Strategies used by people who inject drugs to avoid stigma in healthcare settings
Open accessAbstract
Background People who inject drugs (PWID) have limited engagement in healthcare services and report frequent experiences of stigma and mistreatment when accessing services. This paper explores the impact of stigma against injection drug use on healthcare utilization among PWID in the U.S. Northeast.Methods We recruited PWID through community-based organizations (CBOs; e.g., syringe service programs). Participants completed brief surveys and semi-structured interviews lasting approximately 45 min exploring HIV risk behaviors and prevention needs. Thematic analysis examined the emergent topic of stigma experiences in relation to healthcare utilization.Results Among 33 PWID (55% male; age range 24-62 years; 67% White; 24% Latino), most used heroin (94%) and injected at least daily (60%). Experiences of dehumanization in healthcare settings were common, with many participants perceiving that they had been treated unfairly or discriminated against due to their injection drug use. As participants anticipated this type of stigma from healthcare providers, they developed strategies to avoid it, including delaying presenting for healthcare, not disclosing drug use, downplaying pain, and seeking care elsewhere. In contrast to large institutional healthcare settings, participants described non-stigmatizing environments within CBOs, where they experienced greater acceptance, mutual respect, and stronger connections with staff.Conclusions Stigma against injection drug use carries important implications for PWID health. Increased provider training on addiction as a medical disorder could improve PWID healthcare experiences, and integrating health services into organizations frequented by PWID could increase utilization of health services by this population.
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Building rapport and trust through low-threshold, non-stigmatizing services in community-based organizations, rather than in large institutional clinics, helps mitigate the anticipated discrimination that often deters these patients from seeking care.
“Building rapport and trust through low-threshold, non-stigmatizing services in community-based organizations, rather than in large institutional clinics, helps mitigate the anticipated discrimination that often deters these patients from seeking care [46].”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [46]
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“Therefore, presenting for treatment earlier and avoiding complications of skin and soft tissue infections could result in substantial healthcare savings, as demonstrated through the creation of specialty clinics serving PWID (Harris and Young, 2002; Tookes et al., 2015).”
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“death and are also extremely costly to the healthcare system (Binswanger et al., 2008; Ciccarone et al., 2016; Tookes et al., 2015).”
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“Although little research has focused on building resilience among PWID, some group therapy interventions have demonstrated modest efficacy in building resilience among people living with mental illness and HIV (Corrigan et al., 2009; Mittal et al., 2012; Rao et al., 2018).”
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The Impact of Utilizing HIV-Positive Speakers in AIDS Education
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“Compared to other routes of drug administration, injection drug use may carry additional stigma because it results in distinct physical traits (e.g., track marks) that are easily identifiable, and is associated with undesirable health and social conditions such as HIV, Hepatitis C virus (HCV), transactional sex, crime…”
BackgroundInfluentialTi, L., Voon, P., Dobrer, S., Montaner, J. S. G., Wood, E., & Kerr, T. H. (2015) · Pain Research and Management · doi:10.1155/2015/868746 · Cited by 43 · cited 1× · see citing works
“While efforts to improve general training in addiction medicine are underway, an area that deserves particular attention is pain management, as patients with opioid use who downplay pain may receive lower quality of care (Paschkis and Potter, 2015; Ti et al., 2015).”
BackgroundBrener, L., Cama, E. J., Hull, P., & Treloar, C. (2017) · Health Psychology Open · doi:10.1177/2055102917707180 · Cited by 43 · cited 1× · see citing works
“interventions could help increase cultural competency and decrease stigma towards PWID at multiple levels within health organizations, such models require further research and evaluation (Brener et al., 2017; Livingston et al., 2012).”
BackgroundHepatitis C and injecting drug use: The realities of stigmatisation and discrimination
Habib, S. E., & Adorjany, L. V. (2003) · Health Education Journal · doi:10.1177/001789690306200307 · Cited by 41 · cited 3× · see citing works
“Several international studies have found that stigma can adversely affect decisions to seek healthcare among PWID (Habib and Adorjany, 2003; Heath et al., 2016; Lang et al., 2013; Neale et al., 2007; Simmonds and Coomber, 2009; Treloar et al, 2016; Wilson, et al., 2014).”
BackgroundAkselrod, H., Grau, L. E., Barbour, R. C., & Heimer, R. (2013) · American Journal of Public Health · doi:10.2105/ajph.2013.301357 · Cited by 36 · cited 3× · see citing works
“, track marks) that are easily identifiable, and is associated with undesirable health and social conditions such as HIV, Hepatitis C virus (HCV), transactional sex, crime, and homelessness (Ahern et al., 2007; Akselrod et al., 2014; Crawford et al, 2012; Habib and Adorjany, 2003).”
BackgroundHealthcare avoidance by people who inject drugs in Bangkok, Thailand
Heath, A. J., Kerr, T. H., Ti, L., Kaplan, K., Suwannawong, P., Wood, E., & Hayashi, K. (2015) · Journal of Public Health · doi:10.1093/pubmed/fdv143 · Cited by 34 · cited 2× · see citing works
“Several international studies have found that stigma can adversely affect decisions to seek healthcare among PWID (Habib and Adorjany, 2003; Heath et al., 2016; Lang et al., 2013; Neale et al., 2007; Simmonds and Coomber, 2009; Treloar et al, 2016; Wilson, et al., 2014).”
BackgroundOptimal medical treatment under asymmetric information
Lee, C. (1995) · Journal of Health Economics · doi:10.1016/0167-6296(95)00012-7 · Cited by 31 · cited 1× · see citing works
“Unfortunately, irrelevant services and poor quality care can result from providers lacking important patient health information (Lee, 1995).”
BackgroundMassachusetts Medical Students Feel Unprepared to Treat Patients with Substance Use Disorder
Bäck, D. K., Tammaro, E., Lim, J. K., & Wakeman, S. E. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4192-x · Cited by 31 · cited 1× · see citing works
“Unfortunately, the majority of practicing providers and medical students in the United States believe that they lack adequate training in assessing and treating people with addiction (Bäck et al., 2018; Miller et al., 2001).”
BackgroundInjection drug use and overdose among young adults who use prescription opioids non-medically
Liebling, E. J., Green, T. C., Hadland, S. E., & Marshall, B. D. L. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.07.017 · Cited by 30 · see citing works
Paschkis, Z., & Potter, M. L. (2015) · AJN American Journal of Nursing · doi:10.1097/01.naj.0000471243.30951.92 · Cited by 22 · cited 2× · see citing works
“While efforts to improve general training in addiction medicine are underway, an area that deserves particular attention is pain management, as patients with opioid use who downplay pain may receive lower quality of care (Paschkis and Potter, 2015; Ti et al., 2015).”
BackgroundCrawford, N. D., Rudolph, A. E., Jones, K. C., & Fuller, C. M. (2012) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2012.673664 · Cited by 18 · see citing works
Brener, L., Wilson, H., Rose, G., Mackenzie, A., & de Wit, J. B. F. (2012) · Psychology Health & Medicine · doi:10.1080/13548506.2012.701753 · Cited by 18 · cited 10× · see citing works
“Compared to other routes of drug administration, injection drug use may carry additional stigma because it results in distinct physical traits (e.g., track marks) that are easily identifiable, and is associated with undesirable health and social conditions such as HIV, Hepatitis C virus (HCV), transactional sex, crime…”
BackgroundInfluentialHow to Deliver a More Persuasive Message Regarding Addiction as a Medical Disorder
Humphreys, K. N. (2017) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000306 · Cited by 10 · cited 3× · see citing works
“To be well received, messaging should address the uniqueness of addiction as a disease while acknowledging that negative interactions between healthcare providers and PWID may occur (Humphreys, 2017).”
BackgroundGolub, A. L., Bennett, A. S., & Elliott, L. C. (2015) · AIMS Public Health · doi:10.3934/publichealth.2015.1.142 · Cited by 9 · see citing works
Purchase and Use Patterns of Heroin Users at an Inner-city Emergency Department
Baumann, B. M., Mazzarelli, A. J., Brunner, J., Chansky, M. E., Thompson, N. M., & Boudreaux, E. D. (2010) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2010.06.006 · Cited by 6 · cited 1× · see citing works
“However, PWID in the United States typically have limited healthcare utilization outside of emergency services (Baumann et al., 2012; Drug Abuse Warning Network, 2010; Vivolo-Kantor et al., 2018).”
Background
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Research works printed but not linked: 1
- Drug Abuse Warning Network (DAWN). 2010 The DAWN Report: highlights of the 2010 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. Retrieved October 2, 2018, from https://www.samhsa.gov/data/sites/default/files/DAWN096/DAWN096/SR096EDHighlights2010.htm 27631059
Cited by
Sorted by citations
Karlsen, T. H., Sheron, N., Zelber-Sagi, S., Carrieri, P., Dusheiko, G., Bugianesi, E., Pryke, R., Hutchinson, S. J., Sangro, B., Martin, N. K., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)01701-3 · Cited by 652 · see citing works
Stigma as a fundamental hindrance to the United States opioid overdose crisis response
Tsai, A. C., Kiang, M. V., Barnett, M. L., Beletsky, L. A., Keyes, K. M., McGinty, E. E., Smith, L. R., Strathdee, S. A., Wakeman, S. E., & Venkataramani, A. S. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002969 · Cited by 446 · see citing works
Muncan, B., Walters, S. M., Ezell, J. M., & Ompad, D. C. (2020) · Harm Reduction Journal · doi:10.1186/s12954-020-00399-8 · Cited by 406 · see citing works
Amaro, H. D. L. A., Sánchez, M., Bautista, T. G., & Cox, R. J. A. (2021) · Neuropharmacology · doi:10.1016/j.neuropharm.2021.108518 · Cited by 334 · see citing works
Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions
Jemberie, W. B., Williams, J. S., Eriksson, M., Grönlund, A.-S., Ng, N., Nilsson, M. B., Padyab, M., Priest, K. C., Sandlund, M., Snellman, F., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00714 · Cited by 135 · see citing works
“Resource allocation and clinical practice with embedded stigma and discrimination has a prohibitive effect on healthcare utilization by individuals with SUD (14).”
Motavalli, D., Taylor, J. L., Childs, E., Valente, P. K., Salhaney, P., Olson, J., Biancarelli, D. L., Edeza, A., Earlywine, J. J., Marshall, B. D. L., et al. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06201-6 · Cited by 119 · see citing works
“Location Massachusetts 49 (63) Rhode Island 29 (37) Age, in years; median (interquartile range) 37 (30–43) Race (not mutually exclusive) American Indian or Alaska Native 3 (4) Black or African American 9 (12) White 59 (76) Other 13 (17) Ethnicity: Hispanic/Latino 16 (21) Current gender identity Male 47 (60) Female 29…”
BackgroundLyss, S. B., Buchacz, K. A., McClung, R. P., Asher, A. K., & Oster, A. M. (2020) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiaa112 · Cited by 117 · see citing works
Horner, G., Daddona, J., Burke, D. J., Cullinane, J., Skeer, M. R., & Wurcel, A. G. (2019) · PLoS ONE · doi:10.1371/journal.pone.0224335 · Cited by 101 · see citing works
Meyerson, B. E., Russell, D. M., Kichler, M., Atkin, T., Fox, G., & Coles, H. B. (2021) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103112 · Cited by 99 · see citing works
Reducing the harms of xylazine: clinical approaches, research deficits, and public health context
Zagorski, C. M., Hosey, R. A., Moraff, C., Ferguson, A., Figgatt, M. C., Aronowitz, S. V., Stahl, N. E., Hill, L. G., McElligott, Z. A., & Dasgupta, N. (2023) · Harm Reduction Journal · doi:10.1186/s12954-023-00879-7 · Cited by 90 · see citing works
“Interviewing the person with wounds in a non-judgmental, compassionate way allows for an in-depth understanding of the severity and timeline of the wound and may give way for relevant history [25].”
BackgroundSyvertsen, J. L., Toneff, H., Howard, H. G., Spadola, C., Madden, D. R., & Clapp, J. D. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108677 · Cited by 83 · see citing works
Accessible Hepatitis C Care for People Who Inject Drugs
Eckhardt, B. J., Mateu‐Gelabert, P., Aponte-Meléndez, Y., Fong, C., Kapadia, S. N., Smith, M., Edlin, B. R., & Marks, K. (2022) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2022.0170 · Cited by 76 · see citing works
Kimmel, S. D., Rosenmoss, S., Bearnot, B. I., Larochelle, M. R., & Walley, A. Y. (2020) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000693 · Cited by 74 · see citing works
“Failing to provide these services may exacerbate the stigma people who use drugs experience in the healthcare system.(10,13,14) Moreover, increased effort to find postacute care and potentially longer inpatient hospitalizations may result in resentment among hospital staff toward patients with OUD.”
BackgroundPrinciples of Harm Reduction for Young People Who Use Drugs
Kimmel, S. D., Gaeta, J. M., Hadland, S. E., Hallett, E., & Marshall, B. D. L. (2021) · PEDIATRICS · doi:10.1542/peds.2020-023523g · Cited by 74 · see citing works
Caring for Hospitalized Adults With Opioid Use Disorder in the Era of Fentanyl
Englander, H. L., Thakrar, A. P., Bagley, S. M., Rolley, T., Dong, K. A., & Hyshka, E. (2024) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2023.7282 · Cited by 78 · see citing works
Ivsins, A., Warnock, A., Small, W., Strıke, C., Kerr, T. H., & Bardwell, G. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103910 · Cited by 67 · see citing works
Perceived healthcare stigma among patients in opioid substitution treatment: a qualitative study
Garpenhag, L., & Dahlman, D. (2021) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-021-00417-3 · Cited by 64 · see citing works
“because it makes it impossible for physicians to take medications’ compatibility with OST drugs into account [21, 27].”
BackgroundIntegrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine
Talal, A. H., Markatou, M., Liu, A., Perumalswami, P., Dinani, A. M., Tobin, J. N., & Brown, L. S. (2024) · JAMA · doi:10.1001/jama.2024.2452 · Cited by 64 · see citing works
“It’s not just injecting drugs”: Supervised consumption sites and the social determinants of health
Kerman, N., Manoni-Millar, S., Cormier, L., Cahill, T., & Sylvestre, J. C. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108078 · Cited by 63 · see citing works
Valente, P. K., Bazzi, A. R., Childs, E., Salhaney, P., Earlywine, J. J., Olson, J., Biancarelli, D. L., Marshall, B. D. L., & Biello, K. B. (2020) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2020.102934 · Cited by 61 · see citing works
“This concern is particularly relevant given that providers may hold personal biases against minority patients when considering prescribing opioids in clinical settings and that stigmatization of PWID in healthcare settings is common and may reduce the quality of care received by this population (Basilico, Bhashyam, &…”
BackgroundFraser, S., Moore, D., Farrugia, A., Edwards, M., & Madden, A. (2020) · Sociology of Health & Illness · doi:10.1111/1467-9566.13180 · Cited by 60 · see citing works
Bergstein, R. S., King, K., Meléndez‐Torres, G. J., & Latimore, A. D. (2021) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103296 · Cited by 62 · see citing works
Wright, T., Hope, V. D., Ciccarone, D., Lewer, D., Scott, J., & Harris, M. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235350 · Cited by 58 · see citing works
Ellis, K., Walters, S. M., Friedman, S. R., Ouellet, L. J., Ezell, J. M., Rosentel, K., & Pho, M. T. (2020) · Frontiers in Sociology · doi:10.3389/fsoc.2020.593925 · Cited by 57 · see citing works
“Previous works have studied different healthcare service types, generally have not interviewed people who actively use drugs or were conducted in large urban centers (Earnshaw et al., 2013;McKnight et al., 2017; Paquette et al., 2018; Biancarelli et al., 2019).”
BackgroundKolak, M., Chen, Y., Joyce, S., Ellis, K., Defever, K., McLuckie, C., Friedman, S. R., & Pho, M. T. (2020) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2020.102727 · Cited by 56 · see citing works
Priest, K. C., Englander, H. L., & McCarty, D. W. (2019) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2019.12.003 · Cited by 55 · see citing works
“Our meta-theme on stigma and discrimination during hospitalization is well supported by prior research, which suggests that patients hospitalized with OUD and other drug use disorders commonly face stigma and discrimination perpetuated by hospital staff (Biancarelli et al., 2019; Horner et al., 2019; McNeil et al., 20…”
BackgroundResultThe Past, Present, and Future of PrEP implementation Among People Who Use Drugs
Biello, K. B., Mimiaga, M. J., Valente, P. K., Saxena, N., & Bazzi, A. R. (2021) · Current HIV/AIDS Reports · doi:10.1007/s11904-021-00556-z · Cited by 56 · see citing works
Healthcare stigma and HIV risk among rural people who inject drugs
Surratt, H. L., Otachi, J. K., McLouth, C. J., & Vundi, N. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108878 · Cited by 53 · see citing works
HIV and substance use stigma, intersectional stigma and healthcare among HIV-positive PWID in Russia
Vetrova, M. V., Cheng, D. M., Bendiks, S., Gnatienko, N., Lloyd-Travaglini, C., Jiang, W., Luoma, J., Blokhina, E., Krupitsky, E., Lioznov, D., et al. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03172-5 · Cited by 52 · see citing works
Addressing Stigma to Provide Quality Care to People Who Use Drugs
Aronowitz, S. V., & Meisel, Z. F. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.46980 · Cited by 52 · see citing works
Sanchez, D. P., Tookes, H. E., Pastar, I., & Lev‐Tov, H. A. (2021) · Advances in Wound Care · doi:10.1089/wound.2020.1243 · Cited by 52 · see citing works
“care settings.(61) PWID have described some encounters with health care personnel as stigmatizing and embarrassing, which discourages them from accessing and utilizing health services.”
BackgroundStrathdee, S. A., Abramovitz, D. A., Vera, A., Vera, C. F., Rangel, G., Artamónova, I., Patterson, T. L., Mitchell, R. A., & Bazzi, A. R. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab975 · Cited by 50 · see citing works
“The significant role of COVID-19 disinformation in influencing vaccine hesitancy extends a long-established foundation of medical mistrust among PWID who often avoid traditional clinical settings, preferring to receive prevention information and services in community-based settings [11].”
Høj, S. B., Jacka, B. P., Minoyan, N., Artenie, A. A., & Bruneau, J. (2019) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2019.04.001 · Cited by 50 · see citing works
Austin, E. J., Tsui, J. I., Barry, M. P., Tung, E. L., Glick, S. N., Ninburg, M. H., & Williams, E. C. (2021) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2021.108684 · Cited by 48 · see citing works
Causes of Death in the 12 Months After Hospital Discharge Among Patients With Opioid Use Disorder
King, C., Cook, R., Korthuis, P. T., Morris, C. D., & Englander, H. (2021) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000915 · Cited by 46 · see citing works
Safer opioid supply: qualitative program evaluation
Haines, M., & O’Byrne, P. (2023) · Harm Reduction Journal · doi:10.1186/s12954-023-00776-z · Cited by 45 · see citing works
Awareness, perception and utilization of a mobile health clinic by people who use drugs
Grieb, S. M. D., Harris, R., Rosecrans, A. M., Zook, K. J. C., Sherman, S. G., Greenbaum, A. H., Lucas, G. M., & Page, K. R. (2022) · Annals of Medicine · doi:10.1080/07853890.2021.2022188 · Cited by 44 · see citing works
Uptake of COVID-19 vaccination among people who inject drugs
Iversen, J., Wand, H. C., Kemp, R., BEVAN, J. S., Briggs, M., Patten, K., Heard, S., & Maher, L. (2022) · Harm Reduction Journal · doi:10.1186/s12954-022-00643-3 · Cited by 43 · see citing works
“PWID are typically under-represented in primary health care [14], with access to COVID-19 vaccination likely to be constrained by concerns about stigma and discrimination [15], costs associated with receipt of a vaccine [16], including transportation [17], the complexity of booking systems [4], and a lack of trust in…”
BackgroundConsidering the Potential Benefits of Over-the-Counter Naloxone
Evoy, K. E., Hill, L. G., & Davis, C. S. (2021) · Integrated Pharmacy Research and Practice · doi:10.2147/iprp.s244709 · Cited by 43 · see citing works
Mayer, S., Langheimer, V., Nolan, S., Boyd, J., Small, W., & McNeil, R. (2023) · PLoS ONE · doi:10.1371/journal.pone.0282215 · Cited by 43 · see citing works
“While previous studies have similarly identified that PWUD continue to experience stigma in health care settings [13, 14, 18, 45], and unmanaged pain and withdrawal symptoms [18], this study specifically investigates PWUD experiences in EDs who left or were discharged against medical advice, highlighting how structura…”
BackgroundJo, Y., Nosal, R., Vittori, A., Córdova, L., Vandever, C., Alvarez, C., Bartholomew, T. S., & Tookes, H. E. (2021) · Addiction · doi:10.1111/add.15393 · Cited by 42 · see citing works
Khan, G. K., Harvey, L. H., Johnson, S., Long, P., Kimmel, S. D., Pierre, C. M., & Drainoni, M. (2022) · Harm Reduction Journal · doi:10.1186/s12954-022-00622-8 · Cited by 41 · see citing works
“The ACS clinicians and harm reduction specialists interviewed were intimately familiar with the spectrum of addiction care, including harm reduction and non-abstinence-focused strategies.”
BackgroundInfluentialWalters, S. M., Perlman, D. C., Guarino, H., Mateu‐Gelabert, P., & Frank, D. (2022) · Substance Use & Misuse · doi:10.1080/10826084.2022.2064509 · Cited by 41 · see citing works
Kapadia, S. N., Griffin, J. L., Waldman, J., Ziebarth, N. R., Schackman, B. R., & Behrends, C. N. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06409-6 · Cited by 40 · see citing works
McDonald, H. S., Attaway, P. R., Richardson, N. J., Davidson, P. J., & Kral, A. H. (2022) · Health & Justice · doi:10.1186/s40352-022-00172-y · Cited by 40 · see citing works
“…(Chen et al.,2020; Collins et al., 2021; Curran et al.,2021; D’Onofrio et al., 2015; Herring et al.,2021), most emergency rooms do not offer culturally competent services for people who have overdosed (Bergstein et al.,2021; Biancarelli et al.,2019; Chan Carusone et al.,2019; Reddy et al.,2021).”
BackgroundThe Necessity of a Trauma-Informed Paradigm in Substance Use Disorder Services
Bartholow, L. A. M., & Huffman, R. T. (2021) · Journal of the American Psychiatric Nurses Association · doi:10.1177/10783903211036496 · Cited by 38 · see citing works
“The less likely they are to feel stigmatized and dehumanized, the more likely they are to return promptly on a recurrence of disease symptoms (Biancarelli et al., 2019).”
BackgroundStigma Surrounding the Use of Medically Assisted Treatment for Opioid Use Disorder
Witte, T. H., Jaiswal, J., Mumba, M. N., & Mugoya, G. C. T. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1936051 · Cited by 38 · see citing works
Jakubowski, A. U., Fowler, S., & Fox, A. D. (2023) · Addiction Science & Clinical Practice · doi:10.1186/s13722-023-00394-x · Cited by 37 · see citing works
Bazzi, A. R., Valasek, C. J., Streuli, S. A., Vera, C. F., Vera, A., Philbin, M. M., Biello, K. B., Roth, A. M., Strathdee, S. A., & Pines, H. A. (2022) · AIDS Patient Care and STDs · doi:10.1089/apc.2022.0068 · Cited by 36 · see citing works
Alrawashdeh, M., Rhee, C., Klompas, M., Larochelle, M. R., Poland, R. E., Guy, J. S., & Kimmel, S. D. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08059-w · Cited by 36 · see citing works
Muncan, B., Jordan, A. E., Perlman, D. C., Frank, D., Ompad, D. C., & Walters, S. M. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1892142 · Cited by 35 · see citing works
“Furthermore, SSPs have been identified as non-stigmatizing environments, which could lessen the barrier of stigma that PWID experience in healthcare settings (Ahern et al., 2007; Biancarelli et al., 2019).”
BackgroundResultInfluentialTanner, M. R., O’Shea, J., Byrd, K. M., Johnston, M., Dumitru, G. G., Le, J. N., Lale, A., Byrd, K. K., Cholli, P. A., Kamitani, E., et al. (2025) · MMWR Recommendations and Reports · doi:10.15585/mmwr.rr7401a1 · Cited by 33 · see citing works
A missing perspective: injectable pre-exposure prophylaxis for people who inject drugs
Biello, K. B., Edeza, A., Salhaney, P., Biancarelli, D. L., Mimiaga, M. J., Drainoni, M., Childs, E., & Bazzi, A. R. (2019) · AIDS Care · doi:10.1080/09540121.2019.1587356 · Cited by 33 · see citing works
Douglass, C. H., Win, T. M., Goutzamanis, S., Lim, M. S. C., Block, K., Onsando, G., Hellard, M. E., Higgs, P., Livingstone, C. H., & Horyniak, D. (2023) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-023-01468-3 · Cited by 34 · see citing works
“People from non-migrant and ethnic minority backgrounds have reported similar stigma manifestations, including negative AOD treatment experiences [5, 74, 76].”
BackgroundThe ecology of overdose mortality in Philadelphia
Johnson, L. T., & Shreve, T. (2020) · Health & Place · doi:10.1016/j.healthplace.2020.102430 · Cited by 32 · see citing works
Bazzi, A. R., Shaw, L. C., Biello, K. B., Vahey, S., & Brody, J. K. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-022-07672-5 · Cited by 31 · see citing works
“Although long-acting injectable PrEP could reduce the need for this level of daily outreach, frequent contact with patients can also help retain patients in care, enable referrals to other services, and support the trusting patient-provider relationships that are critical for this often-stigmatized population.(25) Lim…”
BackgroundExperiences of stigma and subsequent reduced access to health care among women who inject drugs
Brener, L., Cama, E. J., Broady, T. R., Harrod, M. E., Holly, C., Caruana, T., Beadman, K., & Treloar, C. (2024) · Drug and Alcohol Review · doi:10.1111/dar.13806 · Cited by 30 · see citing works
Compton, P. A., Aronowitz, S. V., Klusaritz, H. A., & Anderson, E. D. (2021) · Harm Reduction Journal · doi:10.1186/s12954-021-00581-6 · Cited by 29 · see citing works
Furukawa, N. W., Blau, E. F., Reau, Z., Carlson, D., Raney, Z. D., Johnson, T., Deputy, N. P., Sami, S., McClung, R. P., Fanfair, R. N., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa507 · Cited by 28 · see citing works
“To avoid stigma, PWID presenting to healthcare with non–IDU-related problems may not disclose their IDU [23].”
BackgroundCalabrese, S. K., Kalwicz, D. A., Modrakovic, D. X., Earnshaw, V. A., Edelman, E. J., Bunting, S. R., del Río‐González, A. M., Magnus, M., Mayer, K. H., Hansen, N. B., et al. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03495-3 · Cited by 27 · see citing works
“Negative attitudes toward people who use drugs are pervasive in medicine [44, 45], and individuals who use drugs commonly report having experienced unfair, dehumanizing treatment by providers during past medical encounters because of their drug use [46, 47].”
BackgroundScott, K., Murphy, C. M., Yap, K. R., Tosto, S. A., Hurley, L., & Becker, S. J. (2020) · Translational Issues in Psychological Science · doi:10.1037/tps0000245 · Cited by 26 · see citing works
Klusaritz, H. A., Bilger, A., Paterson, E., Summers, C., Barg, F. K., Cronholm, P. F., Saine, M. E., Sochalski, J. A., & Doubeni, C. A. (2023) · The Annals of Family Medicine · doi:10.1370/afm.2920 · Cited by 26 · see citing works
Chatterjee, A., Baker, T. J., Rudorf, M., Walt, G., Stotz, C., Martin, A., Kinnard, E. N., McAlearney, A. S., Bosak, J., Medley, B., et al. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209272 · Cited by 25 · see citing works
Schneider, K. E., White, R. H., Musci, R. J., O’Rourke, A., Kilkenny, M. E., Sherman, S. G., & Allen, S. T. (2020) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2020.81.740 · Cited by 25 · see citing works
“Stigmatization of PWID can disincentivize persons from engaging in positive health-seeking behaviors (Biancarelli et al., 2019; Paquette et al., 2018).”
BackgroundMattocks, K. M., Moore, D. T., Wischik, D. L., Lazar, C. M., & Rosen, M. I. (2022) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2022.108777 · Cited by 24 · see citing works
“, 1993) and the stigma they anticipate from others (Biancarelli et al., 2019; Brener et al., 2010) have both been associated with less engagement in treatment.”
Interventions to reduce self-stigma in people who use drugs: A systematic review
Sibley, A. L., Colston, D. C., & Go, V. F.-L. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209284 · Cited by 27 · see citing works
Cahn, B. A., Bartholomew, T. S., Patel, H. P., Pastar, I., Tookes, H. E., & Lev‐Tov, H. A. (2021) · International Wound Journal · doi:10.1111/iwj.13572 · Cited by 24 · see citing works
Ogden, S. N., Harris, M. T. H., Childs, E., Valente, P. K., Edeza, A., Collins, A. B., Drainoni, M., Mimiaga, M. J., Biello, K. B., & Bazzi, A. R. (2021) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103285 · Cited by 23 · see citing works
Broman, M. J., Pasman, E., Brown, S., Lister, J. J., Agius, E., & Resko, S. M. (2022) · Addiction Research & Theory · doi:10.1080/16066359.2022.2101640 · Cited by 24 · see citing works
“Because stigma reduces help-seeking (Keyes et al. 2010; Biancarelli et al. 2019) and may reduce social support, psychosocial interventions are necessary to make it feel less threatening to seek treatment.”
BackgroundGoodman‐Meza, D., Tang, A. B., Aryanfar, B., Vazquez, S., Gordon, A. J., Goto, M., Goetz, M. B., SHOPTAW, S. J., & Bui, A. A. T. (2022) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofac471 · Cited by 24 · see citing works
Gaps and barriers in drug and alcohol treatment following implementation of the affordable care act
Tomko, C. A., Olfson, M., & Mojtabai, R. (2022) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2022.100115 · Cited by 24 · see citing works
“In contrast, community-based organizations are often preferred sources of care for people who use drugs, including SUD treatment, because of the non-stigmatizing environment (Biancarelli et al., 2019; McNeil et al., 2014).”
A qualitative study of a publicly funded pharmacy-dispensed naloxone program
Antoniou, T., Pritlove, C., Shearer, D., Martins, D., Tadrous, M., Munro, C., & Gomes, T. (2021) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103146 · Cited by 23 · see citing works
Moe, J., Chong, M., Zhao, B., Scheuermeyer, F. X., Purssell, R. A., & Slaunwhite, A. (2021) · CMAJ Open · doi:10.9778/cmajo.20200169 · Cited by 23 · see citing works
Tookes, H. E., Bartholomew, T. S., Suarez, E., Ekowo, E., Ginoza, M., Forrest, D. W., Serota, D. P., Rodriguez, A. E., Kolber, M. A., Feaster, D. J., et al. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.109124 · Cited by 22 · see citing works
Norris, W. K., Allison, M. K., Fradley, M. F., & Zielinski, M. J. (2022) · Health & Justice · doi:10.1186/s40352-022-00166-w · Cited by 22 · see citing works
Boucher, L. M., Shoemaker, E. S., Liddy, C. E., Leonard, L., MacPherson, P. A., Presseau, J., Martin, A., Pineau, D., Lalonde, C., Diliso, N., et al. (2022) · Qualitative Health Research · doi:10.1177/10497323221083353 · Cited by 22 · see citing works
“Marginalized people who use drugs (PWUD) tend to experience complex health conditions characterized by chronicity and multimorbidity, as well as intersectional stigma and disparities related to social determinants of health (Biancarelli et al., 2019; Boucher et al., 2017; Dassieu et al., 2020; Degenhardt et al., 2013;…”
BackgroundSumnall, H. R., Hamilton, I., Atkinson, A. M., Montgomery, C., & Gage, S. H. (2020) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2020.1820450 · Cited by 22 · see citing works
“…and experiences of public and internalised stigma can lead to reduced self-worth and label avoidance, and act as a barrier to treatment seeking and recovery (Biancarelli et al., 2019; Birtel et al., 2017; Chan Carusone et al., 2019; Luoma et al., 2007; Neale et al., 2011; Stringer & Baker, 2018).”
BackgroundEarlywine, J. J., Bazzi, A. R., Biello, K. B., & Klevens, R. M. (2020) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2020.09.011 · Cited by 21 · see citing works
Saunders, E. C., Moore, S. K., Walsh, O., Metcalf, S. A., Budney, A. J., Cavazos‐Rehg, P. A., Scherer, E. A., & Marsch, L. A. (2021) · Addiction Science & Clinical Practice · doi:10.1186/s13722-021-00213-1 · Cited by 21 · see citing works
“This opinion echoes findings of a recent qualitative study [105] in which people who injected drugs thought addiction medicine specialists were more empathetic and helpful than general medical providers.”
BackgroundWard, K., McCormick, S. D., Sulkowski, M., Latkin, C. A., Chander, G., & Falade-Nwulia, O. O. (2020) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2020.103019 · Cited by 20 · see citing works
“Consequently, PWID internalize a feeling of undeservingness and subsequently modify their behavior during interactions with healthcare providers, including delaying presentation, not disclosing or underrepresenting drug use, or obtaining care from somewhere else (Biancarelli et al., 2019; Madden et al., 2018).”
BackgroundWalters, S. M., Kral, A. H., Lamb, S., Goldshear, J. L., Wenger, L. D., & Bluthenthal, R. N. (2021) · Journal of Urban Health · doi:10.1007/s11524-020-00494-y · Cited by 20 · see citing works
Djordjevic, F., Ryan, K., Gunn, J., Brener, L., O’Keefe, D., Draper, B. L., Schroeder, S., Gold, J., Treloar, C., Broady, T. R., et al. (2021) · Journal of Viral Hepatitis · doi:10.1111/jvh.13612 · Cited by 20 · see citing works
Dahl, R., Vakkalanka, J., Harland, K., & Radke, J. (2022) · Journal of addiction medicine · doi:10.1097/adm.0000000000000970 · Cited by 13 · see citing works
“PWUD have reported delaying healthcare visits to avoid facing stigma, which results in presenting with advanced disease and use of a higher proportion of emergency medical services.(3,6,9,10) PWUD are vulnerable to nutritional, mental health, immune, and infectious disorders,(11) and so there is a critical need for th…”
BackgroundAcceptability of a HIV self-testing program among people who use illicit drugs
Peiper, N. C., Shamblen, S., Gilbertson, A., Guest, G., Kopp, M., Guy, L., & Rose, M. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103613 · Cited by 20 · see citing works
Edeza, A., Bazzi, A. R., Salhaney, P., Biancarelli, D. L., Childs, E., Mimiaga, M. J., Drainoni, M., & Biello, K. B. (2019) · Substance Use & Misuse · doi:10.1080/10826084.2019.1673419 · Cited by 20 · see citing works
“…many PWID in this sample reported stigma and discrimination from clinical care providers for reasons relating to their injection drug use overall (Biancarelli et al., 2019), which may limit candid discussions between PWID and healthcare providers about HIV risk, particularly sexual risk, and…”
BackgroundStudent-Run Free Clinic at a Syringe Services Program, Miami, Florida, 2017–2019
Ginoza, M., Tomita‐Barber, J., Onugha, J., Bullock, C., Bartholomew, T. S., Tookes, H. E., & Serota, D. P. (2020) · American Journal of Public Health · doi:10.2105/ajph.2020.305705 · Cited by 20 · see citing works
Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment
Torrens, M., Soyemi, T., Bowman, D., & Schatz, E. (2020) · BMC Infectious Diseases · doi:10.1186/s12879-020-05426-4 · Cited by 19 · see citing works
“A possible reason for this is that PWID visit community-based organisations more regularly than other healthcare settings [37].”
BackgroundBrener, L., Caruana, T., Broady, T. R., Cama, E. J., Ezard, N., Madden, A., & Treloar, C. (2021) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2021.100398 · Cited by 19 · see citing works
Ciaccio, M. D., Villes, V., Perfect, C., Kaim, J. L. E., Klinger, M. D., James, C., Easterbrook, P., & Delabre, R. M. (2023) · Harm Reduction Journal · doi:10.1186/s12954-023-00743-8 · Cited by 19 · see citing works
“Community-based HCV services, which engage all stakeholders affected by HCV, could be well placed to identify and respond to the specific needs of people who inject drugs and address stigma issues [17, 25].”
BackgroundA national survey of law enforcement post-overdose response efforts
Ray, B. R., Richardson, N. J., Attaway, P. R., McDonald, H. S., Davidson, P. J., & Kral, A. H. (2023) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2023.2169615 · Cited by 19 · see citing works
Galarneau, L. R., Scheuermeyer, F. X., Hilburt, J., O'Neill, Z. R., Barbic, S. P., Moe, J., Buxton, J. A., Orkin, A. M., Kaczorowski, J. A., Dong, K. A., et al. (2023) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2023.02.007 · Cited by 19 · see citing works
Applying the Infectious Diseases Literature to People who Inject Drugs
Serota, D. P., Chueng, T. A., & Schechter, M. C. (2020) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2020.06.010 · Cited by 19 · see citing works
“…used for the treatment of severe infections Stigmatization by health care system • Many report experiences of dehumanization and discrimination 89 • Experiences of trauma during prolonged hospitalization 28 • Associated with delay in presenting for health care, self-treatment attempts, and…”
BackgroundTelehealth for people who inject drugs: An acceptable method of treatment but challenging to access
Delisle-Reda, S., Bruneau, J., & Martel‐Laferrière, V. (2022) · Journal of Addictive Diseases · doi:10.1080/10550887.2022.2035166 · Cited by 19 · see citing works
Stigma Communication Surrounding Nonmedical Opioid Use Among Affected Family Members
Pasman, E., O’Shay, S., Hicks, D. L., Resko, S. M., Agius, E., & Brown, S. (2023) · Health Communication · doi:10.1080/10410236.2023.2167588 · Cited by 17 · see citing works
“…communication, the ways in which families frame conversations about NMOU have potential to affect perceptions of NMOU (Goodyear et al., 2018), strategies for addressing NMOU (Kelly et al., 2010), help-seeking (Biancarelli et al., 2019), and treatment and recovery outcomes (Crapanzano et al., 2018).”
BackgroundKapadia, S. N., Katzman, C. L., Fong, C., Eckhardt, B. J., Guarino, H., & Mateu‐Gelabert, P. (2020) · Journal of Viral Hepatitis · doi:10.1111/jvh.13437 · Cited by 18 · see citing works
Cohort profile: The provincial substance use disorder cohort in British Columbia, Canada
Homayra, F., Pearce, L. A., Wang, L., Panagiotoglou, D., Sambo, T., Smith, N., McKendry, R., Wilson, B., Joe, R. S., Hawkins, K., et al. (2020) · International Journal of Epidemiology · doi:10.1093/ije/dyaa150 · Cited by 17 · see citing works
Bryant, J., Caluzzi, G., Bruun, A., Sundbery, J., Ferry, M., Gray, R. M., Skattebol, J., Neale, J., & MacLean, S. J. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103631 · Cited by 18 · see citing works
Opioid Use Disorder Diagnosis and Management
Wakeman, S. E. (2022) · NEJM Evidence · doi:10.1056/evidra2200038 · Cited by 17 · see citing works
Implementation and evaluation of a syringe vending machine trial in Tbilisi, Georgia
Otiashvili, D., Kirtadze, I., Mgebrishvili, T., Beselia, A., Tabatadze, M., Vardanashvili, I., & Ober, A. J. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103649 · Cited by 17 · see citing works
The Opioid Epidemic and the State of Stigma: A Pennsylvania Statewide Survey
Kaynak, Ö., Whipple, C. R., Bonnevie, E., Grossman, J. A., Saylor, E., Stefanko, M., McKeon, C., Smyser, J., & Kensinger, W. S. (2022) · Substance Use & Misuse · doi:10.1080/10826084.2022.2064506 · Cited by 17 · see citing works
“Stigma also can lead individuals to delay healthcare, avoid disclosing drug use or downplay pain to medical staff, or request to be discharged against medical advice (Biancarelli et al., 2019; Simon et al., 2020).”
Background
- Authors
- Biancarelli, D. L., Biello, K. B., Childs, E., Drainoni, M., Salhaney, P., Edeza, A., Mimiaga, M. J., Saitz, R., & Bazzi, A. R.
- Affiliations
- Boston University (US)
- Brown University (US)
- Corresponding author
- Bazzi, Angela R.
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2019-05
- Volume
- 198
- Pages
- 80-86
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC6521691
- OpenAlex
- W2921016611
- Cited by
- 524
- References
- 79
- Citations by year
- 2026: 51 · 2025: 92 · 2024: 109 · 2023: 79 · 2022: 73 · 2021: 69 · 2020: 42 · 2019: 8
- FWCI
- 36.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Drug and Alcohol Dependence (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Providence/Boston Center for AIDS Research (P30AI042853)
- NIH/NIDA (K01DA043412)
- BU Peter Paul Career Development Professorship
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- people who inject drugs, stigma, health care utilization, dehumanization, community organizations, syringe services programs, HIV risk behavior, provider training, integrated care
- MeSH terms
- Adult, Female, Health Personnel, Humans, Male, Middle Aged, New England, Patient Acceptance of Health Care, HIV Infections, Substance Abuse, Intravenous, Drug Users, Young Adult, Social Stigma
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