Credit: Subject Matter Health Research Lab
Let’s do a thought experiment. Imagine you’re living with opioid use disorder, also known as opioid addiction. This condition can affect anyone and can have devastating consequences. But you’ve sought help. Methadone is one part of your treatment. With the help of this medication, support and a lot of hard work, you’ve had a more stable life for almost two years. But you’re still stuck with the stigma. This creates major challenges – including when you need treatment for acute pain.
Now, imagine you’ve fractured your arm. You’re treated in the ER but you’re in a lot of pain, so the doctor says they can prescribe something to help. You know it’s relevant so you mention the methadone.
“Drug-seeking,” “addict,” “high risk” …
Prescribing an opioid pain medication is routine for this injury but now you get the sense they don’t trust you.
“Umm, you’ll have to see your methadone provider.”
You get one dose of pain medication and you go home in pain and feeling rejected. You wish you’d never mentioned the methadone.
At the methadone clinic the doctor tells you they only handle methadone, and that you should see your primary care provider instead.
You can’t get an appointment with your primary care provider before next week. But you’re in pain now, so you try a walk-in clinic. This time, you don’t mention the methadone, and you’re prescribed a short course of a low dose opioid.
At the drugstore, the pharmacist reviews your file.
“Double doctoring,” “overdose risk,” “diversion” …
They speak to you sternly about mixing medications.
“Drug problem,” “addict” …
“No point” …
You’re discouraged, but hopeful your primary care provider can help. But before you can see them you’re asked to do a drug test.
“Difficult,” “addict” …
Your primary care provider reluctantly gives you yet another short prescription for a low dose opioid. They tell you it’s actually your methadone provider who needs to handle this, and that maybe they should increase your dose.
Now, exhausted by the run-around, frustrated by the way you’ve been made to feel, and overwhelmed by your ongoing pain, you feel you’re out of options. So how do you cope? You resort to something you thought you’d left in your past. You contact a drug dealer.
You know this might be dangerous for you, but it’s convenient and available – and you trust your dealer. You finally get some pain relief, but now you’re ashamed and fearful of losing all your progress.
“Worthless,” “failure” …
Now, let’s imagine this scenario again – but this time, the providers you meet are aware of stigma and systematic changes have been made to reduce its impact on the care you receive.
When you mention you take methadone, instead of reacting with suspicion and discomfort, your providers ask you some important questions:
“How long have you been taking methadone at this dose?”
Instead of making quick assumptions, they see a more complex picture. They tell you your pain should be treated aggressively and with close follow-up.
“When did you last use other opioids?”
They understand you may require higher doses of opioids to effectively treat your pain. They explain that for some people with substance use disorders the brain perceives pain differently.
“How do you feel about treating your pain with an additional opioid?”
Your providers know that just increasing the dose of your methadone is unlikely to be effective.
“How is this plan working for you?”
They understand that the distress of untreated acute pain increases the risk of returning to old coping strategies.
Now that you’re fully informed, you and your providers work out a treatment plan together.
This plan is not simple, but with the support of your care team, your treatment is successful. The opioid pain medication is tapered off as your pain subsides, and you continue with your regular methadone dose. Imagine how you feel now.
Stigma shames and discredits people with opioid use disorder, and creates health care systems that dismiss and disconnect people from care. To change this, individuals must examine their biases, and systems rooted in stigma must be reformed. Only then can people with opioid use disorder get the compassionate, evidence-based care they deserve.
We can move beyond stigma.
