Social Stigma Is One Reason The Opioid Crisis Is Hard To Confront

Oct 31, 2018
Originally published on October 31, 2018 10:43 am

There are many reasons why the opioid crisis is so hard to confront. One of them is social stigma. It often extends beyond users themselves, to their families.

Hope and Pete Troxell live in Frederick, Maryland. Last year, their 34-year-old daughter Alicia died after overdosing on fentanyl – a synthetic form of heroin. She was seven months pregnant. Hope says before Alicia's death, they often felt the weight of judgment.

"So many people look at these [people] that are addicted to drugs, they call them every name in the book. They're junkies, they're thieves."

Pete Troxell says even some relatives have stayed away.

"Nobody from my immediate family has called us, stopped in [to] say 'How are you doing? Can I help you?'" he says. "Not one phone call, not one visit from my immediate family."

Researchers say one reason there is so much stigma around drug use is that many people view addiction as a moral weakness. Leo Beletsky, a public health researcher from Northeastern University, says stigma enters the political discourse "around personal responsibility versus coddling and enabling."

He says the argument over whether drug users should simply "just say no" distracts us from what needs to be the top priority: saving lives.

"Look, if you want the person to take personal responsibility, you have to give them the tools to do that. And unless you revive the person who is dying, they are not going to take personal responsibility for anything."

But the political discourse is just part of it. The language of addiction is also implicitly pejorative. Urine tests—and users--for example, are called clean or dirty depending on whether they test negative or positive for drugs.

After Alicia died, the Troxells put up a small memorial to their daughter in the backyard. Hope Troxell says few people have come by to visit.

"People just stay away. And I often think, well, do they think I have some kind of a disease? That's what it feels like."

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RACHEL MARTIN, HOST:

Earlier this year, the Centers for Disease Control and Prevention released a stunning statistic - 72,000 people, it estimates, died of drug overdoses in 2017. The huge increase in deaths is largely due to heroin and powerful synthetic opioids like fentanyl. There are many reasons why the opioid crisis is so hard to confront. One of them is social stigma, and that stigma often extends beyond users themselves to their families. NPR's Shankar Vedantam reports.

SHANKAR VEDANTAM, BYLINE: The word stigma has its origins in slavery. It comes from ancient Greek and Latin and refer to a brand that was seared into the skin of slaves. But over time, stigma took on a different meaning. Now it suggests an ugly mark you cannot see, a kind of invisible brand. Society often places it on whole groups of people like the mentally ill, the homeless and drug users.

CARIN MILLER: A lot of people say they're just junkies.

VEDANTAM: This is Carin Miller. She's an advocate for families coping with heroin addiction and other opioid abuse in Maryland. Miller says for many years she herself had a harsh view of people addicted to drugs.

MILLER: I would be like, oh my God, I can't believe that such and such's daughter is on heroin.

VEDANTAM: But then one day, it was her own son, Lucas. He had gotten hooked on pain pills in his early 20s and then started shooting heroin.

MILLER: My son never thought that it would go as far as it did.

VEDANTAM: Miller watched as her youngest child came close to dying.

MILLER: There was times when he was so gray and frail I didn't know if he was going to make it to the next day. And all I wanted was my son back. He was so sick. But I'm a fighting mama and I was going to do anything to save my son.

VEDANTAM: One of her biggest opponents in that fight was stigma. Miller says many people no longer saw her son as someone worth saving.

MILLER: I actually got into a fight with a security guard at the hospital. I said, if we don't get my son some help, he's going to leave here and he's going to go use drugs and he could die. And the security guard looked to me right in my face and said, oh well.

VEDANTAM: It wasn't just strangers who wrote off her son.

MILLER: I actually have a neighbor who still doesn't talk to me because of that. And we were friends. She said, your son's an addict. And if my son had cancer, she had been bringing me cookies and, you know, sending prayers.

VEDANTAM: A son with cancer is worthy of sympathy. A son with a heroin addiction has a character flaw. Why do many of us think of these two cases differently? Researchers say one reason is that many people view drug addiction as a moral weakness.

LEO BELETSKY: And in many ways, this maps onto some of the political discourse around personal responsibility versus coddling and enabling.

VEDANTAM: Leo Beletsky is a professor of law and health sciences at Northeastern University. He says the argument over whether drug users should simply just say no, this argument - partly philosophical, partly political - distracts us from what needs to be the top priority - saving lives.

BELETSKY: Look; if you want the person to take personal responsibility, you have to give them the tools to do that. And unless you've revived a person who is dying, they're not going to take personal responsibility for anything.

VEDANTAM: The problem is not just the political conversation. Public health experts say stigma seeps into the whole framework of how we think about drug addiction. Even the language we use is often implicitly pejorative. Urine tests and users are called clean or dirty depending on whether they test negative or positive for drugs. And the stigma around drug use is often compounded by stigma around race. When it comes to heroin, the idea that some lives are worth saving and some are not is not new. For a long time, the face of heroin addiction was poor and black. Many advocates say little was done to help until opioids started to make inroads into white communities. But black or white, stigma and judgment in different communities obscure what the science says - that drug addiction is a chronic illness.

HOPE TROXELL: Many people don't understand that it alters - that they think you can say, OK, I can just stop. And you cannot just stop. It is a life-long struggle.

VEDANTAM: Hope Troxell and her husband Pete live in the western Maryland city of Frederick. Last year, their 34-year-old year old daughter Alicia died after overdosing on fentanyl, a synthetic form of heroin. She was seven months pregnant. Hope says, before her daughter died, the family often felt the weight of judgment.

H. TROXELL: So many people look at these that are addicted to drugs. They call them every name in the book. They're junkies. They're thieves.

VEDANTAM: Pete Troxell said that after his daughter died, even relatives turned away.

PETE TROXELL: I had - nobody from my immediate family has called us, stopped in, say, hey, how are you doing? I know you were going through some rough times. Can I help you? Can - not one phone call, not one visit from my immediate family. So...

VEDANTAM: It's almost like the world is telling him, your daughter didn't matter.

P. TROXELL: She's just not another number. Well, she's just another addict dead. No. She's somebody to us. Maybe not to nobody else, but to us, she was everything.

VEDANTAM: The Troxells step into their backyard to show me the memorial they have built for their daughter. Hope Troxell says few have come by to visit it, just as they didn't come by when Alicia was in the throes of addiction.

H. TROXELL: People just stay away. And I often think, well, do they think I have some kind of disease? That's what it feels like.

VEDANTAM: Stigma, she says, feeds on itself.

H. TROXELL: Of course, then we pull away because you know your daughter's doing something wrong. She shouldn't be doing it, so you have that problem there, too.

VEDANTAM: But after Alicia died, she says something changed.

H. TROXELL: Especially after she passed, I said, no, I'm not holding back anymore because maybe we could save somebody else.

VEDANTAM: They attend meetings in the community. They reach out to other families who are affected by the opioid crisis. The Troxells have come to learn that fighting stigma, it's on all of us. Shankar Vedantam, NPR News.

(SOUNDBITE OF OSKAR SCHUSTER'S "MARIBEL")

MARTIN: Shankar is the host of the Hidden Brain podcast. You can hear more reporting on the opioid epidemic on the latest episode. Transcript provided by NPR, Copyright NPR.