Local View: Address stigma to reduce opioid overdose deaths
Opioid overdose deaths are at an all-time high with no sign of subsiding. While education and prevention can be effective in preventing someone from developing a substance use disorder, addressing and confronting shame and stigma is a crucial step in preventing opioid overdose deaths.
Addiction is a medical condition and should be treated with a medical model similar to other chronic diseases. Many individuals with high cholesterol, high blood pressure, or diabetes are able to manage their conditions with diet and exercise. Some are able to make significant lifestyle changes and never need medications to control their chronic conditions. Others may have a genetic predisposition for a chronic condition and despite their best efforts to manage their condition with lifestyle changes will still need medications to prevent further harm.
Addiction is no different. Many are able to manage their substance use disorder by making significant lifestyle changes and go on to lead healthy and productive lives. For others, when professional intervention and treatment are indicated, it is too often the shame and stigma attached to addiction that prevents those struggling from seeking treatment.
Addressing stigma is a critical step to reducing opioid-related deaths.
Harm reduction is an intervention that keeps people alive until they decide to take steps to treat their opioid use disorder. Clean syringe exchanges, HIV/Hep C testing and treatment, and safe-use protocols are examples of harm-reduction interventions.
The drug Narcan — generic name, Naloxone — is another life-saving intervention available at pharmacies and through the Rural Aids Action Network (RAAN) to anyone in the community. Stigma around the use of Narcan prevails, however. We need to continue efforts to educate professionals and the community regarding the benefits of Narcan and confront and debunk the myths surrounding its use. We hear people questioning the reason for reversing an overdose or who want to limit how many times overdoses should be reversed. Some suggest three reversals — and if there is a fourth, let them die. There are also myths circulating that Narcan promotes opioid and heroin use. These myths are not supported by research and only serve to further perpetuate the stigma surrounding the use of Narcan.
Medication-assisted treatment, or MAT, is evidenced-based and has been proven effective in treating opioid-related use disorder. Simply stated, MAT reduces overdose deaths and increases retention in treatment long enough for patients to develop the skill and support needed for long-term recovery. It is the stigma attached to MAT that prevents many people from accessing this life-saving treatment. We don't shame patients who are prescribed insulin, cholesterol, blood pressure, or tobacco-cessation medications when other treatments and lifestyle changes have not been effective in controlling their conditions. MAT, combined with trauma-informed care and counseling in a treatment setting, can effectively treat patients who have not benefited from non-medical paths to recovery. Recovery-oriented MAT programs, such as the one at ClearPath in Duluth, provide viable paths to recovery by implementing recovery-oriented methadone or Suboxone and other medication services, including medication tapers, as part of the treatment continuum that literally saves lives.
The opioid crisis continues to claim lives across northern Minnesota. These are our relatives and community members. If we are to make progress in addressing the opioid crisis, we must eliminate the stigma that is a barrier to care. Seeing a human being as one who needs care and not labeling that person as "just an addict" is a first step to saving lives.
Marcia Gurno is a social worker for St. Louis County Substance Abuse Prevention and Intervention. Gary Olson and Laura Palombi contributed to this commentary. Olson is CEO of the Center for Alcohol and Drug Treatment in Duluth. Palombi is an assistant professor in the College of Pharmacy at the University of Minnesota Duluth. This commentary also was reviewed, endorsed, and co-signed by Maggie Kazel, a harm-reduction coordinator for the Rural AIDS Action Network in Duluth, and Greg Anderson, a social service supervisor for St. Louis County Public Health and Human Services in Duluth.