug injection, treatment, and overdose prevention in rural communities

Author

Listed:
  • Ezell, Jerel M.
  • Walters, Suzan
  • Friedman, Samuel R.
  • Bolinski, Rebecca
  • Jenkins, Wiley D.
  • Schneider, John
  • Link, Bruce
  • Pho, Mai T.

Abstract

Stigma is a known barrier to treating substance use disorders and dramatically diminishes the quality of life of people who use drugs (PWUD) nonmedically. Stigma against PWUD may be especially pronounced in rural areas due to their decreased anonymity and residents' limited access, or resistance, to “neutralizing” information on factors associated with drug use. Stigma often manifests in the attitudes of professionals whom stigmatized individuals regularly interact with and often materially impact. We analyzed interviews conducted between July 2018 and February 2019 with professional stakeholders in rural southern Illinois who interact with PWUD, specifically those who use opioids nonmedically or who inject drugs (n = 30). We further analyzed interview data from a complementary PWUD sample (n = 22). Interviews addressed perspectives around nonmedical drug use and treatment/harm reduction, with analysis centered around the Framework Integrating Normative Influences on Stigma and its focus on micro, meso and macro level stigmatization processes. Stakeholder participants included professionals from local law enforcement, courts, healthcare organizations, emergency management services, and faith-based and social services organizations. Most stakeholders, particularly law enforcement, negatively perceived PWUD and nonmedical drug use in general, questioned the character, agency and extrinsic value of PWUD, and used labels (e.g. “addict,” “abuser,” etc.) that may be regarded as stigmatizing. Further, most respondents, including PWUD, characterized their communities as largely unaware or dismissive of the bio-medical and sociocultural explanations for opioid use, drug injection and towards harm reduction services (e.g., syringe exchanges) and naloxone, which were frequently framed as undeserved usages of taxpayer funds. In conclusion, rural stigma against PWUD manifested and was framed as a substantial issue, notably activating at micro, meso and macro levels. Stigma prevention efforts in these communities should aim to improve public knowledge on the intricate factors contributing to opioid use and drug injection and harm reduction programming's moral and fiscal value.

Suggested Citation

  • Ezell, Jerel M. & Walters, Suzan & Friedman, Samuel R. & Bolinski, Rebecca & Jenkins, Wiley D. & Schneider, John & Link, Bruce & Pho, Mai T., 2021. "Stigmatize the use, not the user? Attitudes on opioid use, drug injection, treatment, and overdose prevention in rural communities," Social Science & Medicine, Elsevier, vol. 268(C).
    • Handle: RePEc:eee:socmed:v:268:y:2021:i:c:s0277953620306894
    DOI: 10.1016/j.socscimed.2020.113470
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953620306894
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2020.113470?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Moore, David & Fraser, Suzanne, 2006. "Putting at risk what we know: Reflecting on the drug-using subject in harm reduction and its political implications," Social Science & Medicine, Elsevier, vol. 62(12), pages 3035-3047, June.
    2. Phelan, Jo C. & Lucas, Jeffrey W. & Ridgeway, Cecilia L. & Taylor, Catherine J., 2014. "Stigma, status, and population health," Social Science & Medicine, Elsevier, vol. 103(C), pages 15-23.
    3. Timmermans, Stefan & Almeling, Rene, 2009. "Objectification, standardization, and commodification in health care: A conceptual readjustment," Social Science & Medicine, Elsevier, vol. 69(1), pages 21-27, July.
    4. Pescosolido, Bernice A. & Martin, Jack K. & Lang, Annie & Olafsdottir, Sigrun, 2008. "Rethinking theoretical approaches to stigma: A Framework Integrating Normative Influences on Stigma (FINIS)," Social Science & Medicine, Elsevier, vol. 67(3), pages 431-440, August.
    5. Keyes, K.M. & Cerdá, M. & Brady, J.E. & Havens, J.R. & Galea, S., 2014. "Understanding the rural-urban differences in nonmedical prescription opioid use and abuse in the United States," American Journal of Public Health, American Public Health Association, vol. 104(2), pages 52-59.
    6. J Whitehead & John Shaver & Rob Stephenson, 2016. "Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-17, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Bardwell, Geoff & Ivsins, Andrew & Wallace, James R. & Mansoor, Manal & Kerr, Thomas, 2024. "“The machine doesn't judge”: Counternarratives on surveillance among people accessing a safer opioid supply via biometric machines," Social Science & Medicine, Elsevier, vol. 345(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mpho M. Pheko & Rapelang Chilisa & Shyngle K. Balogun & Christina Kgathi, 2013. "Predicting Intentions to Seek Psychological Help Among Botswana University Students," SAGE Open, , vol. 3(3), pages 21582440134, July.
    2. Mwita Wambura & Daniel Josiah Nyato & Neema Makyao & Mary Drake & Evodius Kuringe & Caterina Casalini & Jacqueline Materu & Soori Nnko & Gasper Mbita & Amani Shao & Albert Komba & John Changalucha & T, 2020. "Programmatic mapping and size estimation of key populations to inform HIV programming in Tanzania," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-18, January.
    3. Martimianakis, Maria Athina (Tina) & Hafferty, Frederic W., 2013. "The world as the new local clinic: A critical analysis of three discourses of global medical competency," Social Science & Medicine, Elsevier, vol. 87(C), pages 31-38.
    4. Brüggemann, Jelmer & Persson, Alma & Wijma, Barbro, 2019. "Understanding and preventing situations of abuse in health care – Navigation work in a Swedish palliative care setting," Social Science & Medicine, Elsevier, vol. 222(C), pages 52-58.
    5. Martijn van Hasselt & Christopher R. Bollinger & Jeremy W. Bray, 2022. "A Bayesian approach to account for misclassification in prevalence and trend estimation," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 37(2), pages 351-367, March.
    6. Ida Viktoria Kolte & Lucia Pereira & Aparecida Benites & Islândia Maria Carvalho de Sousa & Paulo Cesar Basta, 2020. "The contribution of stigma to the transmission and treatment of tuberculosis in a hyperendemic indigenous population in Brazil," PLOS ONE, Public Library of Science, vol. 15(12), pages 1-13, December.
    7. Katarzyna Zawisza & Beata Tobiasz-Adamczyk & Aleksander Galas & Katarzyna Jabłońska & Tomasz Grodzicki, 2021. "Changes in Body Mass Index and Quality of Life—Population-Based Follow-up Study COURAGE and COURAGE-POLFUS, Poland," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 16(2), pages 501-526, April.
    8. Balfe, Myles, 2016. "Standardizing psycho-medical torture during the War on Terror: Why it happened, how it happened, and why it didn't work," Social Science & Medicine, Elsevier, vol. 171(C), pages 1-8.
    9. Shannon M. Monnat, 2022. "Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999–2020," The ANNALS of the American Academy of Political and Social Science, , vol. 703(1), pages 50-78, September.
    10. Lucy, Meghann, 2024. "“Fighting demons”: Stigma and shifting norms in explicit mention of overdose in obituaries, 2010–2019," Social Science & Medicine, Elsevier, vol. 350(C).
    11. Billings, Katie R. & Cort, David A. & Rozario, Tannuja D. & Siegel, Derek P., 2021. "HIV stigma beliefs in context: Country and regional variation in the effects of instrumental stigma beliefs on protective sexual behaviors in Latin America, the Caribbean, and Southern Africa," Social Science & Medicine, Elsevier, vol. 269(C).
    12. Ihlebæk, Hanna Marie, 2021. "Time to care - An ethnographic study of how temporal structuring affects caring relationships in clinical nursing," Social Science & Medicine, Elsevier, vol. 287(C).
    13. Per Magnus Mæhle & Ingrid Kristine Small Hanto & Sigbjørn Smeland, 2020. "Practicing Integrated Care Pathways in Norwegian Hospitals: Coordination through Industrialized Standardization, Value Chains, and Quality Management or an Organizational Equivalent to Improvised Jazz," IJERPH, MDPI, vol. 17(24), pages 1-32, December.
    14. Keetie Roelen & Caroline Ackley & Paul Boyce & Nicolas Farina & Santiago Ripoll, 2020. "COVID-19 in LMICs: The Need to Place Stigma Front and Centre to Its Response," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 32(5), pages 1592-1612, December.
    15. Samuel Taylor & Heather M. Stephens & Daniel Grossman, 2022. "The opioid crisis and economic distress: Consequences for population change," Journal of Regional Science, Wiley Blackwell, vol. 62(2), pages 541-577, March.
    16. Kreuzer, Maria & Cado, Vesna & Raïes, Karine, 2020. "Moments of care: How interpersonal interactions contribute to luxury experiences of healthcare consumers," Journal of Business Research, Elsevier, vol. 116(C), pages 482-490.
    17. Aysel Sultan, 2022. "‘What’s the Problem Represented to Be?’ The Place and Wellbeing of Young People in Azerbaijan’s Drug Policy," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 15(4), pages 1163-1178, August.
    18. Miller, Laurie C. & Pinderhughes, Ellen & Pérouse de Montclos, Marie-Odile & Matthews, Jessica & Chomilier, Jacques & Peyre, Janice & Vaugelade, Jacques & Sorge, Frédéric & de Monléon, Jean-Vital & de, 2021. "Feelings and perceptions of French parents of internationally adopted children with special needs (SN): Navigating the triple stigma of foreignness, adoption, and disability," Children and Youth Services Review, Elsevier, vol. 120(C).
    19. Mynti Hossain & Lauren Akers & Patricia Del Grosso & Marisa Shenk & Michael Cavanaugh & Melissa Azur, "undated". "Touchpoints for Addressing Substance Use Issues in Home Visiting: Phase 1 Final Report," Mathematica Policy Research Reports 0761ea54498b4f27b8d238e2b, Mathematica Policy Research.
    20. Simpson, Bob & Khatri, Rekha & Ravindran, Deapica & Udalagama, Tharindi, 2015. "Pharmaceuticalisation and ethical review in South Asia: Issues of scope and authority for practitioners and policy makers," Social Science & Medicine, Elsevier, vol. 131(C), pages 247-254.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:268:y:2021:i:c:s0277953620306894. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.