🤰 Stigma and Judgment

This section focuses on staff training related to stigma, trauma-informed language, and biases towards pregnant individuals in jail who use opioids and who may be on MOUD (also referred to as MAT).

image of stigma and judgment towards mom holding baby
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Key Points

HOW 

  • Assess stigma, judgment, and the language used by staff regarding pregnant patients with OUD. Use the MOMCARE Workshop Discussion Guide: Overcoming Stigma & Objections related to Substance Use in Pregnancy to facilitate a group discussion about stigma.
    • There are additional self and group assessments (see Resources tab) to help you better understand stigma within your facility.
  • Educate staff on the evidence-based treatment of MOUD to treat opioid use and address misconceptions like it is substituting one drug for another. Using a licensed medical professional or expert to deliver this information may be most effective.
  • Engage all staff in open dialogue about their thoughts and feelings regarding using MOUD to treat OUD and about pregnant individuals who use substances.
  • Utilize and practice non-judgmental language for patient interactions. Post corrective language reminders in places where jail staff will see them as a daily refresher.
  • Call out and correct staff who use stigmatizing and judgmental language. Use it as a learning opportunity to educate them and practice patient-centered interactions.
  • Allow staff members to voice their thoughts, feelings, and concerns with other staff about substance use and pregnancy. Having an open-door policy promotes learning, growth, and trust among staff.

WHY 

  • Treatment like MOUD can help people who suffer from opioid addiction live healthy and meaningful lives. However, stigma and misconceptions about MOUD, especially in pregnancy, lead to underutilization.
  • Negative treatment experiences deter pregnant individuals with OUD from asking for and getting help in the future.
  • Addiction stigma leads to ostracizing those who use drugs, which further disconnects them from the support and resources needed for recovery.
  • How you speak to, look at, and talk about pregnant patients with OUD matters.

KEEP IN MIND 

  • Addiction is a disease and should be viewed and treated as such, even in pregnancy. Under no circumstances should a pregnant person’s drug use be construed as disregard or lack of care for herself or her baby.
  • Language matters and can greatly impact how patients view themselves and their worthiness of care.
  • MOUD with methadone and buprenorphine is recommended in pregnancy and has both maternal and fetal health benefits.
  • Consider which custody staff within your facility look after pregnant individuals and those with OUD. They should have an attitude that is conducive to positive interactions and building rapport with this unique population.
  • Staff who exhibit a stigmatizing and judgmental manner should be corrected and educated. If they continue to use non-trauma-informed and patient-centered language, they should be reprimanded and should not have any contact with pregnant individuals who use substances.

Deeper Dive

HOW

Action Items

  1. Assess stigma, judgment, and the language used by staff regarding pregnant patients with OUD. Use the MOMCARE Workshop Discussion Guide: Overcoming Stigma & Objections related to Substance Use in Pregnancy to facilitate a group discussion about stigma. There are additional self and group assessments (see Resources tab) to help you better understand stigma within your facility.
  2. Educate staff on the evidence-based treatment of MOUD to treat opioid use and address misconceptions like it is substituting one drug for another. Using a licensed medical professional or expert to deliver this information may be most effective.
  3. Engage all staff in open dialogue about their thoughts and feelings regarding using MOUD to treat OUD and about pregnant individuals who use substances.
  4. Utilize and practice non-judgmental language for patient interactions. Post corrective language reminders in places where jail staff will see them as a daily refresher.
  5. Call out and correct staff who use stigmatizing and judgmental language. Use it as a learning opportunity to educate them and practice patient-centered interactions.
  6. Allow staff members to voice their thoughts, feelings, and concerns with other staff about substance use and pregnancy. Having an open-door policy promotes learning, growth, and trust among staff.

We recommend that ALL jail staff participate in training related to stigma and judgment regarding addiction and pregnant individuals who use drugs. Ensuring that all staff receive training will help create a jail culture that is compassionate towards this population. Doing so will also foster open dialogues among staff to help each other address stigma through teaching rather than a disciplinary approach if it does occur.

Stigma can be reduced by using person-centered language and recognizing that treatment works. Using words that can reduce stigma like person-first language helps focus on the human being and not his or her condition. Here are some examples of alternative words to use and why to reduce stigma.

Treatment like MOUD can help people who suffer from opioid addiction live healthy and meaningful lives. However, stigma and misconceptions about MOUD, especially in pregnancy, lead to underutilization.

Identifying one’s stigma is vital to actively and intentionally dismantling those beliefs. We suggest that staff complete the short self-assessments on stigma related to pregnant individuals who use drugs to get an understanding of their beliefs. We then encourage staff (administrative, medical, and custody) to facilitate open group discussions about their beliefs while including factual medical and public health information to increase knowledge and shift attitudes.

Stigma will not disappear overnight but it is important to frequently and openly discuss these topics as they arise and hold each other accountable. Regardless of how you may feel, pregnant individuals with OUD deserve evidence-based, respectful care.

WHY 

Stigma related to substance use is discrimination against people who use drugs. It involves the inaccurate labeling of people who use drugs as dangerous and incapable of adhering to treatment. Stigma related to addiction may stem from the belief that drug use is a personal choice. Addiction stigma leads to ostracizing those who use drugs which further disconnects them from the support and resources needed for recovery. Pregnant individuals who use drugs face stigma and judgment and may be labeled as a bad parent or someone who does not care about their baby.

Stigma from jail staff towards pregnant patients who use opioids can have a significant impact on their care experiences as well as their self-esteem and self-worth. Interactions that are not trauma-informed or patient-centered can have lasting effects on pregnant individuals with OUD and be detrimental to their treatment trajectory. Many pregnant individuals who use drugs do not get adequate prenatal care due to fear of judgment from health providers. How you speak to, look at, and talk about pregnant patients with OUD matters. Promoting a non-judgmental care environment for pregnant patients with OUD can help build rapport between the patient and provider and enhance the patient’s treatment experience.

It’s important to remember that negative treatment experiences deter pregnant individuals with OUD from asking for and getting help in the future. It can also lead to self-medicating which exposes the fetus to unsafe fluctuating opioid levels and dramatically increases the risk of overdose death.

“It’s a lot of wasted energy, judging people and labeling them as noncompliant,” he said. “My job isn’t to determine if a patient is deserving of health care. If a patient is sick or has a disease, I have the skills to help, so I’m going to do it.” — Kyle Patton, a family doctor who treats pregnant people who are unhoused and use substances (KFF Health News)

Resources

This issue brief addresses common questions and misconceptions about using medications to treat opioid addiction.

This website describes how you can help reduce the stigma around moms and babies. It describes what stigma is, demonstrates narrative examples of stigma, and provides information on how you can be a change-maker.

This toolkit was created by retired Judge Linda Davis when she recognized the stigma, judgment, mistreatment, and lack of services for people with substance use disorders. It describes why words matter and the impact of stigma. 

Resources with individual and group assessments to address stigma:

  • Mothering and Opioids: Addressing Stigma and Acting Collaboratively (Centre of Excellence for Women’s Health, 2019)
    • Practitioner Behaviors and Values (p.11-12)*
    • Examining use of language (p.13)
    • ACTS Scripts to Address Stigmatizing Behaviors by Coworkers (p.14)**
    • 10 Things Pregnant and Parenting Women who use substances would like practitioners to know (p.16)
    • Women who used opioids during pregnancy: Three scenarios for discussion (p.24)**
    • Bringing Evidence-based and Values-based approaches into our work with pregnant and parenting women who use substances (p.26)**
    • Bringing trauma-informed principles into our work with pregnant and parenting women who use substances (p.28)**
  • Improving Linkages to Comprehensive Care for People at Risk of Overdose: A toolkit for Maryland Providers and Community Members (astho & Maryland Department of Health, 2023)
    • 10 things people who use drugs would like practitioners to know (p.13)
    • SAMHSA’s principles for being trauma-informed (p.15)
    • Assessing Trauma-informed care practices (p.17-18)*
    • Discussion questions for understanding and strategies for challenging stigma
      • Leadership questions (p.22)*
      • Individual staff member questions (p.23)*

*Individual staff assessment tools

**Group activities for staff