Confronting Stigma in the Opioid Crisis

Carolyn Bogdon, MSN, FNP-BC

Treating any form of addiction can be challenging, but treating the disorder while simultaneously confronting the stigma that comes with it creates a new host of issues to overcome.

In an exclusive interview with MD Magazine^®, Lindsey Jennings, MD, MPH, and Carolyn Bogdon, MSN, FNP-BC, of Medical University of South Carolina (MUSC) shared how the stigma that accompanies an opioid addiction affects the treatment of patients with opioid use disorder and how the health care community can help overcome the widely spread bias against these patients.

[Editor’s note: Transcript is lightly modified for readability.]

MD Mag: What is the most important thing for physicians, health care providers, and institutions to keep in mind when treating patients with an opioid addiction?

Bogdon: I would say, for me, [the most important thing] is a nonjudgmental attitude and knowing that addiction, in general, is a disease that can affect anyone and any family at any time, if it hasn’t already. I think most of us, especially with the opioid crisis at this point, have directly or indirectly been impacted.

Having a nonjudgmental, open-minded mentality when treating, approaching, and assessing for [opioid use disorder] is most important because then you can (hopefully) get actual answers from patients. If someone comes to you with a judgmental attitude, you are probably not going to bring up [your disorder] if you are the patient.

Part of our program [MUSC] is a foundation of SBIRT [Screening, Brief Intervention, and Referral to Treatment], which includes motivational interviewing in terms of how we approach patients.

Jennings: I would definitely say stigma is a big barrier that patients have in getting into treatment. There certainly is stigma [about opioid use disorder] within medicine. As Bogdon said, we use a SBIRT model to approach these patients in the emergency department.

All our patients who come through the emergency department initially get screened using a 2-question screener from the National Institute on Drug Abuse through the National Institutes of Health. We use that tool, they get screened, and then we have a patient navigator appear with a recovery coach to come talk with them. The brief intervention interview is like a motivational interview. We assess and talk with the patient about what kind of complications and negative outcomes they have had related to their substance use disorder.

We then try to meet them where they are at, even if they do not want a referral now—we do everything we can to help them at that point. We know that this is a chronic disease and that there is a process that patients go through for getting into treatment.

I would definitely say stigma is a both big barrier and something that physicians, advanced health care providers, and all health care providers should do their best to set aside for the best patient outcomes.

Bogdon: We’ve also worked with a consulting group in Maryland, the Mosaic Group, who have also implemented this [SBIRT] in Baltimore and many hospitals [in that area]. We worked with them to include a peer-recovery model, [meaning] most of the individuals who are having conversations with these patients are in recovery themselves. They can share a very different perspective than someone in a white coat or scrubs. They can say, ‘I’ve been there, I’ve walked in your shoes.”

In some cases, the navigators who are in these roles have been in the hospital they are now working in and can say, ‘I’ve been there, and there is help. There is recovery. We can get there together.’ I think that is a unique aspect of the program that helps increase patient engagement.

When you have not only staff—nurses, physicians, and providers—who are open to treating this [disorder], but also a peer recovery model, I think it attributes a lot to our success.