Hospital-Based Stigma Practices Towards Individuals With Opioid Use Disorder: A Qualitative Study in Austin, Texas

Abstract

Background

Individuals with opioid use disorder (OUD) commonly face stigma when receiving healthcare. Although experienced stigma of patients with OUD in hospital settings is linked to worse treatment outcomes, less is known about the stigmatizing care practices of hospital-based providers that result in experienced stigma.

Objective

This study aimed to explore hospital-based stigma experiences and positive care experiences of people with OUD to identify stigmatizing and nonstigmatizing care practices to inform hospital-based care.

Design

This was a qualitative study based on semi-structured, in-person focus groups.

Participants

Participants were people who self-identified as being in recovery from opioid use disorder recruited through a community recovery organization in Austin, TX.

Approach

Focus groups followed a semi-structured interview guide encouraging discussion of stigmatizing healthcare experiences. We used applied thematic analysis in a systematic, inductive approach to categorize themes around hospital-based care experiences.

Key Results

Among participants (n = 18), stigmatizing experiences reflected the following hospital-based care practice themes: using non-person-first language, ignoring pain, labeling as “drug-seeking,” and not valuing the lived expertise of patients. These practices resulted in fear/avoidance of care, distrust of the care team, and internalized stigma. On the other hand, using recovery-oriented language, being polite, and engaging in shared decision making resulted in open communication with providers and trust of the care team.

Conclusions

Stigma experienced in hospital settings has significant consequences for patients with OUD. Hospital systems must implement policies that promote patient-centered practices and avoid stigmatizing practices to improve hospital-based care delivery for people with OUD.