Support for evidence-informed opioid policies and interventions: The role of racial attitudes, political affiliation, and opioid stigma

Abstract

Political affiliation, racial attitudes, and opioid stigma influence public support for public health responses to address opioid use disorders (OUD). Prior studies suggest public perceptions of the opioid epidemic are less racialized and less politically polarized than were public perceptions of the crack cocaine epidemic. Analyzing a cross-sectional, nationally representative sample (n = 1161 U.S. adults) from the October 2020 AmeriSpeak survey, we explored how political affiliation, racial attitudes (as captured in the Color-Blind Racial Attitudes Scale [CoBRAS]), and OUD stigma were associated with respondents' expressed views regarding four critical domains. Respondents with unfavorable attitudes towards Black Americans were less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and distributing naloxone for overdose prevention. Democratic Party affiliation was associated with greater support for all three of the above measures, and increased support for mandatory treatment, which may be seen as a substitute for more punitive interventions. Black respondents were also less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and of distributing naloxone. Our finding suggest that negative attitudes towards African-Americans and political differences remain important factors of public opinion on responding to the OUD epidemic, even after controlling for opioid stigma. Our findings also suggest that culturally-competent dialogue within politically conservative and Black communities may be important to engage public support for evidence-informed treatment and prevention.

Keywords: Opioid treatment; Opioid use; Political affiliation; Racism; Stigma; Substance use.

Fig. 1.

A–C. Predicted probabilities of support for government policy, by political affiliation, racial attitudes, and OUD stigma. In each graph, we used the R margins package to compute and plot predicted probabilities and 95% CI for each dependent variable, holding constant all other independent variables at the sample mean. A. Shows the predicted support for each of the Four OUD support outcomes, by Political Affiliation; B. Shows the predicted support for each OUD support outcome, by CoBRAS score; and C. Shows the predicted support for each OUD support outcome, by OUD Stigma score.