Shared Stigma: The Effect of LGBT Status on Attitudes About the Opioid Epidemic

• Published date: 01 September 2021
• Author: Simon F. Haeder,Steven Sylvester,Timothy Callaghan
• Date: 01 September 2021
• DOI: http://doi.org/10.1002/wmh3.391

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doi: 10.1002/wmh3.391

© 2021 Policy Studies Organization

Shared Stigma: The Effect of LGBT Status on Attitudes

About the Opioid Epidemic

Simon F. Haeder , Steven Sylvester, and Timothy Callaghan

Over the past decade, the United States has been ravaged by an unprecedented public health crisis. In

2017 alone, the Centers for Disease Control and Prevention identified more than 70,000 individuals

who died from an overdose. The dominant culprit in these deaths are opioids, which accounted for two‐

thirds of cases. Scholars have worked diligently to provide a better understanding of the root causes,

extent, implications, and possible solutions to the opioid epidemic. A group that is disproportionately

affected by illicit drug use, substance abuse disorder, and mental health issues has received little

attention in this growing body of research: people who identify as lesbian, gay, bisexual, or trans-

gender (LGBT). We conducted a large national survey to study this issue in depth. Specifically, our

analysis uses a national survey weighted to population benchmarks with an oversample of LGBT

respondents to better understand attitudes about the opioid epidemic and whom the public blames for

the crisis. Our analysis finds consistent evidence that LGBT individuals are less likely to blame

individuals with addictions for the opioid epidemic. Simultaneously, we find that conservatism, high

levels of religiosity, addiction status, and high levels of racial resentment all increase the likelihood

that individuals blame addicts themselves.

KEY WORDS: opioid pandemic, LGBT, attribution, stigma

Introduction

The opioid epidemic in the United States has surged in recent years, with

roughly three million Americans experiencing its effects (Schuckit, 2016). From

1999 to 2017, the epidemic claimed more than 700,000 deaths and wreaked havoc in

communities across America (Center for Disease Control and Prevention, 2019).In

2017 alone, the Centers for Disease Control and Prevention noted that roughly

70,000 individuals died from drug overdoses, with opioids accounting for roughly

two‐thirds of those deaths (Center for Disease Control and Prevention, 2019). While

the epidemic has changed over time, morphing from prescription drugs to heroin

and now into synthetic opioids, the death toll remains staggering. Secondary and

tertiary implications will continue to pose tremendous challenges to all levels of

government for the foreseeable future. Not surprisingly, both federal and state

governments are increasingly seeking policy solutions to combat the epidemic.

Most notably, President Trump has declared the opioid epidemic a public health

emergency and, in 2018, put forth an initiative to stop opioid abuse and reduce the

supply and demand of illicit drugs (White House, 2018).

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Who is to blame for the epidemic? Some narratives have focused on the

individuals coping with opioid addiction by arguing that, in the vein of Nancy

Reagan, “they could have just said no to drugs.”President Trump has openly

contributed to this narrative, stating that “If they don't start, they won't have a

problem”(White House, 2017). This line of reasoning has been carried to local

communities by some street‐level bureaucrats like the tough law‐and‐order

sheriff in Butler County, OH, who refused to let his deputies carry Narcan to

reverse overdoses (Wootson, 2017).

Yet, there are alternative narratives. The stories presented in the Netflix

documentary Heroin(e), which features the struggles of Huntington, WV, show

“typical”Americans and how circumstances outside their control, including rural

hopelessness and economic depression, have led, or at the very least contributed to,

their addiction. More recently, public discussion has centered on the role that

pharmaceutical companies have played in the opioid epidemic (Lopez, 2017).

Media reports have highlighted stories about how several companies have eagerly

sought to expand the use of prescription opioids, raking in massive profits along

the way. The maker of oxycontin, Purdue Pharma, has featured most prominently

in this discussion (Taddonio, 2019). This narrative has been amplified by dozens of

state attorneys‐general seeking restitution from opioid manufacturers and their

owners for the damage the crisis has done to their states (Lopez, 2019). Another

reporting has focused on individual medical providers operating the so‐called “pill

mills,”some of which prescribed in excess 500,000 doses of opioids (Hassan, 2019)

or received kickbacks from manufacturers (Lawrence & Feeley, 2018). Yet other

narratives have focused on the role of pharmaceutical wholesalers and pharmacies

in the epidemic (Eyre, 2016; Hakim, Rashbaum, & Rabin, 2019; McGreal, 2019).

To understand the unique role played by the attribution of blame in policy

attitudes about the opioid epidemic, our study utilizes attribution theory as an

explanatory framework. The attributional analysis involves an individual's ex-

amination of an outcome (in this case, the opioid epidemic)and seeks to determine

the underlying cause of that outcome. Policy analysts often refer to this as an

underlying causal model (Weimer & Vining, 2017)or belief system (Jenkins‐Smith

& Sabatier, 1994). Specifically, individuals try to determine whether the outcome of

interest is caused by some internal disposition or instead emerges because of sit-

uational forces (Heider, 1944, 1958). Following prior research on attribution theory,

we posit that this attribution depends on the causal stories that individuals develop

or internalize to explain the events, behaviors, and conditions in the world around

them, and that the narrative they select has important policy consequences

(Stone, 2012). In the case of the opioid epidemic, we anticipate that individuals will

attribute addiction to opioids to either personal choices (i.e., factors controllable by

the addict)or situational factors like the behavior of drug companies or doctors

overprescribing medication (i.e., factors outside the control of the addict).

Yet beliefs about attribution may be affected by a variety of factors, including a

personal connection to someone coping with addiction by highlighting the personal

struggle of addiction firsthand. Similarly, one's ability to empathize with in-

dividuals experiencing addiction may be increased if one is part of a group that is

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