Stigma and Support for Public Policy Responses to the US Overdose Crisis

Background and Purpose: Innovative strategies are needed to combat the rising drug overdose crisis. However, policy responses are constrained by stigma toward drug use and public acceptance of harm reduction. Though the past decade has seen increased efforts to expand treatment services, harm reduction interventions are not widely implemented. Understanding public sentiment regarding harm reduction is important given the impact of public opinion on public policy. This study identifies factors associated with support for various policy responses to the overdose crisis.

Methods: Adults in Michigan (N=823) were recruited from a Qualtrics market research panel (June – July 2022). Participants self-administered a web-based survey, reporting their socio-demographics (age, gender identity, race/ethnicity, education, community type), political leaning, history of and connection to heroin use, and attitudes toward people who use opioids (Link et al., 1999). Surveys assessed support for four policy responses to the overdose crisis: (1) increasing funding for treatment, (2) passing Good Samaritan laws, (3) legalizing safe consumption sites, and (4) limiting the number of times a person can receive naloxone for an overdose. Logistic regression models predicting support for each policy were calculated in Mplus.

Results: Overall, 62.4% expressed support for increased funding for substance use treatment, 56.0% for Good Samaritan laws, and 33.5% for safe consumption sites; 31.0% expressed support for limiting how many times a person who overdoses can be saved. In the multivariate models, stigma toward people who use opioids and political leaning were consistently associated with support for various policies. Greater stigma was associated with lower odds of supporting funding for treatment [OR=0.983, 95% CI (0.970, 0.997)], Good Samaritan laws [OR=0.969, 95% CI (0.954, 0.981)], and safe consumption sites [OR=0.966, 95% CI (0.952, 0.980)]; and greater odds of supporting naloxone limits [OR=1.030, 95% CI (1.015, 1.045)]. Conservative ideology was similarly associated with lower odds of supporting funding for treatment [OR=0.841, 95% CI (0.759, 0.932)], Good Samaritan laws [OR=0.806, 95% CI (0.730, 0.890)], and safe consumption sites [OR=0.823, 95% CI (0.742, 0.912)]; and greater odds of supporting naloxone limits [OR=1.321, 95% CI (1.186, 1.473)]. Knowing someone who had used heroin was associated with greater odds of supporting funding for treatment [OR=1.675, 95% CI (1.185, 2.367)], but not harm reduction. A personal history of heroin use was associated with greater odds of supporting naloxone limits [OR=2.128, 95% CI (1.188, 3.810)].

Conclusion and Implications: Although many adults supported funding for substance use treatment, fewer expressed support for harm reduction. Findings point to strategies to build support for evidence-based public health policy. Interventions to reduce stigma toward people who use opioids (e.g., education about addiction) may increase support for treatment and harm reduction. To build bipartisan support, advocacy initiatives may attempt to appeal to conservative values, for example by emphasizing the cost-efficiency of services. The positive association between personal history and support for naloxone limits, and the lack of association between personal connection and support for harm reduction, suggest a need for further research on attitudes toward harm reduction among people in recovery and their friends and family members.