Cited by 525HIV, Drug Use, Sexual RiskOpioid Use Disorder TreatmentSubstance Abuse Treatment and Outcomes

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Strategies used by people who inject drugs to avoid stigma in healthcare settings

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Biancarelli, Dea L., Biello, Katie B., Childs, Ellen, Drainoni, M., Salhaney, Peter, Edeza, Alberto, Mimiaga, Matthew J, Saitz, Richard, Bazzi, Angela R.·2019·Drug and Alcohol Dependence

DOI 10.1016/j.drugalcdep.2019.01.037PMC PMC6521691

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Abstract

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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Stigma: Notes on the Management of Spoiled Identity
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“Stigma, defined by Goffman as a “deeply discrediting attribute,” is well researched among the larger population of people who use illicit drugs (Goffman, 1963; Kulesza et al., 2013).”
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“Internalized stigma carries harmful effects on health and wellbeing (Ahern et al., 2007; Cama et al., 2016; Hatzenbuehler et al., 2013; Kamaradova et al., 2016; Luoma et al., 2007; Rivera et al., 2014; Skeer et al., 2018; von Hippel et al., 2018).”
Background
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“, “external reactions to stigma”) as they emerged (Earnshaw and Chaudoir, 2009).”
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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).”
Background
Further evaluation of the Dutch supervision system for suicides of mental health care users
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“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).”
Background
Stigma, discrimination and the health of illicit drug users
Ahern, J., Stuber, J., & Galea, S. (2006) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2006.10.014 · Cited by 860 · cited 2×
“Internalized stigma carries harmful effects on health and wellbeing (Ahern et al., 2007; Cama et al., 2016; Hatzenbuehler et al., 2013; Kamaradova et al., 2016; Luoma et al., 2007; Rivera et al., 2014; Skeer et al., 2018; von Hippel et al., 2018).”
Background

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“7–9 Ultimately, internalized and public stigma can lead to social exclusion and isolation, which in turn negatively impacts substance use.”
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Nonadherence to Ledipasvir/Sofosbuvir Did Not Predict Sustained Virologic Response in a Randomized Controlled Trial of Human Immunodeficiency Virus/Hepatitis C Virus Coinfected Persons Who Use Drugs
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BackgroundInfluential
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“This suggests a process in which the expectation of negative interactions causes people to avoid disclosing use (Biancarelli et al., 2019; Kumar Mishra et al., 2020).”
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“Pain management is essential to improve the hospital experience of all patients, but pain medications are often used conservatively in PWID, leading to inadequate pain management [21, 22, 34, 35].”
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“44,45 At the program/process level, participants expressed a desire for more proactive offers of services and more supportive connections; power dynamics, including racial dynamics, in medical and other settings 46–50 can create a barrier to overdose survivors advocating for themselves when…”
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“Notably, people who use injection drugs are frequently discriminated against in sexual, reproductive, and other health care settings, creating barriers to timely, compassionate care that is responsive to their needs [118–120].”
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“9,22,23 Stigma-related treatment dropout is alarmingly prevalent, 9,12,24 and medical conditions often deteriorate as PWUD delay seeking help until their symptoms worsen.”
Background
Willingness to use and distribute HIV self-testing kits among people who inject drugs in the San Diego–Tijuana border region
Pines, H. A., Eger, W. H., Skaathun, B., Vera, C. F., Vera, A., Rangel, G., Strathdee, S. A., & Bazzi, A. R. (2024) · Harm Reduction Journal · doi:10.1186/s12954-023-00922-7 · Cited by 6
“PWID often prefer to access health services, information, and referrals through SSPs [13, 72, 80, 81], which have a long history of deploying peers (i.e., “secondary exchangers”) in distributing harm reduction supplies within their social networks [38–41, 66, 67].”
Background
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Result
The use of person-first language in scientific literature focused on drug-seeking behavior: a cross-sectional analysis
Sharp, P., Slattery, J., Johnson, A., Torgerson, T., Ottwell, R., Vassar, M. B., & Hartwell, M. L. (2021) · Journal of Osteopathic Medicine · doi:10.1515/jom-2021-0149 · Cited by 8
“The expected stigmatization among these patients resulted in delay of treatment, delay in drug use reporting, and ultimately resulted in seeking healthcare elsewhere [13].”
Background
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“These stereotypes emanate from the preconception that an affected person injects drugs or is sexually promiscuous (Biancarelli et al., 2019).”
Background
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“In addition to the multilevel barriers to healthcare utilization among PWID [4, 5], emerging research has identified distrust of the public health pandemic response and mandatory nature of COVID-19 testing often encountered by people experiencing homelessness and incarceration (e.”
Background
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“Stigma in healthcare settings has also been recognized as a major barrier to linkage and engagement in healthcare, including HCV care among PWID (Austin et al., 2022; Biancarelli et al., 2019).”
Background
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“Further, training of healthcare providers on compassionate treatment of PWID, SUD treatment, harm reduction, and HIV and SUD stigma reduction may help address stigma and discrimination in clinical settings [58, 59].”
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“Moreover, stigmatizing experiences and discrimination at the point of care can result in feelings of worthlessness, depression, isolation, anger, anxiety, and fear among people who use illicit substances, resulting in delayed or avoidance accessing care (Biancarelli et al., 2019; Pauly, 2008a).”
Background
Willingness to use syringe service programs and safe consumption sites among methadone patients with histories of injection drug use in a small Midwest community
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“Substance use disorders are stigmatized health conditions (Yang et al. 2017), and PWID may represent a particularly marginalized subgroup of persons with substance use disorders (Bozinoff et al. 2018; Biancarelli et al. 2019).”
Background
Self and professional treatment of skin and soft tissue infections among women who inject drugs: Implications for wound care provision to prevent endocarditis
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“For example, PWID regularly experience stigma and discrimination in health care settings, often resulting in them avoiding or delaying care (Biancarelli et al., 2019; Grau et al., 2002; Paquette et al., 2018).”
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Gazzola, M. G., Maclean, E., Beitel, M., Carmichael, I. D., Cammack, K. M., Eggert, K. F., Roehrich, T., Madden, L. M., Jegede, O. O., Zheng, X., et al. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-022-07813-w · Cited by 6
“Anticipated stigma from clinicians, partly based on prior negative experiences, can attenuate the likelihood of MOUD entry and retention(2,19,20) and seeking healthcare generally.(21,22) Unfortunately, stigma against people with OUD and other substance use disorders is common in healthcare settings,(23) including prim…”
Background
“It’s within your own power”: shared decision-making to support transitions to buprenorphine
Williams, B. E., Martin, S. A., Hoffman, K. A., Andrus, M. D., Dellabough-Gormley, E., & Buchheit, B. M. (2025) · Addiction Science & Clinical Practice · doi:10.1186/s13722-025-00555-0 · Cited by 5
“Past studies have shown that providers who approach patients with OUD with compassion and seek to empower patients can help reduce internalized stigma associated with SUD treatment [30, 31].”
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Leon, K., Weger, R., Weinstock, N., Jawa, R., & Wilson, J. D. (2025) · Harm Reduction Journal · doi:10.1186/s12954-025-01240-w · Cited by 8
“Furthermore, people who inject drugs experience higher risk of infectious complications as well as significant stigma due to their method of consumption [6, 7, 8].”
Perceived stigma and its role in substance use disorder treatment completion
Isman, K., Giorgi, S., Ellis, J. D., Huhn, A. S., Liu, T., & Curtis, B. L. (2025) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2025.2528778 · Cited by 9
Improving Outcomes for People With Injection Drug-related Endocarditis: Are Medications for Opioid Use Disorder Enough?
Kimmel, S. D., & del Rı́o, C. (2019) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000573 · Cited by 5
“In many hospitals, MOUD are not available to patients, but even when these treatments are available, patients may face poorly managed withdrawal and cravings, lack of access to valve replacement surgery (Vlahakes, 2017), postacute medical care and MOUD upon discharge (Wakeman and Rich, 2017), stigma (Biancarelli et al…”
Background
A wound care and immunization needs assessment for participants of a mobile syringe services program in Austin, TX
Britton, T. R., Clague, M. R., Zagorski, C. M., Hill, L. G., & Loera, L. J. (2022) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2022.10.018 · Cited by 5
“No Good Choice”: What are the Issues of Having no Harm Reduction Strategies in Hospitals?
Forchuk, C., Serrato, J., Scott, L., Rudnick, A., Dickey, C. C., & Silverman, M. E. (2023) · Substance Abuse Research and Treatment · doi:10.1177/11782218231186065 · Cited by 5
Attitudes Toward Injection Practices Among People Who Inject Drugs Utilizing Medical Services: Opportunities for Harm Reduction Counseling in Health Care Settings
Applewhite, D. P., Regan, S., Donelan, K., Macias‐Konstantopoulos, W., Kehoe, L. G., Williamson, D., & Wakeman, S. E. (2023) · Health Promotion Practice · doi:10.1177/15248399231192996 · Cited by 5
“Future studies should examine how to best counsel PWID in medical settings, particularly given the significant trauma that this population has experienced in medical settings (Biancarelli et al., 2019; Simon et al., 2019).”
“Everything is kind of the same except my mind is with me”: exploring cannabis substitution in a sample of adults in early recovery from an opioid or stimulant addiction
Beaugard, C. A., Walley, A. Y., & Amodeo, M. (2024) · Harm Reduction Journal · doi:10.1186/s12954-024-01002-0 · Cited by 5
“Taking a harm reduction approach to drug use and addiction recovery has the potential to positively transform this population’s recovery experiences and willingness to seek support [61, 62].”
Background
A qualitative exploration of health care workers’ approaches to relational harm reduction in HIV primary care settings
Kay, E. S., Creasy, S. L., Townsend, J., & Hawk, M. E. (2024) · Harm Reduction Journal · doi:10.1186/s12954-024-01021-x · Cited by 5
“To avoid experiences of stigma and discrimination when receiving health care services, PWUD may seek to avoid stigma by concealing their drug use from HCWs, minimizing symptoms of pain, and even delaying care altogether [6, 7].”
Background
Health information-seeking on Reddit, by people who use opioids
Sullivan, M., Hancock, J., Shaw, G. B., & Ni, C. (2024) · Information Research · doi:10.47989/ir292565 · Cited by 5
Nurse-led safer opioid supply and HIV pre-exposure prophylaxis: a novel pilot project
Haines, M., & O’Byrne, P. (2022) · Therapeutic Advances in Infectious Disease · doi:10.1177/20499361221091418 · Cited by 5
The hidden cost of dalbavancin: OPAT RN time required in coordination for persons who use drugs
Douglass, A. H., Mayer, H. S., Young, K. M., Sikka, M. K., Strnad, L. C., Makadia, J. T., Sukerman, E. S., Lewis, J. S., & Streifel, A. C. (2023) · Therapeutic Advances in Infectious Disease · doi:10.1177/20499361231189405 · Cited by 5
Uptake of SARS-CoV-2 vaccination among structurally-marginalized people who use drugs in Vancouver, Canada
Reddon, H., Barker, B., Bartlett, S. R., Márquez, A. C., Sekirov, I., Jassem, A. N., Morshed, M. G., Clemens, A., McGreevy, P. B., Hayashi, K., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-44069-8 · Cited by 5
“These experiences, in addition to the criminalization of substance use, have been found to contribute to medical and governmental mistrust, as well as limit engagement with health and harm reduction services 18, 46, 47 .”
Posttraumatic stress disorder in people who use drugs: syringe services program utilization, treatment need, and preferences for onsite mental health care
López‐Castro, T., Sohler, N., Riback, L. R., Bravo, G., Ohlendorf, E., Ghiroli, M. M., & Fox, A. D. (2024) · Harm Reduction Journal · doi:10.1186/s12954-024-01019-5 · Cited by 5
“SSPs engage PWUD by working from a harm reduction framework that actively counteracts stigma, makes minimal demands on clients to access care, and prioritizes building client trust [21–24].”
Background
The Analogy of Child Protection as Public Health: An Analysis of Utility, Fit, Awareness, and Need
Jenkins, B. Q. (2021) · Social Service Review · doi:10.1086/714490 · Cited by 5
“Clinicians can treat these conditions within a clinical relationship that is nonjudgmental, and prevention efforts can be supported by attempts to reduce stigma associatedwith both the condition and treatment (Geter et al. 2018; Biancarelli et al. 2019).”
BackgroundInfluential
Building Therapeutic Commitment in University Nursing Students
Dion, K. A., Choi, J., & Griggs, S. A. (2021) · Nurse Educator · doi:10.1097/nne.0000000000001060 · Cited by 5
“2 As a result of anticipated stigma, people with SUD will avoid seeking care and often engage in 3 behaviors: (1) delay health care, (2) not disclose their drug use, or (3) seek alternate ways to manage their health problems.”
Background
Perceived Mistreatment in Health Care Settings and its Relationship with HIV Clinical Outcomes in HIV-positive People who Use Drugs in Vancouver, Canada
Jaibat, L., Cui, Z., Mitra, S., Loh, J., Reddon, H., Fairbairn, N. S., & Milloy, M. (2022) · AIDS and Behavior · doi:10.1007/s10461-022-03895-z · Cited by 5
Prevalence and correlates of experiencing drug-related discrimination among people who use drugs presenting at emergency department at high risk of opioid overdose
Nolen, S., Wilson, T. T., Jacka, B. P., Li, Y., Beaudoin, F. L., & Marshall, B. D. L. (2023) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2023.100496 · Cited by 5
Increasing linkage to hepatitis C care following trauma‐informed rehabilitation: An education and quality improvement project among women
Crespi, A., Uum, R. V., Lathouris, H., Masterman, C., Muncaster, K., Gaete, K., Capraru, C. I., Shah, H., Feld, J. J., & Biondi, M. J. (2023) · Drug and Alcohol Review · doi:10.1111/dar.13713 · Cited by 5
Spatial inequities in access to medications for treatment of opioid use disorder highlight scarcity of methadone providers under counterfactual scenarios
Tatara, E. R., Lin, Q., Ozik, J., Kolak, M., Collier, N. T., Halpern, D., Anselin, L., Dahari, H., Boodram, B., & Schneider, J. A. (2024) · PLoS Computational Biology · doi:10.1371/journal.pcbi.1012307 · Cited by 5
“For persons with OUD, access is especially complex because of the interplay of MOUD resource scarcity and drug use stigma, as patients experiencing stigma from MOUD providers are less likely to return [23].”
Background
Patient or prisoner? Perceptions of prison healthcare services in Norway and the conflict between care and control
Nyvoll, P. S. (2025) · Incarceration · doi:10.1177/26326663241311554 · Cited by 4
“This also aligns with previous research on how people with drug issues experience stigma and have poor overall experiences with healthcare services (Biancarelli et al., 2019; Muncan et al., 2020), and how health-care professionals generally have a more negative attitude towards patients with…”
Hepatitis C Treatment Initiation During Hospitalization for People Who Use Drugs: A Narrative Review of the Literature
Denkins, J., Babiarz, J., Ham, Y., Ryu, H., Ricci, B. C., Williams, C., Alexander, I., Tucker, K. J., McCrary, L. M., & Levander, X. A. (2025) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofaf237 · Cited by 4
“In addition, stigma may contribute to delaying or avoiding care and loss to follow-up [9].”
Understanding the Perspectives of Women Who Use Intravenous Drugs and are Experiencing Homelessness in an Urban Centre in Canada: An Analysis of Ethnographic Data
Kitson, C., Haines, M., & O’Byrne, P. (2022) · Global Qualitative Nursing Research · doi:10.1177/23333936221080935 · Cited by 4
“This aligns with the literature that PWUD report stigma and discrimination when accessing healthcare through hospitals and urgent-care clinics (Biancarelli et al., 2019; Chan Carusone et al., 2019; McCradden et al., 2019; Muncan et al., 2020).”
Background
Experiences Using a Multidisciplinary Model for Treating Injection Drug Use Associated Infections: A Qualitative Study
Nolan, N. S., Gleason, E. G., Marks, L. R., Habrock-Bach, T., Liang, S. Y., & Durkin, M. J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.924672 · Cited by 4
Educational training to improve opioid overdose response among health center staff: a quality improvement initiative
Stephenson, A., Calvo–Friedman, A., Altshuler, L. A., Zabar, S. R., & Hanley, K. (2023) · Harm Reduction Journal · doi:10.1186/s12954-023-00803-z · Cited by 4
From trauma to transmission: exploring the intersection of adversity, substance use, and HIV risk in women’s life histories
West, N., Kussaga, F. M., Rittenhouse, A. G., Duroseau, B., Knight, D., Mbwambo, J. K. K., Likindikoki, S. L., & Saleem, H. T. (2023) · International Journal for Equity in Health · doi:10.1186/s12939-023-01994-4 · Cited by 4
“People who use drugs are less likely to engage in the health system overall [40, 41], with anticipated or past experiences of drug use stigma being a reason for avoidance [42, 43].”
Background
A linguistic analysis of dehumanization toward substance use across three decades of news articles
Giorgi, S., Habib, D. R. S., Bellew, D., Sherman, G. T., & Curtis, B. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1275975 · Cited by 4
Access to Healthcare Among Young Adult Probationers Participating in a Pilot Health-Focused Reentry Program
Ojeda, V. D., Parker, T., Lyles, M., Edwards, T. M., Jimenez, C., Hiller-Venegas, S., Berliant, E., & Lister, Z. D. (2024) · International Journal of Offender Therapy and Comparative Criminology · doi:10.1177/0306624x241240700 · Cited by 4
“For example, JIA often experience overlapping stigmatized identities and discrimination (e.g., justice-involved status, racial and ethnic minority status, low education and income, unstably housed, living with mental illness, substance use-related; Biancarelli et al., 2019; Motavalli et al., 2021).”
A systematic review exploring healthcare professionals' perceptions of take‐home naloxone dispensing in acute care areas
Osinski, K., & Afseth, J. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16181 · Cited by 4
More than Just Buying a Van: Lessons Learned from a Mobile Telehealth HCV Testing and Treatment Study
Bianchet, E., de Gijsel, D., Toro-Mejías, L. M. D., Stopka, T. J., Hoskinson, R. A., Dowd, P., & Friedmann, P. D. (2024) · Viruses · doi:10.3390/v16091388 · Cited by 4
Results from a retrospective case finding and re-engagement exercise for people previously diagnosed with hepatitis C virus to increase uptake of directly acting antiviral treatment
Etoori, D., Simmons, R., Desai, M., Foster, G. R., Stuart, A., Sabin, C. A., Mandal, S., & Rosenberg, W. M. (2024) · BMC Public Health · doi:10.1186/s12889-024-19919-3 · Cited by 4
“Individual barriers affecting re-engagement could include anticipated stigma [51], mistrust of institutions charged with their care [52], and the mobility and tran-sience of some people affected by HCV as demonstrated in other studies [53, 54].”
Result
Exploring health inequities through the actor‐network theory lens
Fisher, M., Tulloch, J., & Petrovskaya, O. (2024) · Nursing Philosophy · doi:10.1111/nup.12504 · Cited by 5
Examining naloxone access and interest in secondary naloxone distribution on an American Indian Reservation in the Northern Midwest of the United States
Schneider, K. E., Allen, S. T., O’Rourke, A., Reid, M. C., Conrad, M. A., Hughes, P., Palombi, L. C., Wakemup, T., Medley, A., & Walls, M. L. (2024) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2024.100285 · Cited by 5
“Stigma is a well-documented barrier to accessing services for PWUD across communities in the scientific literature (Ayon et al., 2018; Biancarelli et al., 2019; Cernasev et al., 2021; Davis et al., 2022; Hammarlund et al., 2018; Livingston, 2020; Luoma, 2011; Paquette et al., 2018; Shirley-Beavan…”
Background
Considerations for equitable distribution of digital healthcare for people who use drugs
Papalamprakopoulou, Z., Roussos, S., Ntagianta, E., Triantafyllou, V., Kalamitsis, G., Dharia, A., Sypsa, V., Hatzakis, A. E., & Talal, A. H. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12619-7 · Cited by 4
“Considering that stigma is a significant barrier to healthcare access for PWUD, engendering trust and empathy are key for effective healthcare delivery, including through digital approaches [5, 27, 50].”
Predictors of non-transport by emergency medical services after a nonfatal opioid overdose: a national analysis
Taylor, J., Bandara, S. N., Parks, C. L., Saloner, B. K., Fredericks, P. J., & Shen, K. (2025) · Health Affairs Scholar · doi:10.1093/haschl/qxaf101 · Cited by 4
Substance use and other factors associated with child welfare case duration: Looking beyond out of home care
Hall, M. T., Hardy, G. C., Golder, S., Huebner, R. A., McNeil, A. J., & Walton, M. T. (2022) · Child & Family Social Work · doi:10.1111/cfs.12948 · Cited by 4
Internalized shame among justice-involved women in substance use disorder treatment: Measurement invariance and changes during treatment.
Joseph, V. W., Moniz-Lewis, D. I. K., Richards, D. K., Pearson, M. R., Luoma, J. B., & Witkiewitz, K. A. (2023) · Stigma and Health · doi:10.1037/sah0000427 · Cited by 6
Why do people use drugs? A neglected question
McLoughlin, A. (2023) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-023-03416-4 · Cited by 4
Harm Reduction: A Missing Piece to the Holistic Care of Patients Who Inject Drugs
Nolan, N. S., Francis, S. M. F., Marks, L. R., Beekmann, S. E., Polgreen, P. M., Liang, S. Y., & Durkin, M. J. (2023) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofad402 · Cited by 4
“navigating outpatient follow-up appointments [16, 17].”
Non-disclosure of drug injection practices as a barrier to HCV testing: results from the PrebupIV community-based research study
Anwar, I., Donadille, C., Protopopescu, C., Michels, D., Herin, J., Pladys, A., Bader, D., Carrieri, P., & Roux, P. (2023) · Harm Reduction Journal · doi:10.1186/s12954-023-00841-7 · Cited by 5
“Current and former PWID adopt strategies to avoid stigma and discrimination, including delaying healthcare as much as possible and not disclosing their drug use [28, 29].”
Background
Perceptions of Overdose Response Hotlines and Phone Application Services Among Women and Gender-diverse Individuals Who Use Drugs in Canada: A Qualitative Study
Lee, A. J., Jafri, F., Viste, D., Seo, B., Skiber, D., Medwid, M., & Ghosh, S. M. (2024) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001325 · Cited by 4
Stigma toward cocaine use in Mexico City: does gender matter?
Washburn, M., Gearing, R. E., Yu, M., Brewer, K. B., Cruz, P. D. L., & Torres, L. R. (2023) · Journal of Social Work Practice in the Addictions · doi:10.1080/1533256x.2023.2170601 · Cited by 4
“Given that women who inject drugs tend to experience the highest levels of substance-use-related stigma (Biancarelli et al., 2019; Muncan et al., 2020), the means of ingestion might account for the lack of gender differences in this study.”
Importance of pharmacist-patient relationship in people living with HIV and concomitant opioid use disorder
Cernasev, A., Veve, M. P., Hohmeier, K. C., Summers, N. A., & Kumar, S. (2021) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2021.100052 · Cited by 4
Integrating Hospital-Based Harm Reduction Care—Harnessing the Nursing Model
Goff, A., Lujan-Bear, S., Titus, H. E., & Englander, H. L. (2024) · Substance Use & Addiction Journal · doi:10.1177/29767342231219577 · Cited by 5
“31 Finally, the barriers we face impeding comprehensive supply distribution may be a useful warning to others in states contending with similar restrictions, where local laws may also limit which supplies hospital teams can distribute.”
Background
Substance use Attitudes, Beliefs, Experience, and Knowledge Among Nursing and Nursing Assistant Students
Fokuo, J. K., Hutman, P., Gruber, V. A., Masson, C. L., Lum, P. J., Bush, D. M., Naugle, J., & Sorensen, J. L. (2024) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2024.2343402 · Cited by 3
“Health-care providers hold stigmatizing attitudes toward persons with SUD that are similar to attitudes held by the general public (Biancarelli et al. 2019; Livingston et al. 2012; van Boekel et al. 2014).”
Staff perspectives of barriers and facilitators to implementation of the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in New York City safety net hospitals
Bunting, A. M., Fawole, A., Fernando, J., Appleton, N., King, C., Textor, L., Schatz, D., & McNeely, J. (2024) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2024.209560 · Cited by 3
Stigmatizing Terminology and Patient-Centered Language in Perinatal Substance Use Chart Notes
Friedman, S. R., Hughes, P. M., Blake, E., Tak, C. R., Ostrach, B. M. M., & Ramage, M. (2025) · Journal of Addictions Nursing · doi:10.1097/jan.0000000000000616 · Cited by 3
“Substance use disorders (SUDs) are one such condition, with stigma being a widely recognized issue impacting access to SUD treatment (Biancarelli et al., 2019; Burgess et al., 2021; Dickson-Gomez et al., 2022; Paquette et al., 2018).”
On-site health service delivery models at syringe services programs in the United States: Results of a national cross-sectional survey
Behrends, C. N., Jarlais, D. C. D., Luhur, W., Lu, X., Corry, G. J., Glick, S. N., Kapadia, S. N., Perlman, D. C., & Schackman, B. R. (2025) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2025.100355 · Cited by 5
An Advanced Practice Nurse's Contributions to the Care of Opioid‐Dependent Patients in an Acute Somatic Hospital: A Qualitative Study
Schneider, K., Grossmann, F. F., Jaiteh, C., & Lauener, S. K. (2025) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.70083 · Cited by 3
“They often receive delayed and superficial care [4, 5, 11].”
Influential
Pre-implementation findings on the barriers and potential solutions to initiate same-day antiretroviral therapy among people who inject drugs in Malaysia
Oliveros, D., Jenarun, G., Salleh, N. A. M., Saifi, R. A., Earnshaw, V. A., Madden, L. M., Bromberg, D. J., Sutherland, R., Nikitin, B. M., Kamarulzaman, A., et al. (2025) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2025.104967 · Cited by 3
ADLM Guidance Document on Laboratory Testing for Drugs of Misuse to Support the Emergency Department
Snozek, C. L. H., Krasowski, M. D., Colby, J. M., Johnson‐Davis, K. L., Bruccoleri, R., & Melanson, S. E. F. (2025) · The Journal of Applied Laboratory Medicine · doi:10.1093/jalm/jfaf172 · Cited by 3
Sequential endogenous endophthalmitis, fungal keratitis, bacteremia and vertebral osteomyelitis in a person who injects drugs
Lewis, C. Y., Zegans, M. E., Batra, N. N., & Jordan, K. L. (2021) · American Journal of Ophthalmology Case Reports · doi:10.1016/j.ajoc.2021.101140 · Cited by 3
Role of Stigma for Health Care Professionals With Nonmedical Substance Use
McNeely, H. L., Nelson‐Brantley, H. V., Teel, C. S., & Peterson, M. (2023) · Western Journal of Nursing Research · doi:10.1177/01939459231187983 · Cited by 3
“838 Western Journal of Nursing Research 45(9)”
Influential
Participant experiences in a pilot study for methamphetamine withdrawal treatment: Implications for retention
Acheson, L. S., Clay, S., McKetin, R., Lintzeris, N., Dunlop, A. J., Brett, J., Christmass, M. A., Rodgers, C., SHOPTAW, S. J., Farrell, M., et al. (2024) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2024.104383 · Cited by 3

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: Biancarelli, Dea L.
Biello, Katie B.
Childs, Ellen
Drainoni, M.
Edeza, Alberto
Mimiaga, Matthew J
Saitz, Richard
Bazzi, Angela R.
Venue: Drug and Alcohol Dependence
Publisher: Elsevier BV
Published: 2019-05
Volume: 198
Pages: 80-86
ISSN: 0376-8716 (ISSN-L)
DOI: 10.1016/j.drugalcdep.2019.01.037
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 319 d)
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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Strategies used by people who inject drugs to avoid stigma in healthcare settings

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