Fighting stigma to save lives
Pervasive stigma against people with addiction is a major barrier to recovery, and it affects nearly every aspect of substance use disorder: from prevention to diagnosis to accessing evidence-based treatments and lifesaving antidotes. Community coalitions are working with HEALing Communities Study researchers in a range of ways, including coming up with strategies to confront stigma in their communities.
Stigma can be internalized — experienced by a person with opioid use disorder — as well as held by many others within families and in community settings.
New York project leader Nabila El-Bassel, Ph.D., of Columbia University, New York City, notes that stigma can arise not only about drug use but also about racial injustices in our society toward people of color. Stigma about substance use can be compounded when it intersects with other pervasive forms of discrimination, like racism.
“Stigma is a problem for most people seeking help for opioid use disorder, but it’s a triple threat for many people of color who use drugs,” she explains.
El-Bassel says that it’s especially important to ensure that community coalitions pay attention to the unique needs of people of color and the inequities these communities face in accessing evidence-based practices to address opioid use disorders. Approximately one-fifth of the people in the New York HEALing Community Study locales are Black/African American or Hispanic/Latinx, providing opportunities to listen to these important community voices.
Stigma within the healthcare system is also a challenge. Finding doctors who will prescribe these medications and pharmacists who will fill prescriptions can be difficult. Likewise, access to naloxone is limited in some states, some of which require a prescription for it. Like with medications to treat opioid use disorder, some physicians are reluctant to prescribe naloxone, and some pharmacies do not keep it in stock.
“It’s a myth that Narcan enables drug use in people with opioid use disorder,” says Sharon Walsh, Ph.D., of the University of Kentucky School of Medicine, who leads the Kentucky project of the HEALing Communities study.
“What it does is it let people live to see another day.”
Coping with new realities
The COVID-19 pandemic occurred in the United States a few months after the HEALing Communities Study began to introduce locally chosen sets of strategies into participating communities. The communities rapidly introduced virtual health approaches through videoconferencing and other remote-delivery strategies – many had been using these technologies already throughout the planning stages of the research.
Yet isolation and access to in-person treatment was restricted due to pandemic-related closures and physical distancing recommendations. These restrictions put people at high risk for relapse or overdose.
The HEALing Communities Study leveraged its community partnerships to fast-track distribution of naloxone. Community coalitions worked with research teams to enhance availability and access to naloxone to individuals most at risk of overdose, including people being released from prison and jail because of COVID-19.
Some communities took the lead in finding creative ways to meet people where they are, safely, to provide naloxone. This included distribution at gas stations, in supermarkets — even at beaches after they had re-opened when conditions on the ground were deemed safe. Study scientists are collecting data about effects of these strategies on increasing the number of people accessing naloxone.
Despite many effective tools to reduce opioid-related overdose deaths, far too many Americans continue to die. The HEALing Communities Study is poised to identify much needed strategies to increase access to evidence-based treatments in ways that are responsive to local needs.
This scientific knowledge is using the power of people to help other communities make life-saving treatments more widely available for everyone who deserves them.
Editor’s note: This story is the first in a two-part series about the HEALing Communities Study. Next up: Voices from the Community
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National Institute on Drug Abuse (NIDA)
Learn more about NIDA’s role in the NIH HEAL Initiative.