Drug-related Stigma Among People Who Inject Drugs – Development and Validation of the Drug Use Stigma Scale (DUSS)
Robin A. Pollini, Catherine E. Paquette, Brandon Irvin, Jennifer L. Syvertsen, Christa L. Lilly
Abstract
Drug use is a highly stigmatized behavior, and drug-related stigma is a key driver of behavioral risk, lower health care utilization, and associated adverse health outcomes among people who inject drugs (PWID). While instruments exist for measuring drug-related stigma, their applicability to community-based PWID across multiple stigma types (enacted, anticipated, internalized) and settings (health care, society, family) is limited, as most were developed using treatment-based samples and all were developed in urban populations.
Introduction
Drug use is a highly stigmatized behavior, and people who inject drugs (PWID) experience even greater stigma than those who use drugs through non-injection routes. Research suggests that drug-related stigma in healthcare and social settings is a key driver of behavioral risk, lower healthcare utilization, and associated adverse health outcomes among PWID.
Materials and Methods:
Data collection for this study was conducted between May 23, 2023, and August 8, 2024. All research activities were approved by the West Virginia University Institutional Review Board (IRB) and all participants provided informed consent. To ensure anonymity for study participants, the WVU IRB approved a waiver of documented consent and related protocols for all phases for the study. For qualitative data collections, participants reviewed an IRB-approved consent form and provided verbal consent to participate.
Discussion
Drug-related stigma contributes to adverse health experiences and barriers to healthcare engagement among people who use drugs. Efforts to develop and evaluate interventions designed to reduce this stigma require valid stigma measurement instruments that can be applied across different stigma types, settings, and user groups.
In this study, we used both qualitative and quantitative methods to develop a new instrument, the DUSS, for assessing drug-related stigma among PWID.
Acknowledgments
The authors wish to acknowledge the community partners who facilitated recruitment and all the study participants who contributed to this work. This paper is dedicated in loving memory to Rebel.
Citation: Pollini RA, Paquette CE, Irvin B, Syvertsen JL, Lilly CL (2025) Drug-related stigma among people who inject drugs – development and validation of the drug use stigma scale (DUSS). PLoS One 20(12): e0338691. https://doi.org/10.1371/journal.pone.0338691
Editor: Joseph Gregory Rosen, Johns Hopkins University Bloomberg School of Public Health, UNITED STATES OF AMERICA
Received: April 2, 2025; Accepted: November 26, 2025; Published: December 12, 2025.
Copyright: © 2025 Pollini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Survey data related to the development of the Drug Use Stigma Scale (DUSS) are available at https://www.openicpsr.org/openicpsr/project/240104/version/V1/view.
Funding: This study was funded by the National Institute on Drug Abuse (R21DA054899; PI: Pollini). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared no competing interests exist.
