Clinician Stigma Toward People With Substance Use Disorder is Common and Associated With Clinical Practices

Clinician stigma (i.e., negative attitudes and behaviors) is a barrier to addressing substance use disorder (SUD). In a US national survey of primary care physicians (PCPs), emergency medical physicians (EMPs), and dentists, researchers assessed stigma toward patients with three categories of SUD—opioid, stimulant, and alcohol—and their association with clinical practices.

• The response rate was 54 percent with 503 PCPs, 352 EMPs, and 385 dentists completing the survey.
• Stigma scores were highest for stimulant use disorder, followed by opioid use disorder, then alcohol use disorder. Stigma scores for SUD were significantly higher than for other stigmatized conditions including depression, diabetes, and HIV; over 30 percent of clinicians reported preferring not to work with patients with opioid or stimulant use disorders.
• EMPs had the highest stigma scores, followed by PCPs, then dentists.
• The following clinical practices were associated with lower stigma scores: provision of SUD referrals, provision of medications for opioid use disorder, and having access to SUD consultation services.

Comments: Negative attitudes toward people with SUD are highly prevalent among clinicians and associated with clinical practices. This association is probably bidirectional: stigma leads to negative attitudes toward effective treatments, and having little experience with—or exposure to—effective treatments reinforces this stigma.

Darius A. Rastegar, MD

Reference: Parish CL, Feaster DJ, Pollack HA, et al. Healthcare provider stigma toward patients with substance use disorders. Addiction. 2025;120(10):2005–2019.