PREPRINT: The role of prejudice and prior contact in support for evidence-based interventions to reduce drug-related deaths: Results from a survey across the island of Ireland.

Background:
Stigmatized attitudes, opinions on opioid use, and prior contact with people who use drugs (PWUD) can contribute to what policies are supported and implemented to reduce drug-related deaths. This study examined how these variables relate to policy support for implementation of supervised injection sites, laws protecting bystander at the scene of an overdose, and over the counter naloxone on the island of Ireland.

Methods:
A sample of 472 adults across the Island of Ireland completed an online survey. Hierarchical linear regression was performed to examine associations between respondent attitudes and policy support. Mediation analysis explored how stigma mediated the relationship between prior contact and policy support. Open-ended questions explored attitudes further and were analysed using codebook Thematic Analysis.

Results
The final model accounted for 29% of the variance in policy support. Non sympathetic attitudes towards people who use opioids predicted less policy support (β=-.18) and agreement that PWUD were not criminals predicted more policy support (β = .14). Mediation analysis showed that medium or high levels of familiarity with PWUD (compared to low) reduced social stigma, avoidance, and disgust which in turn increased levels of policy support. Medium familiarity (compared to low) showed a small indirect effect via sympathetic attitudes and condemnation. Meta-inferences from the qualitative analysis evidenced mechanisms of stigma and prior contact.

Conclusion
Stigma reduction programs should consider the role of prejudice and target negative emotional reactions such as lack of sympathy towards PWUD. Programs aimed at reducing stigma should be informed by the lived or living experience of PWUD, families and carers, to help increase social acceptance, understanding, and policy support.