Stigma and substance use disorders: a scoping review of patient and health care professionals’ attitudes.

Background: Regardless of the increase of substance use disorders (SUDs), access to treatment remains disproportionately low and stigma is an identified hinderance. Health care professionals (HCPs) have been identified to express stigmatizing attitudes towards persons with SUDs, however, no synthesis has pooled both HCP and SUD patient-focused studies. Objective: We performed a scoping review of qualitative studies describing HCPs’ stigma, attitudes, and perceptions towards patients with SUDs and summarized patients with SUDs’ experienced stigma, attitudes, and perceptions of HCPs. Methods: PubMed, PsycINFO & Embase databases were systematically searched for articles published between March 2014 to March 2024. Qualitative studies evaluating HCPs and SUD-patient stigma, attitudes, or perceptions were included. The study protocol was registered with Open Science Foundation and Covidence software was utilized for review process with data extraction by two reviewers. Coded experts across studies were analyzed for key themes at HCP and patient-level as well as the overlap between groups. Results: Of 321 articles screened, 29 met inclusion criteria, including 16 HCP-focused and 16 patient-focused studies. Included articles represented 7 countries and 406 HCPs and 385 patients across different settings with the most commonly treated/experienced SUD being opioid use disorder. For providers, three main overarching themes were identified: 1) negative perceptions of patients, 2) perceptions of addiction, and 3) attitudes reflecting challenges delivering care. Thematic analysis indicates a contrast between negative stigmatizing views and more compassionate, understanding perspectives, as well as the recognition of the complex needs, and professional challenges involved in treating patients with SUDs. For patients, two main themes were identified: 1) poor healthcare provider-patient relationship and 2) quality of care. Patient-level thematic analysis indicates a lack of trust and comfort with health-care providers combined with negative patient-perceived attitudes and altered care after disclosing substance use history, although there are some experiences of supportive, compassionate, and respectful care. Both HCPs and patients discuss negative attitudes and behaviors that include distrust, labeling, surveillance, judgment, and social distancing, as well as the dichotomy of perceiving addiction as a disease versus a choice and how this perception impacts compassion, communication, and readiness for change. Conclusions: This work is amongst the first to describe both HCP and patient perspectives of providing/experiencing SUD-related care across various settings. Multiple themes and subthemes were identified that can inform current practice and healthcare delivery to improve treatment of SUDs.