Dealing With the Stigma of Opioid Misuse

Medically Reviewed by Jennifer Casarella, MD on April 21, 2022
5 min read

If you’ve ever misused or continue to use opioids even if you suspect they’re causing problems for you, you may know the feeling of being judged. Some people may blame you for your use disorder. Others may judge you even if you’re on pharmacotherapy such as methadone or buprenorphine to stop using opioids.

The reasons for this stigma are complex. People may have strong beliefs about drug use. Or they may not know much about what leads to misuse, dependence, and use disorders. The good news is that the public is becoming more educated about the dangers of these potent drugs. And less stigma and more understanding will make it easier to feel supported and accepted.

Most judgment is rooted more in myth and bias than fact. Some people might hold outdated or inaccurate beliefs around substance use disorders. That can lead to various forms of misconceptions:

Using opioids is criminal. Although opioids are legal with a prescription, they also can be bought illegally. Even if you have a prescription, people still might think you possess something illegal. Some, however, may feel more comfortable with you and less judgmental of your opioid use if your doctor has prescribed the drug for you.

Addiction is a personal choice. In national polls, nearly 4 out of 5 Americans blamed people with opioid use disorder (OUD) for their problem. Most wrongly believe it stems from a lack of self-control. Others blame over-prescribing by doctors or people who sell drugs illegally. OUD is a chronic disease.

Research has found that if you get methadone treatment, those around you may think you’ve been on street drugs like heroin. But you may be among the 50% of people on methadone maintenance treatment (MMT) who began opioids with your doctor’s prescription. It’s also common for people to view methadone as just another drug you get high on or a switch from one drug problem to another. That is not true. Methadone is a medication prescribed for treatment. Unfortunately, research shows that if your co-workers know about your MMT, some of them may view you as incompetent and not to be trusted.

When polled, only about half of Americans believed there’s a long-term treatment for OUD that works. This is despite a report from the National Academies of Sciences, Engineering, and Medicine that noted that there are effective, FDA-approved medications that can help you stop opioid misuse.

Make sure you know the facts about OUD so you can educate others and get treatment with less stigma.

A survey found that if you use opioids or have OUD, chances are that people around you will probably judge you. But it also showed that their bias against you might be lower than against people who use other substances. This may be because prescription opioids are legal. Most people who took the survey still blamed the user, however.

The survey also showed:

  • If you show symptoms of OUD with prescription opioids, people are more likely to see your problem as a physical illness instead of a mental illness, compared with major depression, schizophrenia, or alcohol use disorder (AUD).
  • If you have OUD, others may see you as less competent at managing your personal affairs and other tasks than people with AUD.

Society tends to blend opiate use stigma with other types of bias and discrimination. This includes your gender, sexual orientation, race, and social class. One example of this was the “War on Drugs,” which locked up mostly people in Latino and Black communities. Others include:

  • OUD rates are similar between Black and white people. Yet one study estimates that 35 white patients are given a prescription for opiate treatment for every one person from another race or culture.
  • A study of news media coverage found more supportive reports and profiles of white people with OUD than those for Black and Latino people.
  • Pregnant women and mothers face stigma due to false ideas about substance use and abuse, beliefs that they’re choosing to harm their babies, and assumptions that they’re bad parents.
  • Society still uses the “fallen woman” image to judge women with OUD. They’re seen as straying from their traditional roles in the home and family.

Tell your story. Sharing your personal background lends a face to opioid use that most people haven’t seen. You can shift attitudes, change beliefs, and educate – and help stamp out stigma. Wherever you are with your opioid use, you can:

  • Explain that a use disorder isn’t a simple weakness or escape, and it can happen to anybody.
  • Note that 1 in 14 people in the United States has a substance use disorder.
  • Show former or current opioid users that they’re not alone and can own and speak out about their experience.

Correct false information. When you hear or read myths, falsehoods, or biased info, challenge the idea or correct it. Give people and groups helpful sources that back you up and inform them further.

Use anti-stigma language. Addiction isn’t what you are, it’s what you have. Sub in positive terms for negative ones. Here’s how:

  • Say “a person with a substance use disorder,” or “a person with OUD” instead of “the addict.”
  • Say “they have a substance abuse disorder” or “they are addicted” instead of “they suffer from” or “they are a victim of.”
  • Avoid the words “abuse” or “abuser.” These words feed stigma.

The Research Recovery Institute offers a guide to positive wording in their “Addictionary.”

Invite loved ones to OUD meetings. You may feel that your family and friends stigmatize your OUD the most. Invite them to come with you, which may clear up the false views they might have about your treatment. It also can help them learn why treatment is important to you. Then, they can share what they’ve learned with your other family members and friends.

Join an educational outreach program. They can help you start an in-person or online conversation with a person without a stigmatized condition. This can show others “real people” with OUD. You can share your story and talk about your plans and dreams for the future.

These programs often give you an outlet for a blog about your OUD journey or to share your story in an online profile, where many people may find and benefit from them. You may find it’s an effective and satisfying way for you to advocate and educate others – and help reduce stigma.