How many more of these articles must we read about combating and ending stigma?

I recently read SAMHSA’s blog post, “Combatting Stigma with Knowledge”, which rightly highlights how stigma keeps countless individuals from seeking the help they need for substance use disorders. While education is vital, I believe there’s more to the story—particularly around how our current treatment approaches and policies may unintentionally reinforce the very stigma we’re trying to dismantle.

In this blog post, I want to share my perspective on why stigma persists, how it’s tied to treatment models, and what we can do to create a truly stigma-free path to recovery.

The enduring stigma against people impacted by drugs and alcohol is entirely man-made and benefits only one group—special interest groups with a vested interest in maintaining the status quo. Sadly, stigma is immensely profitable.

This stigma persists because of what we have done—or failed to do.

Let’s start with opioid use disorder. The preferred treatment, often called the "gold standard," is methadone or buprenorphine, prescribed without a clear endpoint. Both medications have clinical benefits, but their inherent pharmacology—and the regulations surrounding them—only reinforce stigma. Methadone and buprenorphine are opioids, with abuse potential and street value. Their chronic use, even in treatment, becomes inherently stigmatizing. There’s no way around it.

Opioids have been used for decades in hospitals to manage acute pain with little stigma or abuse. But outside of that context, stigma explodes. Healthcare professionals are now encouraged to avoid opioids for chronic pain—and studies are emerging showing that OTC pain relievers often outperform opioids! Yet, for opioid addiction, we’re encouraged to prescribe methadone and buprenorphine indefinitely as the only viable option.

Patients must jump through demeaning hoops to access these medications. That is stigma.

Ask patients about the barriers they face trying to get methadone or buprenorphine. That is stigma.

Most people with chronic conditions like diabetes or heart disease will openly discuss their medications. How many patients impacted by opioids will readily talk about the substitute opioid they’re taking? That is stigma.

Now, let’s turn to alcohol—a legal drug that claimed 178,000 lives last year. People with alcohol use disorder are often expected to self-stigmatize by joining “anonymous” groups to achieve recovery. That, too, is stigma. The same is true for other substances, from cocaine to stimulants. That is stigma.

If stigma is tied to using addictive, abusable drugs, doesn’t it make sense to develop new, non-addictive medications for treating chronic conditions like substance use disorder? Why haven’t we?

We are urged to stick with current treatments and then blamed for perpetuating stigma. How absurd!

We don’t have to look far to see the power of a non-addictive, non-abusable medication in saving lives. Naloxone has reversed tens of thousands of overdoses. Millions of doses are being distributed, and the drug is now available over the counter. Why? Because naloxone works—it has zero abuse potential and no street value.

We’ve seen similar breakthroughs in treating other chronic conditions like depression and diabetes.

It’s time to acknowledge that stigma in addiction treatment isn’t the fault of providers. The solution lies in developing a wide range of non-addictive, non-abusable medications. When we do, the stigma will begin to fade—and patients may finally have a path to true recovery.