“Not human, dead already”: Perceptions and experiences of drug-related stigma among opioid-using young adults from the former Soviet Union living in the U.S.

Abstract

Background Young people from the former Soviet Union (FSU) in the U.S. are engaging in opioid and injection drug use (IDU) in substantial numbers, paralleling nationwide trends. Yet opioid-using FSU immigrants face distinctive acculturation challenges, including perceived stigmatisation as drug users within their immigrant communities, which may exacerbate the negative health and psychosocial consequences of such use. Methods This qualitative study draws on semi-structured interviews with 26 FSU immigrant young adults (ages 18–29) living in New York City who reported opioid use in the past month and/or were currently in treatment for opioid use disorder. Interviews probed youths’ drug use histories, immigration/acculturation experiences, family and peer relationships, and service utilisation. Interviews or focus groups were also conducted with 12 FSU mothers of opioid-using youth and 20 service providers familiar with the FSU population. In a content-based thematic analysis, verbatim transcripts were coded for salient themes. Results All three participant groups emphasized that stigma towards drug users within the FSU community is pervasive and acute, in contrast to the cultural acceptance of heavy drinking, and is rooted in punitive Soviet-era drug policies, fostering widespread ignorance about drugs and addiction. Young adults and service providers reported instances in which anticipation of community stigmatisation deterred youth from accessing drug treatment and harm reduction services. Similarly, stigma contributed to parents’ failure to recognize early signs of their children’s opioid problems and their reluctance to seek drug treatment for their children until opioid use had become severe. Young adults described how drug-use stigma is frequently internalized, leading to shame and loss of self-esteem. Conclusion Findings indicate an urgent need for community-wide education about drugs within FSU immigrant communities, and suggest specific service modalities that may be less stigmatizing for youth, such as peer-delivered syringe exchange and harm reduction education, and technology-based interventions that can be accessed privately and discreetly.

Review of the effects of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals with drug- and alcohol-use disorders

“… 45 More specifically, participants across various studies reported compounded effects on treatment decisions of being both substance users and older, 57 , 67 a member of a racial or ethnic minority, 8 , 50 , 59 , 64 , 68 , 69 HIV-positive, 61 dually diagnosed with depression, 11 or female. 6 , 30 , 37 , 50 , 54 , 56 , 64 , 70 – 74 Females in several studies had a number of additional stigmas, including that of being pregnant, 54 incarcerated, 72 or black. 74 Stigmas were particularly influential on women when their substance use and/or usage of treatment services had implications for child-custody arrangements.…”

Young adults' opioid use trajectories: From nonmedical prescription opioid use to heroin, drug injection, drug treatment and overdose

“…Finally, targeted outreach efforts to engage the new generation of young opioid users (including those who inject, as well as those who have not transitioned to regular in-jection) should be developed to involve them in harm reduction pro-grams, inform them of the HCV/HIV and other risks associated with drug injection, provide OD prevention/response training with na-loxone, and reduce stigma associated with services such as syringe exchange and methadone maintenance which can be high in this group (Frank et al, 2015; Gunn & Guarino, 2016). …”

“…The finding that participants' first overdose tended to occur < 6 months after their first episode of drug treatment suggests that treat-ment programs have a critical role to play in expanding access to overdose prevention/reversal education and naloxone (especially since the period immediately after leaving drug treatment is a well-known time of heightened risk for overdose). Finally, targeted outreach efforts to engage the new generation of young opioid users (including those who inject, as well as those who have not transitioned to regular in-jection) should be developed to involve them in harm reduction pro-grams, inform them of the HCV/HIV and other risks associated with drug injection, provide OD prevention/response training with na-loxone, and reduce stigma associated with services such as syringe exchange and methadone maintenance which can be high in this group (Frank et al, 2015; Gunn & Guarino, 2016).…”

Exclusão social vivenciada por pessoas dependentes de drogas e seus familiares: revisão integrativa da literature

“…Quanto às pessoas dependentes de drogas, verificou-se que muitos demonstram medo de expor fatos sobre a própria condição devido ao estigma, desconfiança e à hipervigilância, como por exemplo, nas tentativas de suicídio. Já os familiares omitem a dependência para que não sejam rejeitados, alvo de inferiorização ou responsabilizados pela dependência de seus ente querido (11,(15)(16) .…”

“…Tais questões culminam no estado pleno das desigualdades, denominado exclusão social. Caracterizado pelo processo acumulativo e multidimensional que separa e inferioriza as pessoas, os grupos, as comunidades e os territórios (4,12,15) . A exclusão social coexiste em vários tipos de fenômenos sociais, tais como o desemprego, a marginalidade, o preconceito e o pauperismo (17)(18) .…”