Words matter: Stigmatizing language in medical records of individuals electing medication for opioid use disorder

Background: There has been a concerted effort to minimize the use of stigmatizing language in healthcare settings; however, its prevalence in health record documentation remains high. This study examined clinicians’ stigmatizing and patients’ self-stigmatizing language in medical records for patients electing medication for opioid use disorder in two settings, office-based opioid treatment and opioid treatment programs. Methods: In this retrospective cohort study, data were extracted from health records for a distributed provider network serving publicly funded patients in Texas. Patients seeking medication treatment for opioid use disorder between December 2020 and November 2021 were included. Using a natural language processing algorithm to review open text fields in the health records, we identified the prevalence of stigmatizing language identified in the National Institute on Drug Abuse's “Words Matter” tool. Results: The analytic sample included 1391 patients (63.8 % White, 27.5 % Hispanic, 40.5 % female, M_age= 40.8 years [SD=10.3]). Of the 6099 notes analyzed, 81.1 % (n = 4944) contained stigmatizing language and 7.1 % (n = 430) contained self-stigmatizing language. In multivariate models, stigmatizing language was associated with age, race, rurality, education, income, opioid use, and treatment setting. Self-stigmatizing language was associated with treatment setting. Conclusions: Findings suggest that a patient's sociodemographic background influences the stigmatizing language their clinicians use while treatment setting influences both provider and self-stigmatizing language. Additional research is needed to explore whether differences in stigmatizing language contributes to differential treatment outcomes seen in different opioid treatment settings.