Diversity in opioid-related stigma interventions: A systematic review.

Girard R, Tomlinson DC, Rodriguez CR, Frabizio K, Coughlin L, Lin LA, Spillane NS. Diversity in opioid-related stigma interventions: A systematic review. Addictive Behaviors. 2025 Nov 1; 170:108432, DOI: 10.1016/j.addbeh.2025.108432.

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Abstract:

BACKGROUND: Opioid use disorder (OUD) is a highly stigmatized, debilitating condition affecting millions in the U.S., with stigma posing a major barrier to treatment engagement, retention, and outcomes. Disparities in OUD and opioid-involved overdoses disproportionately impact marginalized communities, underscoring the urgent need for culturally-informed stigma reduction interventions that address intersecting forms of discrimination and health inequities. This review examined interventions targeting OUD-related stigma, focusing on the diversity and cultural relevance of these initiatives. METHODS: Following PRISMA guidelines, we reviewed articles published through May 2025 that described interventions addressing opioid/OUD-related stigma. RESULTS: Most studies targeted provider or public stigma and involved students, healthcare professionals, or justice-involved individuals. However, demographic representation was inconsistent, with limited attention to race, ethnicity, gender identity, or sexual orientation. Sixty-eight percent of studies incorporated cultural considerations, most commonly through the inclusion of individuals with lived OUD experience. CONCLUSIONS: This is the first review to specifically examine cultural factors in interventions addressing opioid-related stigma. While notable progress has been made, gaps remain-particularly in the consistent collection of sociodemographic data and in the design of tailored interventions that address intersectional stigma and meaningfully engage marginalized communities. To address these gaps, future efforts should adopt inclusive recruitment strategies, apply intersectional frameworks, and collaborate with communities to integrate lived experiences. These culturally informed approaches, defined here as strategies that are responsive to the cultural identities, values, and social contexts of affected populations, could support the development and evaluation of stigma reduction interventions that better serve diverse populations.