Colorado revamps opioid anti-stigma campaign to reach more diverse audience
In 2018, Colorado launched “Lift The Label,” an opioid anti-stigma public awareness campaign encouraging those abusing drugs to seek treatment. But the ads primarily reached one group of people. To address this, the state revamped the campaign to reach a more diverse audience.
Keith Hayes was 12 years old when he first tried marijuana. Alcohol soon followed and before he knew it, he was hooked on opiates.
“Then in my 20s, I got prescribed some Vicodin or some Percocet for a toothache or something. And I liked how it made me feel,” he said.
Hayes started taking other people’s prescription medications and bought pills on the street. His addiction lasted for over a decade.
“As my life continued to spiral and spiral out of control, I found myself in jails and prisons, institutions, hospitals until I was hopeless,” he said.
Then, Hayes said, he was finally sick and tired of being sick and tired. His probation officer told him, ‘If you’re serious about getting sober you should go to a treatment facility.’ But it was hard for him to find a place.
“Me and my mom, we looked all over trying to find any treatment,” he said. “I didn't have any insurance at the time, so I didn't have any resources.”
Ultimately, he got into a free program at the Salvation Army and has been in recovery ever since. But the barriers to finding treatment went beyond knowing where to look.
“Black people don't get into recovery like that, right? Like, it's ingrained in our community and the fabric that if you need help, you need to figure it out for yourself, right?” he said. “It also goes back to the ‘Hey, you're a man, right?’ And men got to take care of things on your own. And you don't ask people for help and you got to figure it out.”
The stigma around admitting he had a problem, and needed help, kept him sick for a long time he said. But now Hayes is sharing his story.
“They were heartbroken. You never know what your family is going through when you're out there in the streets and they feel just as hopeless as you feel in active addiction,” he says in a video titled, “Supporting a Loved One.”
The video, which features Hayes and three others in recovery, is one of several new ads from Lift The Label, the state’s opioid anti-stigma public awareness campaign. They feature people from different genders, religions, races, and ethnicities.
“It is important that this campaign reach a more diverse audience,” said Liz Owens, Lift the Label co-creator and director of policy and communications at the Colorado Department of Human Services’ Office of Behavioral Health. “We know that so many people in our state are not able to access treatment. And then in particular, for communities of color, for LGBTQ plus Coloradans, they face even more barriers to accessing treatment to begin with.”
More than 100,000 Americans died of drug overdoses from April 2020 to 2021. That’s the most deaths ever recorded over a 12-month period according to provisional data from the Centers for Disease Control and Prevention.
Colorado has not been immune to this crisis. In 2020, there was a record number of deaths including 956 people who lost their lives to opioids like prescription pain pills, heroin, and fentanyl. Overall, drug overdose deaths last year were the highest among Black people, American Indian or Alaska Native people and men.
The state launched Lift The Label in 2018. The website includes information from defining opioid addiction to treatment resources and how to support a loved one who is struggling. But according to Owens, the most impactful part of the campaign are the personal stories.
“Everybody in the campaign is from Colorado and has a story to share, whether it's their own story of recovery, their story of potentially losing a loved one,” she said. “How stigma impacted their ability to get treatment, their ability to seek recovery.”
After the first year of the campaign, Owens and her team looked at the digital advertising data and found 92% of impressions were reaching white people.
“Which, of course just contributes to stigma, to access. It just compounds all the issues,” she said.
To target a more diverse audience, the team began a multiyear equity research and campaign improvement process. It started with a literature review and looking at existing data, then focus groups and interviews with people from diverse communities.
The Office of Behavioral Health also consulted with Daniel Goldberg, associate professor and researcher at the University of Colorado Anschutz Medical Campus Center for Bioethics and Humanities, who specializes in structural stigma. People often experience or think about stigma in an individualized way, he said. For example, a person may feel stigmatized seeing their doctor or talk with a social services provider. But stigma, he said, is a “downstream manifestation of an upstream phenomenon.”
“The best evaluations we have of stigma are very clear that stigma flows from upstream structures, things like power,” he said. “The same factors that create social inequalities between people are the factors that actually tend to create stigma.”
“Things like race and class and gender and ability or disability status,” he said. “These same oppressions really that are driving differences between people are the ones that actually create stigmas that separate in groups from out groups, which is what stigma is basically.”
While working with Lift The Label, Goldberg was asked to look at the original campaign and the proposed changes and identify points where they can address some of the structural dynamics driving stigma. One of his suggestions was to acknowledge that stigma “doesn’t exist in a vacuum. It’s a function of social power.” Black and brown communities and other marginalized groups are more likely to experience intersecting forms of stigma (like a pain condition and racial discrimination) at the same time, he said.
“Thinking about how to message to communities that indicates that the Office of Behavioral Health, the state of Colorado, is aware of these kinds of stigmas and how they operate,” he said. “They're aware that this is sort of a dense web that isn't going to just be unraveled or unpacked in a single setting.”
Lift The Label unveiled the new ads in September. The Office of Behavioral Health revised the campaign based on what they had learned including misinformation about medications for opioid use disorder.
“‘That's too expensive.’ ‘That's not for me.’ ‘That's replacing one drug with another.’ Even though there's all this data about it being a very effective form of treatment,” said Owens referencing some of the feedback they received. "The myth, the stigma, it's all extremely pervasive.”
The 2021 Colorado Health Access Survey found about 80,000 Coloradans didn’t get the drug or alcohol treatment they needed this year and stigma and cost were the most common reasons.
Cost is highlighted in one of the new ads that features Dr Lesley Brooks, Chief of Addiction Medicine at SummitStone Health Partners and Assistant Medical Director for the North Colorado Health Alliance in northern Colorado.
“You can help support your loved ones by asking questions of your health care provider about financial assistance programs like Medicaid and Medicare,” she says in the video.
Through their research, Owens also learned that people don’t want to see just one face in an ad because that ties addiction to a particular community.
That’s where Hayes comes in.
“There's a lot of different ways to find recovery. You got to find the treatment that is best for you and your family,” he says in the new “Effectiveness of Medications to Treat Opioid Addiction” video.
The 39-year-old heard about Lift the Label last spring. After completing the interview process and learning more details, he agreed to participate.
“I'm so grateful that I did because it is helping a lot of people,” he said. “I'm literally getting a phone call every day from somebody saying, ‘Hey, I seen you on TV, bringing awareness about the stigma of addiction.’”
Hayes has been sober for over four years and is director of recovery at a recovery high school in Denver. His journey has become an inspiration for others, including black people who have reached out to him.
“(They ask) ‘Do you have any resources that we can use to get me in a treatment?’” he said. “I've been able to use my resources and help them get their journey started. So, I mean, that is exactly what we're aiming to do.”
While Lift The Label urges people to seek help, the state is continuing to expand access to treatment. The program is still being evaluated, said Owens. The next step is targeting ads and trainings to medical, behavioral and law enforcement professionals so they can better treat those with substance use disorder.