Reversing stigma is key to stemming the opioid epidemic
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After two years of bitterly partisan debate on health reform, Congress appears poised to unite on a response to the opioid epidemic. Leaders in both parties should add one essential ingredient to the developing bills: a multiyear, comprehensive public education campaign to reduce the stigma around addiction.

I know our lawmakers are keenly aware of this agonizing issue. On a visit to Washington recently, days before the Senate Health, Education, Labor and Pensions Committee approved the “Opioid Crisis Response Act” last week, I was struck by how many members of Congress shared their feelings with me about the stigma tormenting substance users in their communities.


Even in my home state of Massachusetts, a national leader in substance use disorder treatment, a survey conducted by my company found two-thirds of residents believe the No. 1 barrier to recovery is people simply not wanting to give up their addiction. Some continue to believe that Narcan or other vital medications “enable” riskier drug use. In other words, many people still believe those with substance use disorder have only themselves to blame for their condition.

To be sure, America is responding to the opioid crisis. Overdose drugs are now widely available among first-responders. Treatment programs are becoming more accessible and the overprescribing of painkillers is being curtailed. Congress is considering measures that would expand treatment and research.

But the efforts to combat the epidemic will never fully succeed unless we work together to change the stigma that still unfairly burdens our families, friends and neighbors living with substance use disorder.

“When you look at the reasons that people cite of why they don't seek treatment, the No. 1 answer that comes up for many people is stigma,” Michael Botticelli, former director of the Office of National Drug Control Policy and now executive director of the Grayken Center at Boston Medical Center, told NPR in an interview last year. “They don't want their neighbors finding out, they don't want friends finding out. And one of the contributory factors to that stigma is our language that we use.”

For example, referring to “an addict” rather than as “a person with substance use disorder” can have serious consequences.

A study by Dr. John KellyJohn Francis KellyMORE at the Harvard-MGH Recovery Research Institute offered trained clinicians nearly identical scenarios. But in one scenario Kelly referred to a patient as a “substance abuser,” and in the other, a “person with a substance use disorder.” He found that when you called someone a substance abuser, it elicited, even from physicians, a more punitive response.

We all must do our part to undo this stigma. I was surprised recently to look at my own Blue Cross card, issued by the company I run, only to find a toll-free number for “Substance Abuse” assistance on the back. How many people, I wonder, never called for help because of the subtle deterrent effect of such language? My company is changing those cards now. But it was for me a powerful reminder of the insidious nature of stigmatizing language.

The way we think and talk and write about this epidemic can be addressed on a national scale. After all, we have done it before. In addressing other public health crises, we have made significant strides by embracing science to change public views. Within my own lifetime, drunken driving was once seen as an unfortunate mistake rather than a dangerous crime. Tobacco use was ubiquitous. Some once argued that helmets or seatbelts or condoms would embolden people to act in a riskier fashion. But leaders we respect championed the facts and spoke out. And as a result, we dramatically reduced drunken driving and smoking and increased the use of helmets, seatbelts and condoms, saving countless lives and improving countless others.

Congress can ensure that we can fund an education campaign that can produce the same transformational change around substance use. And there is no time to waste. Our survey found one-quarter of our neighbors here in Massachusetts personally know someone who died of an overdose.

My company, along with many others across the nation, is committed to doing its part by reducing the supply of prescription opioids, expanding treatment options and reducing barriers to care. But we won’t succeed until leaders across the spectrum of society – in our schools, hospitals, businesses, places of worship, and yes, our Congress -- unite behind the science and use their influence to change social norms.

Starting with our words.

And, in my case, changing the language on the back of our cards.

Andrew Dreyfus is CEO of Blue Cross Blue Shield of Massachusetts, which this year commissioned the survey regarding substance use in the state.