The relationship between felt stigma and non-fatal overdose among rural people who use drugs

Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, espe...

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Bibliographic Details
Published in:	Harm reduction journal 2024-04, Vol.21 (1), p.77-77
Main Authors:	Sibley, Adams L, Klein, Emma, Cooper, Hannah L F, Livingston, 3rd, Melvin D, Baker, Robin, Walters, Suzan M, Gicquelais, Rachel E, Ruderman, Stephanie A, Friedmann, Peter D, Jenkins, Wiley D, Go, Vivian F, Miller, William C, Westergaard, Ryan P, Crane, Heidi M
Format:	Article
Language:	eng
Subjects:	Americans with Disabilities Act 1990-US Analgesics, Opioid Analysis Care and treatment Consortia Demographics Drug addicts Drug overdose Drug Overdose - epidemiology Drug use Drugs Eigenvalues Employment Endorsements Fear Harm Reduction Health aspects Heroin Humans Imprisonment Mental disorders Narcotics Opioid-Related Disorders - epidemiology Opioids Overdose Peers People who use drugs Prescription drugs Reduction Rural areas Rural health Self report Self-stigma Sensitivity analysis Social Stigma Stigma Stigma (Social psychology) Substance abuse Substance use Urban areas
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Summary:	Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs. Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose. 6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20-1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20-1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07-2.14). Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.
ISSN:	1477-7517 1477-7517