Stigmatizing language prevalent in clinical notes of patients with opioid use disorder

Key takeaways:

• Of 2,700 patients with opioid use disorder, stigmatizing language was found in 84.4% of patient records.
• The terms “opioid abuse,” “addict” and “substance dependence” were most frequently found in clinical notes.

NEW YORK — Stigmatizing language is highly prevalent in the clinical notes of individuals with opioid use disorder, with a higher incidence reported in the health records of Black and Hispanic patients, according to research.

“Clinicians should be careful of not writing these types of keywords,” Braja Gopal Patra, PhD, a research associate in population health sciences at Weill Cornell Medicine, told Healio during a poster presentation at the American Psychiatric Association Annual Meeting. “They can use alternative terms; that will build [patients’] trust.”

Seeking to examine the use of stigmatizing language (SL) in the records of individuals diagnosed with opioid use disorder, Patra and colleagues developed appropriate, people-first lexicon for SL terms recognized by the National Institute on Drug Abuse as assigning negative labels stereotypes and judgement and implemented a natural-language processing (NLP) algorithm to extract those terms from clinical notes.

They identified 980,194 notes for 2,700 patients diagnosed between 2010 and 2023 at an academic medical center in New York City and determined incidence rates of SL and demographic characteristics of patients with SL vs. those without SL.

Results showed that the NLP system identified 2,279 (84.4%) patients with at least one SL term in their notes and 421 (15.6%) patients with no SL. The most frequently used terms were “opioid abuse,” “addict” and “substance dependence.”

Researchers also identified significant differences between groups by age, gender and race: Patients who were older and female were more likely to have SL, while those aged 18 to 32 years had lower incidence of SL in their notes vs. other age groups.

Additionally, patients who identified as Black had higher incidence of SL (18.2% in SL cohort vs. 15% in no SL cohort) compared with those who identify as white, while those who identified as Hispanic had higher incidence of SL (22.5% in SL cohort vs. 16.9% in no SL cohort) vs. those who identify as non-Hispanic.

Researchers also reported that female providers used SL terms more frequently (50% in SL cohort vs. 42.4% in no SL cohort) than their male counterparts, and mental health providers had a lower incidence of SL use (11.6% in SL cohort vs. 25.6% in no SL cohort) than other specialties. Of note, social workers had a higher SL incidence in their notes (6% in SL cohort vs. 0.2% in no SL cohort).

“For practicing clinicians, they should avoid these keywords,” Patra said. “They would provide stigma to their patients.”