Abstract / Summary
Stigma toward people with opioid use disorder (OUD) limits treatment engagement, particularly in underserved rural communities. This study examined three-year trends in OUD stigma among community members in a rural Tennessee county served by a federal opioid response program. Repeated cross-sectional surveys at the Wilson County and Tennessee State Fair assessed 1,150 adults in 2022 ( n = 393), 2023 ( n = 386), and 2024 ( n = 371). A 12-item scale measured four stigma domains (dangerousness, blame, social distance, fatalism) and two knowledge/attitude items. Covariate-adjusted prevalences were estimated by marginal standardization from logistic models adjusted for age, gender, race/ethnicity, and county of residence, with proportional-odds models fitted to the ordinal scores. Acceptance of medication-assisted treatment (MAT) rose from an adjusted 65.7% (95% CI: 60.7–70.5) in 2022 to 74.1% (69.6–78.5) in 2024 (p-trend = 0.017). Fatalism increased over the same period, from 24.3% (19.9–28.7) to 31.6% (27.0–36.6) (p-trend = 0.029). Social distance was elevated in 2023 (52.5%, 47.2–57.6, vs. 42.7%, 37.4–47.7, in 2022) and returned to baseline by 2024. Dangerousness, blame, and disease recognition did not change. Proportional-odds models produced identical inference. Community attitudes toward OUD treatment improved across three survey years while beliefs about the possibility of recovery worsened. Dangerousness remained the most prevalent stigma domain and was unchanged. Treatment attitudes and recoverability beliefs appear to respond differently and warrant distinct intervention approaches. This three-year repeated cross-sectional study provides domain-specific evidence of change in community OUD stigma coinciding with Rural Communities Opioid Response Program (RCORP) programming. Acceptance of medication-assisted treatment increased significantly and was sustained, while fatalistic beliefs about recovery increased over the same period. Dangerousness stigma remained the most prevalent domain and did not change. These findings identify beliefs about recoverability as a priority target for community stigma programming in rural settings.