Don't Call Them "Unclean" Or "Unkempt": Analyzing the Harmful Direct and Indirect Effects of Opioid Stigma Marks on Stigmatizing Attitudes and Behavioral Intentions.

This study examined the effects of opioid stigma marks (e.g. "dirty," "unclean") on stigma-related outcomes among a sample of Amazon Mechanical Turk workers (N = 371). Using a 2 (stigma mark: yes, no) by 3 (opioid type: prescription opioid, heroin, fentanyl) between subjects factorial experiment, results indicated that compared to those in the no mark conditions, participants in the mark conditions expressed greater desire for social distance from and behavioral regulation of people with opioid use disorders. Opioid stigma marks were also indirectly associated with more behavioral regulation, more stigma message sharing, and less support for opioid-related public health policies through stigma beliefs. Results advance theoretical understandings of the stigma message effects process and offer practical recommendations for public health communicators and journalists.