More than 30% of physicians and dentists said they prefer not to work with patients with an opioid use or stimulant use disorder, a significantly higher rate than reported for other conditions that carry stigma such as HIV (9%), depression (9%), or even alcohol use disorder (17%), according to a study published yesterday in Addiction.
Carrigan Parish, Ph.D., D.D.S., of Columbia Mailman School of Public Health, and colleagues surveyed 1,240 primary care physicians, emergency medicine physicians, and dentists (mean age 53 years, 60% male, 68% white). Stigma was assessed using the Medical Condition Regard Scale, an 11-item scale through which respondents reported the degree to which they found patients with a particular medical condition enjoyable, treatable, and worthy of medical resources. The conditions included type II diabetes, depression, HIV, alcohol use disorder (AUD), opioid use disorder (OUD), and stimulant use disorder.
Respondents were consistently more likely to endorse negative responses regarding patients with substance use disorders (SUDs) than other conditions. Among SUDs, the greatest stigma scores were toward patients with stimulant use disorder, followed by OUD, then AUD. Further:
- Respondents were less likely to feel able to provide effective care to patients with SUDs than other conditions. For example, 22% believed there is little they can do to help patients with stimulant use disorders, compared with 7% who said the same for HIV or depression.
- More than half of respondents reported feeling compassion toward patients with diabetes (51.5%), HIV (57.6%), and depression (57.6%), while significantly fewer said the same for patients with AUD (37.6%), OUD (33.4%), and stimulant use disorders (27.7%).
- Emergency medical physicians had the highest stigma scores toward patients with SUDs, particularly stimulant use disorders. Yet they were the most likely to report providing treatment to these patients.
“While we’ve made progress in expanding access to evidence-based SUD treatment, stigma remains a profound barrier—often embedded in the clinical encounter itself,” Parish said in a news release. “Our findings show that many providers still feel uncomfortable treating patients with substance use disorders, and that hesitancy leads directly to missed opportunities for care. In particular, emergency departments often serve as the first—and sometimes only—point of care for people with [SUDs]. We need to leverage those moments, not miss them.”
For related information, see the Psychiatric News articles “Discrimination Persistent Barrier to Care for OUD Patients” and “Physician Reluctance to Intervene in SUD Tied to Lack of Institutional Support.”
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