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How to Reduce the Opioid Epidemic's Stigma

Framing is key. Empathy is not.

Macro of oxycodone opioid tablets
I met Pennsylvania state Sen. Gene Yaw at a Governing roundtable on his state’s opioid crisis. Working with the Center for Rural Pennsylvania, he had heard 75 hours of testimony at 13 public hearings. He came away believing that the country faces an unprecedented drug addiction and overdose epidemic. He’s right. More than 40,000 Americans died from opioid overdoses in 2016. Deaths from opioids have contributed to a decline in average U.S. life expectancy.

As Yaw and the other state and local officials around the table pointed out, many of those addicted to opioids struggle with mental illness, and many have been jailed for violating drug laws. So they face a triple whammy of stigma -- against addicts, the mentally ill and the formerly incarcerated -- that’s a real barrier to public support for marshaling policies and resources. The stigma also blocks many people from seeking the assistance they need, and it stays with them even if they recover from addiction, making it hard for them to find a job or housing, among other things.

The experts certainly have policy solutions. In November, for example, the Trust for America’s Health partnered with the Well Being Trust to call for a “national resilience strategy” combining prevention and treatment. Their report cites more than 60 policies and programs that could have an impact. But I don’t think policies and programs are going to get a fair chance without a good plan for reducing the stigma. For that you need a different kind of expert.

Nat Kendall-Taylor is the CEO of the FrameWorks Institute, whose social scientists study how to frame issues to bridge the divide between public and expert understanding. Humans relate to the world in stories, and how those stories are framed can make all the difference. The FrameWorks Institute exposes research participants to different frames and measures their impact. “We no longer have to guess which stories work,” says Kendall-Taylor. “These are empirical questions with empirical answers.”

The FrameWorks Institute found some answers in the Canadian province of Alberta, where it tested three ways of framing messages about addiction. Framing stories around interdependence -- the idea that we all depend on one another to achieve our full potential -- increased support for addiction programs. The value of ingenuity -- that we as a community can come together to solve problems -- also increased support, but slightly less so. But using the value of empathy actually depressed support for those programs. That’s unfortunate, but it’s useful to know which kinds of stories might work and which probably won’t.

After all, the most powerful tool that political leaders have is the stories they tell. When I asked Pennsylvania’s Yaw what his most important takeaway about the opioid crisis was, he said that education was key but that he didn’t see how it could cut through the stigma. I think it can, but it has to involve the right kinds of stories. 

Mark Funkhouser, a former publisher of Governing and former mayor of Kansas City, is president of Funkhouse & Associates, an independent consulting firm. He can be reached at
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