Stigma around substance use disorder is common and pervasive. But preliminary data from a study by Indiana University researchers finds that people living in rural areas report significantly higher levels of stigma toward people who use opioids for nonmedical reasons.
The study used data from the Person to Person (P2P) Health Interview Study, a statewide representative, face-to-face survey, to assess negative stereotypes, attitudes and behaviors that affect people with opioid use disorder, their families and friends, and healthcare providers. The study also found people in more rural counties are disproportionately more likely to report knowing someone with a drug addiction problem.
"Our study finds that nearly two-thirds of people in Indiana report knowing someone personally who has struggled with drug addiction," said Anne Krendl, co-author of the study and an associate professor in the Department of Psychological and Brain Sciences at IU. "Many of these individuals are close friends or family members. Although knowing someone with a drug addiction reduces stigma in some ways, it also seems to increase stigma, particularly if the individual's addiction has caused problems or made life more difficult for those around them."
Indiana's rural counties have been disproportionately affected by opioid addiction. According to the study, over two-thirds of people living in Indiana counties designated as rural report that adults in their community "often" use prescription drugs in ways not prescribed (69 percent) or to get high (68 percent). In contrast, about 40 percent of people in metro or metro-adjacent communities report high levels of prescription drug use for nonmedical purposes.
That has an impact on the level of stigma toward nonmedical opioid use in rural and urban counties, according to Brea Perry, co-author of the study and a professor of sociology at IU. Those in rural counties report higher levels of stigma, including stating that getting treatment for addiction would make someone an outsider in their community, would lead to loss of friends, and would result in limited opportunities.
"One of the main concerns about high levels of stigma in rural counties is that addiction is also more prevalent in these communities," said Perry. "In general, higher levels of stigma predict lower willingness to provide support, so this pattern could have very negative downstream consequences for rural communities."
Furthermore, people in more rural counties are less likely to be willing to have someone with an addiction problem marry into their family, move next door, spend an evening socializing with them, or work closely with them on a job. Those living in more rural counties are also significantly more likely than those in urban counties to believe that people with opioid addiction cannot manage their own money and are likely to hurt themselves or others.
"An important aspect of our findings is that some stigmatizing attitudes and beliefs are reduced when individuals have a friend or family member with drug addiction, particularly when the addiction hasn't created burdens on those around them," Krendl said. "We have long known that one of the most effective ways to reduce stigma is by having meaningful and positive interactions with people from stigmatized groups. However, when those interactions become burdensome, stigma persists."
Those higher levels of stigma, the researchers said, translates into a lack of support for harm reduction and medication assisted treatment programs. Specifically, rural county residents are disproportionately less likely to support having needle exchange programs, safe injection sites and police officers carrying Narcan in their communities compared to residents of more urban or suburban counties.
Furthermore, rural county residents are also more likely than their urban counterparts to disagree that medication assisted therapy – an evidence-based treatment for opioid addiction – should be available in their community, the study found.
"Stigmatization of people with nonmedical opioid use has pervasive effects on both the people it is aimed at and the communities they live in," Perry said. "One of the most impactful consequences we see is a rejection of evidence-based treatments for opioid addiction and programs that have proven to reduce secondary harms of drug use, including preventing overdose death and reducing rates of HIV and Hepatitis infection."
The Responding to the Addictions Crisis Grand Challenge initiative engages a broad array of IU's world-class faculty, as well as IU's business, nonprofit and government partners. Working together, the groups are contributing to an initiative to implement a comprehensive plan to reduce deaths from addiction, ease the burden of drug addiction on Hoosier communities and improve health and economic outcomes. This initiative is one of the nation's largest and most comprehensive state-based responses to the opioid addiction crisis -- and the largest led by a university.
