2023 SPSSI Conference:
Characterizing Accounts of Structural Stigma toward Opioid Use on Reddit

Evan L. Eschliman, Columbia University Mailman School of Public Health
Karen Choe, New York University School of Global Public Health
Alexandra DeLucia, Johns Hopkins University
Michelle R. Kaufman, Johns Hopkins Bloomberg School of Public Health

As the overdose crisis continues in the United States, there has been increasing academic attention on the ways structures and systems can both drive and help prevent overdose. Largely missing from this discourse, however, are firsthand accounts of how individuals themselves navigate these structures and systems. To bring these firsthand accounts into the literature, we sought to identify and then qualitatively analyze content on the social media platform Reddit that discussed structural stigma toward opioid use.

First, we used human-in-the-loop natural language processing methods to identify content aligned with our research question. We chose Reddit for a few different reasons, including its semi-anonymous nature (which may allow for greater disclosure and discussion of stigmatized behaviors like opioid use), the fact that most posts are publicly accessible, and the way it is organized into topic-specific subforums called “subreddits.” We started with six months of data from an opioid-related subreddit called r/opiates (over 140,000 posts and comments), and then used an iterative search process involving: 1) a lexical search that used stigma-related keywords and 2) semantic similarity searches that used content we coded as relevant to look for similar phrasing in other posts. This approach narrowed the data to a smaller set of content most likely to be relevant. We then qualitatively analyzed a random sample of 500 posts and comments from this refined set.

Our qualitative analysis involved a directed content analysis. This allowed us to pre-define themes—in this case, the component processes of stigma outlined in Link & Phelan’s (2001) frequently-cited work—as well as remain open to emerging themes that arose during analysis. From our final random sample of 500 posts, 273 did indeed contain at least one theme relevant to structural stigma toward opioid use. Overall, in line with Link & Phelan’s (2001) stigma processes, we found that Redditors described how structures, including healthcare systems, the pharmaceutical industry, and the United States criminal-legal system label people who use opioids, assign negative stereotypes, separate people who use opioids (e.g., as either 'legitimate' or 'illegitimate' patients), and generate status loss and discrimination (e.g., denial of healthcare, loss of employment). Additional themes emerged, such as through Redditors’ robust conceptualizations of how historic and ongoing structural stigma has led to the current state of the overdose crisis and pervasiveness of fentanyl in the drug supply. Some posts and comments highlighted interpersonal and structural resources (e.g., other people who use opioids, harm reduction programs, telemedicine) that can be leveraged to counter structural stigma.

We hope that these findings can help researchers understand the felt impacts of structures and systems among people who use opioids and inform interventions that aim to address the impact of these stigmatizing structural forces. This analysis also helps challenge prevailing tendencies to think of “structure” as “too complicated” for qualitative research; we found that people can and do talk about structure, and we, as academics studying social issues, just have to look in the right places and ask the right questions.

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