Stigma of opioids keeps users from seeking help, taints views of medical professionals

By | October 12, 2019

“Can you think of all the tax dollars it’s cost for you to go to detox?” the doctor asked Raina McMahan when she arrived at the clinic in Revere seeking help for her 15-year heroin addiction. “What is the matter with you?”

McMahan, now six years into her recovery and a certified recovery coach at Massachusetts General Hospital, told the story of her addiction and of the scorn and discrimination she faced, which discouraged her from getting treatment — a dynamic that authorities said Thursday still presents one of the biggest hurdles to fighting the nation’s deadly opioid crisis.

“Stigma is a formidable barrier. Our country has ostracized, punished, and in some cases, even criminalized addiction,” said Michelle Williams, dean of the Harvard T.H. Chan School of Public Health. “And that has led people who know that they need help … to avoiding asking for that help. Even when they do work up the courage to go in and seek that medical care, there’s no guarantee that that courage will be met with the appropriate response.”

Despite being chastised, McMahan wanted help badly enough to keep seeing the doctor, until he misadministered an otherwise effective drug used to treat opioid dependency and explained her subsequent sickness as evidence that she was allergic to the drug — a fiction she carried with her for years afterward. McMahon would go in and out of treatment many times before stepping onto the recovery path she walks today.

Dean Michelle A. Williams
“Stigma is a formidable barrier. Our country has ostracized, punished, and in some cases, even criminalized addiction,” said Michelle Williams, dean of the Harvard T.H. Chan School of Public Health. Lisa Abitbol/Harvard Chan School

McMahan and Williams spoke Thursday at an all-day conference called “Stigma and Access to Treatment: The Harvard University and University of Michigan Summit on the Opioid Crisis,” which brought experts from the two host universities, other academic institutions, law enforcement, and government to the Joseph Martin Conference Center on Harvard’s Longwood Campus in Boston.

Though overdose deaths appear to be plateauing nationally, they still account for the loss of an estimated 70,000 lives annually. The cultural stigma is counterproductive in two ways, speakers said. It makes users feel weak and unworthy, undermining any motivation to control their drug use. Most troubling, perhaps, is evidence that the attitude extends into the health care system, where negative experiences like McMahan’s are repeated across the country.

The bright side, panelists said, is that if users manage to bring themselves forward, medication-assisted treatment with methadone, buprenorphine, and naloxone has proven both effective and straightforward.

The summit was the second of two planned as part of a unique collaboration between Harvard and Michigan that seeks solutions to two of society’s most intractable problems: the opioid crisis and stagnant economic opportunities in struggling areas, particularly in Detroit.

Health & Medicine – Harvard Gazette