ArticleDrug and alcohol dependence2021
"I felt like I had a scarlet letter": Recurring experiences of structural stigma surrounding opioid tapers among patients with chronic, non-cancer pain.
Article in Drug and alcohol dependence, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Interventions to safely and effectively reduce (taper) use of opioids in chronic non-cancer pain: a systematic review.Health technology assessment (Winchester, England) · 2026Pooled it
- Understanding the characteristics and comorbidities of primary care patients with risky opioid use: Baseline data from the multi-site "Subthreshold Opioid Use Disorder Prevention" (STOP) Trial.Journal of general internal medicine · 2025Trial
- Strategies to Deimplement Opioid Prescribing in Primary Care: A Cluster Randomized Clinical Trial.JAMA network open · 2024Trial
- Group-Based Integrative Pain Management: Feasibility of a Factorial Randomized Trial in Safety-Net Primary Care.Journal of primary care & community healthTrial
- Barriers and motivators for opioid deprescribing among Danish adults receiving long-term treatment with short-acting opioids: an exploratory qualitative study in primary care informed by self-determination theory.Scandinavian journal of primary health care · 2026Article
- Safer supply deprescribing during a toxic drug poisoning crisis in Vancouver, Canada.Drug and alcohol dependence · 2026Article
- A qualitative study examining barriers to buprenorphine for pain management in patients with end stage kidney disease undergoing hemodialysis.The journal of pain · 2026Article
- Long-Term Opioid Therapy Tapering and Risk of Substance Use Disorder and Overdose: Differences by Opioid Dose and Duration.Journal of general internal medicine · 2026Article
- "Safer supply is the thing that changes everything": the role of prescribed safer supply in rebuilding trust following experiences of medical abandonment.BMC public health · 2026Article
- Deflecting Before Prescribing: Negotiating About Opioids and Chronic Pain in Primary Care.Health communication · 2026Article
- Stigma, Scarcity and the Price of Legitimacy: Chronic Pain Advocacy and the Politics of Pharmaceutical Partnerships in Canada.Sociology of health & illness · 2026Article
- Opioid deprescribing: rethinking policies to facilitate better patient outcomes.Pain management · 2025Review
- The emergence of fentanyl in a stimulant landscape: Un/intentional use, social relations, and developing communities of care.The International journal on drug policy · 2025Article
- Community pharmacy's role in dispensing androgens and supporting harm reduction amid current policy dilemmas.Substance abuse treatment, prevention, and policy · 2025Article
- Article
- Do veterans with risky substance use (RSU) use distinct pain treatment modalities?The American journal on addictions · 2024Article
- Patient Perspectives on Mental Health and Pain Management Support Needed Versus Received During Opioid Deprescribing.The journal of pain · 2024Article
- Identifying patterns of pain, depression, anxiety, interpersonal trauma exposure, and nonmedical prescription opioid use: Latent class analysis among patients with chronic pain.Pain medicine (Malden, Mass.) · 2024Article
- Impact of Opioid Dose Reductions on Patient-Reported Mental Health and Suicide-Related Behavior and Relationship to Patient Choice in Tapering Decisions.The journal of pain · 2024Article
- Predicting first use of heroin from prescription opioid use subtypes: Insights from the Monitoring the Future longitudinal panel.Drug and alcohol dependence · 2024Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundEfforts to address opioid-involved overdose fatalities have led to widespread implementation of various initiatives to taper (i.e., reduce or discontinue) opioid prescriptions despite a limited understanding of patients' experience.
methodsFrom 2019-2020, we recruited patients with chronic, non-cancer pain who had undergone a reduction in opioid daily dosage of ≥50 % in the past two years at Boston Medical Center or Michigan Medicine. Participants completed semi-structured interviews exploring health history, opioid use, and taper experiences. Inductive analysis, guided by theoretical conceptualizations of structural stigma, identified emergent themes.
resultsAmong 41 participants, three elements of structural stigma were identified across participants' lives. First, participants identified themselves as overlooked subjects of the U.S. opioid crisis, who experienced overprescribing, subsequent stigmatization and surveillance of opioid use (e.g., toxicology screening, "pill counts"), and various tapering initiatives. Second, during the course of pain treatment, participants felt stigmatized and invalidated by cultural norms linking chronic pain to stereotypes of acting disingenuously (e.g., "drug-seeking"). Finally, during and after tapers, institutional policies and programs further increased participants' feelings of marginalization, producing multiple unintended consequences, including reduced access to medical care and feeling "orphaned by the system."
conclusionsOpioid tapers may exacerbate the social production and burden of stigma among patients with chronic pain, especially when processes are perceived to invalidate pain, endorse stereotypes, and label previously effective, acceptable treatment as inappropriate. Findings highlight how various tapering initiatives reinforce the devalued status of people living with chronic pain while also reducing patients' wellbeing and confidence in medical systems.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.