PURPOSE: Women with substance use disorders often experience stigma from others, including healthcare workers (HCW), in part due to gendered expectations about substance use. Thus, there is likely a positive association between health service utilization and perceptions of stigma, but this has been understudied. This project explores the relationship between healthcare utilization and substance use-related stigma from HCW among incarcerated women with opioid use disorder (OUD).
METHODS: Women from nine Kentucky jails were randomly selected, screened for OUD, and interviewed while incarcerated (N = 900). Measures included two subscales from the Substance Use Stigma Mechanisms Scale examining enacted and anticipated substance use-related stigma from HCW and self-reported health service utilization 90 days prior to incarceration (PTI). T-tests and linear regression were used to analyze this relationship.
RESULTS: Independent samples T-tests revealed that participants who reported hospital utilization within 90 days PTI (including emergency visits) reported significantly more enacted (t[897]= -3.349, p < 0.001) and anticipated stigma (t[897]= -3.055, p = 0.002) from HCW than participants who did not. Linear regression confirmed these relationships remained significant after controlling for demographic covariates. No significant difference in enacted or anticipated stigma from HCW was observed between 90-day PTI substance use treatment, outpatient, or residential healthcare.
CONCLUSION: Hospital utilization, but not other healthcare utilization (e.g. substance use treatment), was significantly associated with stigma from HCW among incarcerated women with OUD. Receiving healthcare at hospitals may be a particularly stigmatizing experience for women with OUD. Women’s future healthcare-seeking behavior may be negatively impacted by prior enacted stigma experiences and anticipated stigma from HCW.
Healthcare utilization and perceived substance use-related stigma from healthcare workers among incarcerated women with opioid use disorder
Drug and Alcohol Dependence, 277, 112961. doi: 10.1016/j.drugalcdep.2025.112961. PMCID: PMC12668799.