Patterns of Felt Stigma Among Rural-Dwelling People Who Use Drugs: A Latent Class Analysis.

backgroundStigma is a barrier to help-seeking in rural-dwelling people who use drugs. However, little is known about whether stigma is experienced in patterned ways, and what characteristics are associated with these patterns.

methodsData came from a cohort of people who use drugs at eight geographically diverse Rural Opioid Initiative sites (

resultsBased on fit statistics and interpretability, we selected a five-class solution. Four classes were patterned by severity: Low Stigma (23.7%), Medium-Low Stigma (12.5%), Medium-High Stigma (34.9%), and High Stigma (24.7%). The fifth class ("High Fearers/Low Perceivers," 4.3%) reported high shame and fear of rejection but low perceived stigma from others. Members of higher stigma classes were more likely to have criminal-legal system involvement, inject drugs, and avoid healthcare and drug treatment. In contrast analyses, "High Fearers/Low Perceivers" were more likely to be younger and women, and less likely to have criminal-legal system involvement, experience homelessness, or inject drugs compared with other classes.

conclusionRural people who use drugs experience substance use stigma in distinct severity-based patterns, with four classes ranging from low to high stigma across all dimensions. A fifth, smaller class reports high internalized stigma despite low perceived stigma from others, potentially suggesting non-disclosure of substance use. These distinct profiles and their correlates offer targets for tailored stigma interventions.