The Epidemic as Stigma: The Bioethics of Opioids

Buchman, Daniel Z.; Leece, Pamela; Orkin, Aaron

doi:10.1177/1073110517750600

Cited by 43 publications

(48 citation statements)

References 95 publications

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“…We identified five core overdose response tasks: (1) overdose identification; (2) mobilizing support; (3) following basic first aid instructions; (4) naloxone administration; and (5) postresuscitation management. The data presented counter such perceptions by demonstrating how they can be skillful, knowledgeable and caring, as well as willing and able to save lives (see also [46,58,62]). skills and knowledge in administering first aid and naloxone) and social competency (e.g.…”

Section: Discussionmentioning

confidence: 87%

“…People who use opioids are routinely stigmatized and associated with incapacity and the harms they cause [55,[65][66][67][68]. The data presented counter such perceptions by demonstrating how they can be skillful, knowledgeable and caring, as well as willing and able to save lives (see also [46,58,62]).…”

Section: Discussionmentioning

confidence: 95%

“…Structural competency recognizes that medical problems and their treatment (in this case opioid overdose and its response) cannot be divorced from a priori social, political and economic forces that contribute to ill health and poor health choices. Stigma, criminalization, homelessness and lack of education are all implicated in drug problems [55][56][57][58], but also impede an individual's ability to respond effectively to drug overdose [58,59]. Participants routinely overcame these hurdles to be 'good citizens', 'take charge', provide advice, behave in a caring way and ultimately save lives (see also [46]).…”

Section: Discussionmentioning

confidence: 99%

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How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

et al. 2018

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Background and Aims Providing take-home naloxone (THN) to people who use opioids is an increasingly common strategy for reversing opioid overdose. However, implementation is hindered by doubts regarding the ability of people who use opioids to administer naloxone and respond appropriately to overdoses. We aimed to increase understanding of the competencies required and demonstrated by opioid users who had recently participated in a THN programme and were subsequently confronted with an overdose emergency. Design Qualitative study designed to supplement findings from a randomized controlled trial of overdose education and naloxone distribution. Interviews were audio-recorded, transcribed, systematically coded and analysed via Iterative Categorization. Setting New York City, USA. Participants Thirty-nine people who used opioids (32 men, 7 women; aged 22-58 years). Intervention Trial participants received brief or extended overdose training and injectable or nasal naloxone. Measurements The systematic coding frame comprised deductive codes based on the topic guide and more inductive codes emerging from the data. Findings In 38 of 39 cases the victim was successfully resuscitated; the outcome of one overdose intervention was unknown. Analyses revealed five core overdose response 'tasks': (1) overdose identification; (2) mobilizing support; (3) following basic first aid instructions; (4) naloxone administration; and (5) post-resuscitation management. These tasks comprised actions and decisions that were themselves affected by diverse cognitive, emotional, experiential, interpersonal and social factors over which lay responders often had little control. Despite this, participants demonstrated high levels of competency. They had acquired new skills and knowledge through training and brought critical 'insider' understanding to overdose events and the resuscitation actions which they applied. Conclusions People who use opioids can be trained to respond appropriately to opioid overdoses and thus to save their peers' lives. Overdose response requires both practical competency (e.g. skills and knowledge in administering basic first aid and naloxone) and social competency (e.g. willingness to help others, having the confidence to be authoritative and make decisions, communicating effectively and demonstrating compassion and care to victims post-resuscitation).

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

et al. 2018

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“…While the dynamic Faulkner‐Gurstein () identifies could be said to reposition people who consume opioids with positive social identities, and potentially alleviate stigma (see also Buchman et al . ), take‐home naloxone programs are also open to criticism as responsibilising the marginalised for combatting harms exacerbated, if not produced, by structural inequality and prohibitionist drug policies (Buchman et al . , Farrugia et al .…”

Section: Literature Reviewmentioning

confidence: 99%

Take‐home naloxone and the politics of care

Farrugia

Fraser

Dwyer

et al. 2019

Sociology Health & Illness

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Take-home naloxone' refers to a life-saving intervention in which a drug (naloxone) is made available to nonmedically trained people for administration to other people experiencing an opioid overdose. In Australia, it has not been taken up as widely as would be expected, given its life-saving potential. We consider the actions of take-home naloxone, focusing on how care relations shape its uses and effects. Mobilising Science and Technology Studies insights, we suggest that the uses and effects of naloxone are co-produced within social relations and, therefore, this initiative 'affords' multiple outcomes. We argue that these affordances are shaped by a politics of care, and that these politics relate to uptake. We analyse two complementary case studies, drawn from an interview-based project, in which opioid consumers discussed take-home naloxone and its uses. Our analysis maps the ways take-home naloxone can afford (i) a regime of care within an intimate partnership (allowing a terminally ill man to more safely consume opioids) and (ii) a political process of care (in which a consumer takes care of others treated with the medication by administering it 'gently'). We conclude by exploring the political affordances of a politics of care approach for the uptake of take-home naloxone.

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“…Dr Sarah Wakeman, Medical Director for the Massachusetts General Hospital Substance Use Disorder Initiative and Assistant Professor of Medicine at Harvard Medical School, has gone so far as arguing that stigma—particularly in the medical community and criminal justice system—is currently the biggest barrier to fighting this epidemic (see Wakeman, 2016; Wakeman and Rich, 2015). Many others have echoed Wakeman’s sentiment (Buchman et al, 2017; Kennedy-Hendricks et al, 2017; Kruis and Choi, 2020; McGinty et al, 2019). However, while stigma has been a heavy talking point during the opioid crisis, to date, not much has been done to assess empirically the stigma of substance use disorders (Kruis and Choi, 2020).…”

Section: Introductionmentioning

confidence: 99%

Police officers, stigma, and the opioid epidemic

Kruis

Choi

Donohue

2020

International Journal of Police Science & Management

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Researchers have suggested that provider-based stigma of substance use disorders is one barrier to fighting the opioid epidemic. Yet, to date, virtually no study has examined provider-based stigma among law enforcement officers who are on the front line of the opioid crisis. This study attempts to fill this gap in the literature by assessing provider-based stigma toward opioid-using persons among a sample of 208 police officers working for departments located in the Northeastern Region of the United States. Results show that officers hold relatively high levels of stigma toward this vulnerable population, as measured by perceptions of dangerousness, blame, and social distance; however, comparatively, officers hold less fatalistic views toward this group of persons. Additionally, our multivariable analyses indicated that officer rank, support for the disease model of addiction, and beliefs about the demographic characteristics of a substance-using person are significantly associated with provider-based stigma among officers. Potential policy implications are discussed within.

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The Epidemic as Stigma: The Bioethics of Opioids

Cited by 43 publications

References 95 publications

How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

Take‐home naloxone and the politics of care

Police officers, stigma, and the opioid epidemic

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