Opioid Addiction Stigma: The Intersection of Race, Social Class, and Gender

Abstract

Objectives: To investigate whether public stigma toward people addicted to opioids varies according to the race, social class, and gender of the person who uses opioids, the social class and gender of the individual evaluating them, and their attributions of the cause of opioid addiction. Methods: An online survey was sent to White undergraduate students at a public university. Participants were randomly assigned to one of eight vignettes depicting an individual addicted to opioids as either Black or White, male or female, and working- or middle-class. The vignettes were followed by measures of reactions to the vignette character including stigma, attributions, and preferred consequences, i.e. criminal prosecution or medical care. ANOVAs and mediation analyses were conducted to assess the direct and indirect effects of race, class, and gender on stigma, criminalization, and medicalization. Results: Participants tended to judge working-class opioid users more harshly than middle-class users, and participants who were middle- to upper-class themselves tended to judge all opioid users more harshly than participants who were working class. Expressed stigma was greater toward White than Black opioid users. Attributing addiction to bad character partially mediated the relationships between opioid user social class and the dependent variables. There were few effects of user or participant gender on attitudes. Conclusions: Efforts to shift public opinion toward supporting funding to address the opioid epidemic should be informed by awareness of biases against working-class users on the part of middle- and upper-class members of the public and the consequences of blaming addiction on opioid users’ character.