Framing, stigma, and policy approaches to addressing prescription opioid addiction

opioid addiction;public opinion;stigma;Public Health Studies

Kennedy Hendricks, AleneEnsminger, Margaret ;

Johns Hopkins University

关键词: opioid addiction;    public opinion;    stigma;    Public Health Studies;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60572/KENNEDYHENDRICKS-DISSERTATION-2015.pdf?sequence=1&isAllowed=n

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background: In the last 15 years, rates of prescription opioid addiction and overdose have risen rapidly, leading the CDC to label prescription drug overdose a national epidemic. Social stigma toward persons with opioid addiction is an important barrier to the advancement of public health-oriented solutions to this problem. Particular sub-populations, such as pregnant women, may face added stigma due in part to perceptions of risk associated with prenatal drug exposure and the way in which the problem has been framed in the public discourse. The Affordable Care Act (ACA) includes components to expand access to substance use treatment and integrate primary care and behavioral health services through reforms to the delivery system, such as the Medicaid health home. Maryland is one of only three states to implement health homes in opioid treatment programs (OTPs). Methods: To assess stigma toward persons with prescription opioid addition, I analyzed data from a nationally representative public opinion survey fielded in early 2014 (N=1,111). To examine how narratives framing prescription opioid addiction during pregnancy affect public attitudes, I designed and conducted a randomized experiment with participants drawn from a nationally representative web-based panel (N=1,620). To assess the implementation of health homes in Maryland OTPs, I conducted in-depth interviews with OTP leadership staff and state officials. Results: Stigma toward persons with prescription opioid addiction is associated with internal causal attributions and with greater support for punitive policy and lower support for public health-oriented policy. The degree to which narratives portraying a woman addicted to prescription opioids during pregnancy affect public attitudes depends on the socioeconomic status of the woman portrayed and whether she engages in addiction treatment. To date, few Maryland OTPs have adopted Medicaid health homes. Among those OTPs that have, interpersonal relationships and patient engagement are factors critical to successful implementation.Conclusions: Social stigma toward persons with prescription opioid addiction has important policy implications. Re-framing the issue may reduce stigma and increase support for public health-oriented approaches to addressing opioid addiction. OTPs offer a unique opportunity to implement health homes because many have established relationships with a vulnerable patient population.