History of the Stigma & Criminalization of OUD and its Treatment

As addiction practitioners, we are all too familiar with stigma’s myriad forms: arrests instead of treatment, patients who don’t want their families to know they are on methadone or want to get off as soon as possible, physicians who refuse to offer MAT, pharmacists who are hesitant to fill bupe prescriptions, and stringent federal regulations. Stigma affects everything we do, from our individual interactions with patients to national drug policy. Unfortunately, statistics and figures rarely seem to change minds when it comes to advocating for improved addiction treatment. Perhaps if we understood the historical and emotional origins of stigma, we would be better poised to eradicate its far-reaching effects. This presentation traces the history of stigma within the field of addiction medicine and national drug policy from an anti-racist and pro-MAT lens, starting in the late 19th century and continuing into modern day. Topics will include our country’s first drug legislation, the 1914 Harrison Act, the Lexington Narcotic Farm, the rise and fall of methadone maintenance, the democratization of naloxone, the origins of harm reduction, and the activists behind syringe distribution. Objectives include: understand historical policies that impact our addiction practice today; understand the ways in which stigma and racism have shaped modern drug policy; gain a historical, anti-racist perspective to use when suggesting program and policy revisions.