A majority of Massachusetts residents know someone who has been addicted to opioids and more than a quarter have lost a loved one or an acquaintance to a fatal overdose, according to a survey released Tuesday by Blue Cross Blue Shield of Massachusetts.
Residents see opioid addiction as a severe and worsening public health emergency, with 7 in 10 calling it a “very serious problem,” far more worrisome than health care costs and taxes, the survey found.
“This is not an abstract concept for people. This is being driven by a deep personal connection,” said Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center.
But even so, the stigma that surrounds addiction persists: The vast majority of respondents believe addicted people are at least partially to blame for their illness, and two-thirds think that a lack of desire to stop using drugs is a major barrier to recovery.
The findings offer a glimpse into public attitudes six years into an epidemic that has touched every corner of the state and claimed more than 2,000 lives last year.
Survey responses suggest many people consider addiction a disease and a public health problem, but in what Botticelli called “some troubling contradictions” they continue to blame the people who become addicted. That view runs counter to generally held medical opinion that addiction is a chronic illness brought on by environmental and genetic factors.
“We’re clinging to the belief that it is a personal choice,” Botticelli said.
The telephone survey of 601 Massachusetts residents was conducted Jan. 9 through 15 by Anderson Robbins Research.
Andrew Dreyfus, Blue Cross chief executive, said the insurer intends to repeat the survey every year or two, seeing it as a “powerful public education tool” that will track changes in attitudes and knowledge. This is first extensive survey on opioids that Blue Cross has conducted.
Attitudes on health issues can take years or decades to change, Dreyfus said, but it may happen faster with opioids because so many people are personally affected.
“We’ve had addiction issues in my family and among very close friends,” Dreyfus added. “It opens your eyes in ways that reading about it and working on it professionally doesn’t quite do.”
Robert J. Blendon, director of the Harvard Opinion Research Program and an authority on public opinion in health care, said that concern over opioids looms much larger in Massachusetts than in other states. In a national survey, only 28 percent considered opioid addiction a national emergency, compared with 52 percent in Massachusetts.
That concern has increased dramatically in Massachusetts in just four years.
Asked to name the biggest issue facing their communities, 18 percent of respondents mentioned addiction, drugs, or opioid abuse in 2018. As recently as 2014, only 4 percent put those issues at the top of the list in a similar survey that Blue Cross conducted for internal use.
“It looks like the Massachusetts population has really reached a tipping point around opiates,” said Dr. Ken Duckworth, Blue Cross’s medical director for behavioral health. “Something profound has happened in the societal consciousness of this issue.”
Duckworth said he was particularly struck by the responses from rural parts of the state, which the survey suggests have been especially hard hit. Almost two-thirds of the rural residents questioned know someone addicted to opioids and one-third know someone who died of an overdose. “We know access [to treatment] is worse in rural areas,” he said.
Still, respondents seem to have mixed feelings about people who are addicted.
More than half believe the opioid epidemic is a public health issue, rather than a matter for law enforcement. And yet only 4 in 10 who participated in the survey said they believe that addiction is a disease, and 28 percent say it’s a choice.
About 82 percent believe that people addicted to opioids bear all, most, or some of the blame for their addiction. Two-thirds pointed to “not wanting to give up addiction” as a major barrier to recovery.
These views suggest a misunderstanding of the role of choice in addiction, said Dr. Sarah E. Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital.
People make a choice when they first try drugs, Wakeman acknowledged, but nearly everyone makes that choice: Most people experiment with drugs and walk away unscathed. “Only a minority have a combination of genetic and environmental risk factors that makes them vulnerable to the disease of addiction,” she said.
Once people become addicted, the illness limits their ability to make good choices by impairing the parts of the brain involved with motivation, reward, and impulse control, Wakeman said.
Nearly half of survey respondents think the epidemic is getting worse, and only 1 in 10 think it’s getting better.
But the specialists interviewed pointed to signs of hope, including a drop-off in opioid-related deaths and a slight decline in fatal and nonfatal overdoses in Massachusetts in 2017, compared with 2016.
“We are making progress,” said Vic DiGravio, chief executive of the Association for Behavioral Healthcare, a trade group. “But I think people do have an accurate sense that it still could be getting worse. We are still in the midst of a crisis.”
DiGravio added that “well-founded” concerns led 63 percent to name lack of access to treatment as a major barrier to recovery.
Blue Cross’s Duckworth asserted that access to addiction treatment is improving. “It doesn’t mean you can always get exactly what you want exactly when you need it,” he said. “But services are expanding.”
Even as they called for more treatment, survey respondents were skeptical of whether it’s any good. Six in 10 rated the quality of available treatment as poor or fair.
“We have to do a better job of promoting the fact that people do get better,” said Botticelli, the Grayken Center director, who was director of national drug control policy in the Obama administration.
But he acknowledged that quality varies.
“This is a national issue, to improve the quality of treatment programs but also to make sure that we are arming people with good information to make informed choices” about where to seek treatment, Botticelli said.
Felice J. Freyer can be reached at firstname.lastname@example.org. Follow her on Twitter @felicejfreyer.