“They Are Notoriously Not Very Honest”: Provider-Based Stigma and the Challenge of Integrated Care for Women Experiencing IPV and OUD

A growing literature has documented the frequent co-occurrence of opioid use disorder (OUD) and intimate partner violence (IPV) among women, with IPV victimization prevalence among women with OUD estimated between 44 and 90%. Prior research has identified significant barriers to care for women dealing with IPV or OUD in isolation – barriers that may be further amplified by co-morbidity.

Recruiting a diverse cross-section of professionals (n = 39) who serve women with co-occurring IPV/OUD, this project used semi-structured interviews to describe the unique impediments to engaging and retaining this population within relevant programming, including health care, housing, IPV, and substance use services.

Stigma against both women experiencing IPV and people who use opioids (PWUO) was cited as a major barrier by participants, who described the ways in which stigma deterred service-seeking, service enrollment, and long-term retention. At the same time, many providers expressed stigmatizing attitudes toward women with co-occurring IPV/OUD, characterizing them as blameworthy, dangerous, and incapable of, or unwilling to, change.

Provider-based stigma is prevalent, yet maybe be largely unacknowledged, among professionals who serve women with co-occurring IPV/OUD. Medical-legal partnerships that integrate care for this population, putting OUD and IPV providers in direct collaboration, may mitigate provider-based stigma.