Triple stigma: Experiences of racism and addiction-and homelessness-related stigmas among overdose survivors in Boston

Type: Oral Presentation
Date: November 2022


Jaylen Clarke, Jeff Desmarais, Andres Hoyos-Cespedes, Alykhan Nurani, Shannon E. O’Malley, Angela R. Bazzi, Dan Dooley, Simeon Kimmel, Sunday Taylor, Ranjani Paradise. “Triple stigma: Experiences of racism and addiction-and homelessness-related stigmas among overdose survivors in Boston”. Presented at the 2022 APHA Annual Meeting and Expo (oral presentation). Boston, MA.


Background: Opioid overdoses and homelessness are intertwined critical public health issues. Experiencing homelessness is associated with higher risk of fatal and nonfatal overdose, and in Massachusetts, the drug overdose mortality rate among homeless people ages 25-44 was 16 to 24 times higher than that of the general population (Baggett et al., 2014). Furthermore, there are racial inequities in opioid overdose mortality and post overdose treatment receipt in Massachusetts (Massachusetts Department of Public health, 2021; Dooley et al., Boston Public Health Commission, 2019). As experiences of stigma can reduce treatment readiness (Muncan et al., 2020), we sought to explore how racism, anti-addiction related stigma, and anti-homelessness related stigma has been experienced among overdose survivors in Boston who identify as Black and were experiencing homelessness.

Methods: The Boston Overdose Linkage to Treatment Study was a qualitative examination of racial equity in post-overdose access to and experiences of addiction treatment involving semi-structured interviews with overdose survivors in Boston, MA. This analysis focused on a subsample of participants who identified as Black and were experiencing homelessness. The participants were interviewed between 3 weeks and 3 months after their most recent opioid overdose. We coded transcripts and used the Framework Analysis approach to identify stigma-related themes.

Results: Black participants frequently reported feeling mistreated by treatment and service providers, with many specifically referencing hospital staff. Specifically, Black respondents reported that they experienced racism, anti-addiction related stigma, and/or anti-homelessness related stigma. One person said, “It is a lot of lack of respect. Especially if they know you’re an addict they definitely don’t give you the full respect that you deserve . Another said, “I feel like they give more treatment to the White people than they do Hispanics and Blacks. There was variation in which types of stigmas participants felt were most relevant to their experiences, and some Black participants were unsure if race played a role in their mistreatment. Black participants experiencing homelessness frequently cited the marginalization and stigmatization of homelessness at impacting how they thought about and engaged with different treatment options and services.

Implications: Black people who use opioids and experience homelessness frequently reported “triple stigma across their intersectional identities. Understanding experiences of stigma among this vulnerable population can help healthcare workers and other service providers improve care delivery ensuring that dignity and respect are provided to people who have been marginalized.

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