Partisan Affiliation and Racial Attitudes in Support for Policies to Address Opioid Use Disorders

Background. Partisan affiliation and racial attitudes influence social stigma regarding drug use, and influence public support for policies to treat such disorders. Prior studies suggest that public perceptions of opioid use disorder (OUD) and the opioid overdose epidemic are less racialized and less polarized along partisan lines than are those associated with prior drug use epidemics, particularly crack cocaine, and that stigmatizing attitudes and public support for criminal sanctions are greater regarding drug use associated with non-white populations.

Methods. Analyzing a cross-sectional, nationally representative sample of 1,088 U.S. adults from the April-May 2020 AmeriSpeak survey, we explored how partisan affiliation and negative attitudes towards Black Americans--as captured by the Color-Blind Racial Attitudes Scale (CoBRAS)--were associated with measures of opioid stigma, and support for expanded government-funded OUD treatment for low-income Americans and naloxone distribution to prevent fatal opioid overdoses. Multiple linear regression analysis was used to control for age, race, geography, and other potential confounders. Seemingly-unrelated regression (SUR) was used to examine correlations in individual responses for different dependent variables.

Results. Respondents who expressed negative attitudes towards Black Americans were markedly less likely to support expanded government provision of OUD treatment (p<0.001), less likely to support naloxone distribution to prevent fatal overdoses (p<0.001), and more likely to express stigma towards opioid use disorder (p<0.001). Democratic Party affiliation was also associated with greater support for expanded government supports for such treatment (p<0.001), greater support for naloxone overdose prevention (p<0.001), and was associated with less-stigmatizing attitudes towards individuals who experience OUD (p=0.002). In particular, respondents who identified as Democrats or as “leaning-Democrat” accounted for 71% of respondents who strongly-agreed with the statement: “I favor increasing government spending to improve treatment of opioid use disorder/addiction.” This group Democrats accounted for only 11% of respondents who disagreed or strongly-disagreed with the same statement. The corresponding proportions among respondents who identified as Republican or “leaning-Republican” were 15% and 71%, respectively. The estimated partisan divide in support for such policies declined by more than one-third with the inclusion of CoBRAS scores. We found similar patterns when we examined support for Medicaid coverage of addiction treatment (p<0.001), and even stronger associations between CoBRAS scores and expressed stigma associated with OUD (p<0.001).

Conclusions and implications. While the opioid epidemic may be less polarized on partisan and racial grounds than were prior drug epidemics, negative attitudes towards Black Americans and partisan differences both remain strongly associated with expanded government support for OUD treatment and naloxone overdose prevention, and with expressed stigma regarding such disorders. Culturally-competent dialogue within politically conservative communities may be important to mobilize support for evidence-based treatment and prevention interventions.