The impact of race, gender, and heroin use on opioid addiction stigma

Abstract

Introduction: Stigmatization of an opioid addiction acts as a barrier to those seeking substance use treatment. As opioid use and overdoses continue to rise and affect minority populations, understanding the impact that race and other identities have on stigma is pertinent.

Methods: This study aimed to examine the degree to which race and other identity markers (i.e., gender and type of opioid used) interact and drive the stigmatization of an opioid addiction. To assess public perceptions of stigma, this research team conducted a randomized, between-subjects case vignette study (N = 1833) with a nation-wide survey. Participants rated a hypothetical individual who became addicted to opioids on four stigma indices (responsibility, dangerousness, positive affect, and negative affect) based on race (White or Black), gender (male or female), and end point (an individual who transitioned to using heroin or who continued using prescription painkillers).

Results: Our results first showed that the White individual had higher stigma ratings compared to the Black individual (range of partial η² = 0.002-0.004). An interaction effect demonstrated that a White female was rated with higher responsibility for opioid use than a Black female (Cohen's d = 0.21) and a Black male was rated with higher responsibility for opioid use than a Black female (Cohen's d = 0.26). Last, we showed that a male and an individual who transitioned to heroin had higher stigma than a female and an individual who continued to use prescription opioids (range of partial η² = 0.004-0.007).

Conclusion: This study provides evidence that information about multiple identities can impact stigmatizing attitudes, which can provide deeper knowledge on the development of health inequities for individuals with an opioid addiction.

Keywords: Gender; Heroin; Nonmedical prescriptions; Opioids; Race; Stigma.

Figure 1

a. Race Condition. Participants rated the White individual with higher responsibility (p = .030, partial η2 = .003), dangerousness (p = .048, partial η² = .002) and negative affect (p < .01, partial η² = .004) compared to a Black individual. b. The interaction effect showed that a White female was rated with higher responsibility than a Black female (p < .005, Cohen’s d = .21) and a Black male was rated with higher responsibility than a Black female (p = .05, Cohen’s d = .26). Item ranges: responsibility (1-6), dangerousness (1-6) and negative affect (2-12). ** p < .005, * p = .05, error bars represent standard errors.

Figure 1

a. Race Condition. Participants rated the White individual with higher responsibility (p = .030, partial η2 = .003), dangerousness (p = .048, partial η² = .002) and negative affect (p < .01, partial η² = .004) compared to a Black individual. b. The interaction effect showed that a White female was rated with higher responsibility than a Black female (p < .005, Cohen’s d = .21) and a Black male was rated with higher responsibility than a Black female (p = .05, Cohen’s d = .26). Item ranges: responsibility (1-6), dangerousness (1-6) and negative affect (2-12). ** p < .005, * p = .05, error bars represent standard errors.

Figure 2.. Gender Condition.

Participants rated the male with higher dangerousness (p < .005,partial η² = .004) and lower positive affect (p < .005, partial η² = .005) compared to the female. Item ranges: dangerousness (1-6) and positive affect (2-12), error bars represent standard errors.

Figure 3.. End Point Condition.

Participants rated the individual who transitioned to heroin with higher dangerousness than the individual who continued using painkillers (p = .022, partial η² = .007). Item range: dangerousness (1-6), error bars represent standard errors.