Background: Stigmatised attitudes, opinions on opioid use, and prior contact with People Who Use Drugs (PWUD) contribute to what policies are publicly supported and implemented to reduce drug-related deaths. This study examined how these variables relate to policy support for the implementation of supervised injection sites, laws protecting bystanders at the scene of an overdose, and over-the-counter naloxone.

Methods: An opportunity 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. Unsympathetic attitudes towards people who use opioids predicted less policy support (β = −0.18) and agreement that PWUD were not criminals predicted more policy support (β = 0.14). Medium or high levels of familiarity with PWUD (compared to low) reduced social stigma, avoidance, and disgust which 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 programmes should consider the role of prejudice and target negative emotional reactions such as lack of sympathy towards PWUD. Stigma reduction programmes should be informed by the lived or living experience of PWUD, families and carers, to help increase social acceptance, understanding, and policy support.