Background: Stigma toward those who use drugs significantly impacts recovery and treatment efforts. This project aims to assess and compare the stigma towards individuals using drugs among rural law enforcement officers (LEOs) and community members at different time points, thereby highlighting shifts in perception and the impact of targeted interventions on stigma reduction.

Methods: The study utilized a multi-source survey approach, collecting data from rural LEOs and community members at the Wilson County and State Fair across two consecutive years (2022 and 2023), with 441 responses in the first year from LEOs and fair attendees and 387 responses solely from fair attendees in the second year. Implementing a novel Likert Scale-based questionnaire, the study examined attitudes toward drug use across various stigma domains, including dangerousness, blame, social distancing, and fatalism. Analysis involved standardized scoring and ANOVA, comparing stigma levels by participant characteristics and assessing year-over-year changes within the community.

Results: Initial findings showed significant stigma across all domains among both LEOs and 2022 fair attendees, with a common identification of drug users as predominantly white and varied perceptions regarding socio-economic status and employment. The subsequent year revealed nuanced shifts in community attitudes, including a reduction in social distance stigma and a more accepting view of Medication-Assisted Treatment (MAT), reflecting the potential influence of public health interventions. Personal connections to substance use disorder were linked notably to decreased stigma levels.

Conclusions: This longitudinal and comparative study underscores the dynamic nature of stigma towards drug use within rural Tennessee, demonstrating gradual yet promising shifts in community perceptions. The data emphasizes the critical need for ongoing, culturally sensitive public health interventions aimed at reducing stigma. Future efforts should focus on leveraging personal connections and enhancing community engagement to foster supportive environments conducive to recovery and treatment.