Tweeting Stigma: An Exploration of Twitter Discourse Regarding Medications Used for Both Opioid Use Disorder and Chronic Pain

• Author: Cara L. Sedney,Patricia Dekeseredy,Henry H. Brownstein,Treah Haggerty,Bayan Razzaq
• Date: 01 April 2021
• Published date: 01 April 2021
• DOI: 10.1177/0022042620986508
• Subject Matter: Articles

https://doi.org/10.1177/0022042620986508

Journal of Drug Issues

2021, Vol. 51(2) 336 –353

© The Author(s) 2021

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DOI: 10.1177/0022042620986508

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Article

Tweeting Stigma: An Exploration

of Twitter Discourse Regarding

Medications Used for Both Opioid

Use Disorder and Chronic Pain

Patricia Dekeseredy1,2 , Cara L. Sedney2, Bayan Razzaq3,

Treah Haggerty2, and Henry H. Brownstein2

Abstract

We examined the content of tweets on the social media site Twitter to better understand

the contemporary discourse about medications for opioid use disorder (MOUD), how this

chat contributes to the pervasive underpinnings of drug addiction, chronic pain stigma, and

the impact it has on demand and availability of treatment. A retrospective review of tweets

over 3 months containing keywords buprenorphine, naltrexone, methadone, or bupe was

conducted resulting in 5,068 tweets. A content analysis was carried out focusing on a subset of

tweets. Themes emerged from including suspicion and conspiracy theories about MOUD, and

frustration and lack of control over their treatment options. Other tweets shared stigmatizing

language and attitudes related to OUD/MOUD (e.g., “Junkies”). Twitter is a rich source of

data reflecting thoughts, opinions, and sentiments entities regarding MOUD. However, this

information can contain malicious comments that perpetuate stigma for people with OUD and

result in avoidance of treatment.

Keywords

social media, Twitter, drug abuse, stigma, opioid, MOUD, medication-assisted treatment, MAT

Background

The Centers for Disease Control and Prevention (CDC, 2017) defines opioid use disorder

(OUD) as “a problematic pattern of opioid use that causes significant impairment or distress.”

OUD can include the misuse or abuse of a wide range of medications from illicit street drugs

such as heroin, to prescription medications such as codeine and oxycodone. Chronic pain is

often an inciting diagnosis and a common diagnosis for those with OUD (Hser et al., 2017).

Medications, such as buprenorphine, naltrexone, or methadone, can be used for an effective,

evidence-based treatment of OUD. However, the use of medications for opioid use disorder

(MOUD) is vastly underutilized and often misunderstood (Jones et al., 2015). Despite the

1WVU Medicine, Morgantown, WV, USA

2West Virginia University, Morgantown, USA

3West Virginia University School of Medicine, Morgantown, USA

Corresponding Author:

Patricia Dekeseredy, Department of Neurosurgery, West Virginia University, 1 Medical Center Drive, PO Box 9183,

Morgantown, WV 26506, USA.

Email: patricia.dekeseredy@hsc.wvu.edu

986508JODXXX10.1177/0022042620986508Journal of Drug IssuesDekeseredy et al.

research-article2021

Dekeseredy et al. 337

proven health benefits of treating OUD (Connery, 2015), challenges remain to widespread

implementation of MOUD programs including a pervasive stigma about drug addiction, misper-

ceptions regarding the effectiveness of MOUD, plus a dearth of qualified, willing providers

(Vestal, 2016). Subsequently, there remains a large gap between treatment demand, capacity,

and utilization. According to the Substance Abuse and Mental Health Services Administration

(SAMHSA), in the United States, approximately 19.9 million people were in need of substance

use disorder (SUD) treatment, but only 2.1 million people were able to access treatment at a

specialized facility (Park-Lee et al., 2017). This gap is especially prominent in areas with the

most need, such as rural locations (E. B. Jones, 2018). Rural areas often have barriers to care

with a high prevalence of sole provider clinics who can find the treatment of addiction to be

time consuming and “uncomfortable” (Vestal, 2016).

Even when MOUD is available, it is well documented that stigma can be a barrier to seeking

treatment for many patients (Adams & Volkow, 2020; Hadland et al., 2018; Wakeman & Rich,

2018; Woo et al., 2017). Stigma has been defined as an “attribute that is deeply discrediting” and

thereby can diminish a person so that they are not viewed as a whole person but rather as being

tainted or discounted (Goffman, 1963). The stigma that people with OUD experience can be

multifaceted, and is experienced in the medical community as well as in society as a whole (Woo

et al., 2017) and may include anticipated stigma (expectations of stigma in the future), enacted

stigma (overt behaviors toward the stigmatized individual), and internalized stigma (awareness

and application of stigma to oneself) (Smith et al., 2016). This stigma toward patients diagnosed

with OUD creates a barrier to treatment and can also affect a person’s ability to seek help (Adams

& Volkow, 2020). Intervention stigma can also be experienced by providers of MOUD. Providers

of MOUD can experience prejudice and discrimination from other health care providers who

disagree with the use of MOUD (Madden, 2019). Stigma experienced by those who provide

MOUD and work in the addiction field may decrease patient care and limit access to effective,

safe treatment for OUD. Stigma relating to the medications specifically used in MOUD may have

implications for their use for other complaints, such as chronic pain (Mooney et al., 2020), which

is relevant in considering how social media discourse can affect these related groups of patients.

Stigmatizing ideas and opinions toward people, interventions, or illness has long been shared and

perpetuated through social media (Van Dijck, 2013).

Social media are changing the way people seek information, and interact with each other

and health care providers, with almost 9 out of 10 adults using at least one online social media

site (Bishop, 2019). Twitter is one of the largest social networking sites in the world. Through

Twitter, with 280 characters or less, users compose “tweets” reflecting their interests, con-

cerns, or to relay information in real time to more than 330 million monthly active users

(Twitter, n.d.). Twitter users can reach an enormous audience through retweeting (sharing) a

tweet or by adding hashtags, making their tweet searchable to other users who may share simi-

lar interests. Increasingly, social media sites, such as Twitter, are a preferred source of informa-

tion and understanding about health issues (Bian et al., 2017; Edo-Osagie et al., 2020; Zhang

et al., 2019). However, users need to be cautious using Twitter for health and social issues

because there is limited oversight to ensure the quality or validity of information posted by

users. Also, Twitter has been criticized for being an environment for false information

(Radzikowski et al., 2016; Starbird et al., 2014), and false information on social media sites

has been found to spread faster than truth (Vosoughi et al., 2018). Only recently has Twitter

taken steps to address the posting of false and damaging information by introducing new labels

and warnings to provide users with clarification or additional information on the questionable

Tweet (Roth & Pickles, 2020).

The purpose of this exploratory study is to identify the type of user (individual or group) who

is sharing information on Twitter regarding MOUD, understand the type of information shared,

explore any stigmatizing or supportive attitudes related toward MOUD, and how this may affect