Overdose Measures Matter

Indicator Profile

Describe practices, programs and policies within or supported by your organization to address stigma towards people who use drugs (PWUD)

Category: Stigma Reduction

Audience: Program ImplementerConvenerFunder

Data Type: Qualitative

Indicator Overview

Description:

Description of practices, programs and policies within or supported by your organization to address stigma towards people who use drugs (PWUD).

Rationale:

Stigma can have devastating effects on a person’s health and well-being.1 It can prevent people from seeking the help that they need, accessing care or treatment and building trust with providers.2 Reducing stigma towards PWUD is an important step in improving access to care and supporting effective interventions to reducing overdoses.

Organizations working directly with PWUD can adopt, uphold and advocate for practices, programs and policies to address stigma and help ensure that PWUD feel supported and cared for. Organizations that work indirectly with PWUD through partner organizations, recipients or grantees may support or advocate for practices, programs and policies to address stigma.

Examples include:

  • funding or implementing training and education programs,
  • promoting positive stories of people with lived and living substance use experience and
  • adopting hiring practices that make it easier to hire and retain PWUD

Anti-stigma interventions have been found to decrease feelings of social alienation among PWUD, improve attitudes towards PWUD and increase the level of comfort in working with PWUD.1 By reducing stigma and increasing support for PWUD, organizations and communities can take an important measure in preventing overdoses and reducing its associated harms.

Related Indicators:

To gain a more complete picture of your organization’s approach to working with people with lived and living substance use experience (PWLLE) consider pairing this indicator with the following: Description of how your organization engages PWLLE in planning and key decision making of overdose prevention programs.

Program implementers may also consider tracking this indicator if your organization employs peer workers: Description of efforts to support equitable treatment of peer workers employed by your organization.

Finally, to understand the impact of practices, programs and policies to address stigma towards PWUD throughout your community, program implementers may also consider tracking experiences of stigmatizing treatment in local healthcare and social service settings, as reported by program clients.

Indicator Details

Definitions:

Stigma is a process where people with certain social identities are labeled, stereotyped and devalued, leading to discriminatory behavior and internalized shame3. Stigma can prevent people from seeking treatment and receiving the care and resources that they need.

Examples of practices, programs and policies include:

  • Avoid using stigmatizing language; use “person-first” language
  • Emphasizing societal vs. individual causes of substance use disorders in education programs
  • Promoting positive stories of recovery and those that humanize individuals and their experience
  • Crisis intervention skills training for police
  • Motivational interviewing and compassion training for staff in emergency departments
  • Establishing a substance use disorder (SUD) and stigma education program led by PWLLE
  • Establishing required education for staff about substance use disorders upon being hired
  • Modifying the curriculum to incorporate a structured drug and alcohol education and clinical experience program into medical students’ training
  • Integrating substance use screening into part of general health services provided within a clinic

  • Offering a tax credit to employers who hire PWLLE

Ways to Examine the Data:

Consider grouping practices, programs and policies into broad categories that would be most relevant and useful to you in your work. Some examples may include:

  1. By population the practice, program or policy is focused on. Does it address medical staff, PWUD, organizational leadership, general public, police or another group of people?
  2. By type of practice, program or policy. Does this approach focus on building awareness, education, skill-building, increasing contact with PWLLE or something else?
  3. Are there gaps in populations targeted or in programming? Are there other community groups you can partner with to fill gaps or increase understanding?

Data Sources:

  • Organizational policy handbook
  • Organizational staff, such as those in leadership positions and/or human resources

Data Collection Methods:

  • Document review of organizational practices, programs and policies
  • Surveys with organizational staff
  • Interviews with organizational staff

Application and Considerations

Suggested Use:

Program Implementer

  • To assess how your organization is addressing stigma towards PWUD
  • To identify gaps and opportunities for increased adoption of practices, programs and policies to address stigma in your organization
  • To provide contextual information to understand the effectiveness of programming for PWUD

Community Convener

  • To assess the types of practices, programs and policies supported by your organization
  • To identify gaps and opportunities for increased support of practices, programs and policies to address stigma in the broader community
  • To provide contextual information on the effectiveness of programming for PWUD in your community

Funder

  • To gain insight into organizational practices, programs and policies of grantees and recipients
  • To assess how funds are used to support stigma reduction activities
  • To inform future funding decisions and priorities

Health Access Considerations:

You may want to consider:

  • Which practices, programs and policies are most effective in reducing stigma towards PWUD? How do these align with the practices, program and policies that have been adopted?
  • How is your organization assessing the effectiveness of stigma-reducing approaches?
  • Are PWLLE being included in decisions around which practices, policies and programs are being adopted and how they are implemented?
  • How might other types of stigma impact PWLLE? How might prejudice and discrimination further marginalize certain people? For example, stigma around mental health conditions, sexually transmitted infections and disability. Prejudice and discrimination against people of different backgrounds and nationalities.
  • Are certain populations benefiting from specific practices, programs and policies? Who might not be benefiting? Who might be excluded?

Evaluation Considerations:

Limitations:

  • Does not track adherence to adopted practices, programs and policies
  • Does not track impact of adopted practices, programs and policies
  • Does not consider whether the practices, programs and policies are current and relevant to the needs of PWLLE
  • Does not take into account the combined impact of these practices, programs and policies

Policy Considerations and Resources:

Additional Resources

Examples:

References:

  1. Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction (Abingdon, England), 107(1), 39–50.
    https://doi.org/10.1111/j.1360-0443.2011.03601.x

  2. Centers for Disease Control and Prevention. (2024). Stigma Reduction.
    https://www.cdc.gov/stop-overdose/stigma-reduction/index.html

  3. Judd, H., Yaugher, A.C., O’Shay, S. and Meier, C.L. (2023). Understanding stigma through the lived experiences of people with opioid use disorder. Drug and Alcohol Dependence, (249).
    https://www.sciencedirect.com/science/article/abs/pii/S0376871623011110

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