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Opioid use disorder (OUD) through prescription opioid misuse, heroin, and illicitly manufactured fentanyl use has increased dramatically in the past 20 years. Medications to treat opioid use disorder (MOUD) is considered the gold standard for treating opioid use disorders but uptake remains low. Recently, Madden has argued that in addition to the stigma assigned to substance use and people with SUD, MOUDs also are stigmatized, a process she labels intervention stigma to distinguish it from condition stigma (ie, stigma of SUD) . In this paper, we examine MOUD related stigma from the perspective of people who use opioids (PWUO) and key informants who play some role in providing or referring people to drug treatment. Providers and PWOU often viewed MOUD as one drug replacing another which discouraged providers from recommending and PWUO from accepting MOUD. MOUD stigma was also expressed by providers’ exaggerated fear of MOUD diversion. The extent to which MOUD was accepted as a legitimate treatment varied and influenced treatment providers’ perceptions of the goals of drug treatment and the length of time that MOUD should be used with many feeling that MOUD should only be used as a temporary tool while PWOU work on other treatment goals. This led to tapering off of MOUD after some time in treatment. Some providers also expressed mistrust of MOUD stemming from their previous experiences with the over-prescription of opioids for pain which led to the current crisis. Results from this study suggest that the proportion of PWUO on MOUD is unlikely to increase without addressing MOUD stigma among drug treatment providers and PWUO seeking treatment.

Background: Disparities in health care utilization and outcomes for racial and ethnic minorities with arthritis are well-established. However, there is a paucity of research on racial and ethnic differences in healthcare expenditures and if this relationship has changed over time. Our objectives were to: 1) examine trends in annual healthcare expenditures for adults with arthritis by race and ethnicity, and 2) determine if racial and ethnic differences in annual healthcare expenditures were independent of other factors such as healthcare access and functional disability. Methods: We used the Medical Expenditures Panel Survey (2008-2016) to examine trends in annual healthcare expenditures within and between racial and ethnic groups with arthritis (n = 227,663). A two-part model was used to estimate the marginal differences in expenditures by race and ethnicity after adjusting for relevant covariates, including the impact of healthcare access. Results: Between 2008 and 2016, there were no significant changes in unadjusted healthcare expenditures within any of the racial and ethnic groups, but the trend among non-Hispanic whites did differ significantly from Hispanics and Other. In fully adjusted analysis, mean annual expenditures for non-Hispanic whites was $946, $939, and $1178 more than non-Hispanic blacks, Hispanics, and Other, respectively (p < .001). Healthcare access also independently explained expenditure differences in this population with adults who delayed care spending significantly more ($2629) versus those who went without care spending significantly less (−$1591). Conclusions: Race and ethnicity are independent drivers of healthcare expenditures among adults with arthritis independent of healthcare access and functional disability. This underscores the need for ongoing research on the factors that influence persistent racial and ethnic differences in this population.

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