Abstract
Background
Discrimination and stigmatization of patients who use psychoactive drugs or who have addiction is common in health care.1–4 Using people-first, medically accurate, and stereotype-reducing language with colleagues, trainees, and in documentation 5 is fundamental to dispelling stigma 6 and misperceptions, such as the myth of addiction as a willful personal choice or moral failing. The right words can convey empathy and reduce mistrust in health care for patients who have often faced a history of marginalization. This Fast Facts discusses health care stigmatization of patients who use drugs or have addiction, and will present preferred language that respects personhood, supports recovery, promotes accurate knowledge about the full spectrum of substance use, and supports an understanding of addiction as a chronic treatable condition (see Fast Fact #127).
Stigma in Health Care
Stigma is a social process that occurs in the context of power, 7 characterized by labeling, stereotyping, and discrimination based on real or perceived attributes. Stigma toward people who use drugs or develop addiction, as well as medications to treat this condition, are long-standing. Opioid use disorder (OUD) has long been treated apart from mainstream medicine in the United States, from the 1914 Harrison Narcotics Act that separated treatment of OUD away from routine health care, 8 to the racist “War on Drugs” that treated drug use as a criminal-legal issue removed from public health. Clinicians themselves commonly have negative biases about addiction,9–11 which is often reinforced during medical training through stigmatizing language. 12 For example, patients described as “substance abusers” were perceived by clinicians as more threatening, more worthy of blame, and less likely to benefit from treatment compared with “persons with an SUD.” 13 Altogether, stigma worsens the mental and physical health of people who use drugs,14–16 disproportionately affects communities of color, 17 and harms patients on long-term therapeutic opioids.18,19 It even underlies the crisis of overdose deaths, as only 12.5% of people with OUD receive medication proven to reduce accidental overdose.18,19 The following table presents preferred language for clinicians:
Summary
The language used to describe substance use and addiction must convey respect for individuals, an accurate understanding of the full spectrum of substance use (from nonproblematic use to chaotic use and addiction), and effective treatment. Avoid perpetuating negative stereotypes by first recognizing, addressing, and combatting misunderstandings and stigma.