Community Stigma and Opioid Use Disorder in Southern West Virginia Open Access

Collins, Karina (Spring 2019)

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This thesis explores the different types of stigma experienced during the opioid epidemic, using the town of Pineville, West Virginia as a case study. An exploration of stigma as a common experience during public health epidemics led to the discovery of two new stigmas that had not been previously observed: stigma against treatment and physicians. These different stigmas emerged out of the unique genesis of this epidemic. Unlike epidemics of the past, the opioid epidemic rose to prominence as physicians over prescribed opioids to patients suffering from post-surgical or chronic pain, as opposed to infection from a pathogen in other epidemics. The treatment of this disease also has multiple recovery options, both having variable outcomes depending on the individual and the context which leads to conflicting ideas regarding treatment implementation within one’s community. Through participant observation and analysis of a community survey, I was able to identify the stigma against treatment within the community of Pineville and the opposition in these viewpoints. An anthropological perspective allowed me discern the differences in beliefs and opinions held by individuals of the community and those of the imposing party (in the case of treating epidemics, this would be public health officials). 

Table of Contents

Table of Contents

Introduction _______________________________________________________________ pg. 1

Background _______________________________________________________________ pg. 5

            Defining the Problem: The Opioid Epidemic _______________________________ pg. 5

                        What are Opioids? ______________________________________________ pg. 6

            The Opioid Epidemic __________________________________________________pg. 7

            The Correlation of HIV to OUD ________________________________________ pg. 10

            The HIV Epidemic in America _________________________________________ pg. 11

Stigma __________________________________________________________________ pg. 15

            What is Stigma? _____________________________________________________pg. 16

            Stigma and the HIV Epidemic __________________________________________pg. 18

            Stigma and the Opioid Epidemic ________________________________________pg. 20

                        Community-Based Stigma_______________________________________ pg. 21

                        Internalized Stigma ____________________________________________ pg. 23

                        Physician Stigma______________________________________________ pg. 25

            Comparisons of Stigma of the HIV and Opioid Epidemics ____________________pg. 26

Research Question _________________________________________________________pg. 28

Case Study: West Virginia and the Community of Pineville ________________________ pg. 29

            Observations _______________________________________________________ pg. 33

            Survey_____________________________________________________________pg. 34

                        Overview ____________________________________________________ pg. 34

                        Respondents __________________________________________________pg. 35

                        Survey Construction ____________________________________________pg. 35

                        Procedures ___________________________________________________ pg. 36

            Pineville __________________________________________________________ pg. 37

Results__________________________________________________________________ pg. 42

            Community Meetings in West Virginia __________________________________ pg. 42

                        Community Meeting—Wyoming County, March 15, 2018 _____________ pg. 42

                        Partners in Hope Consortium—Pineville, August 10, 2018 _____________ pg. 44

            Themes from Survey and Meetings _____________________________________ pg. 47

Stigma Against Medication Assisted Treatment (MAT) _______________ pg. 48

Stigma Against Needle Exchange Programs ________________________ pg. 51

            Anthropology, Public Health, and the Opioid Epidemic _____________________ pg. 54

Analysis of Survey Data ____________________________________________________ pg. 56

            Development of Measures ____________________________________________ pg. 57

            Empirical Patterns __________________________________________________ pg. 58

Discussion ______________________________________________________________ pg. 61

Conclusion ______________________________________________________________ pg. 66

References Cited __________________________________________________________ pg. 69

Appendix ________________________________________________________________ pg. 80

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