Drug Addiction Stigma in the Context of Methadone Maintenance Therapy: An Investigation into Understudied Sources of Stigma

Earnshaw, Valerie A.; Smith, Laramie R.; Copenhaver, Michael

doi:10.1007/s11469-012-9402-5

Cited by 221 publications

(195 citation statements)

References 26 publications

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“…For example, patients receiving methadone maintenance therapy in the United States experience different forms of enacted stigma from family/friends, coworkers/employers, and health service providers (Earnshaw, Smith, & Copenhaver, 2013). HIV-infected PWID in Vietnam describe experiences of layered stigma within the community but not within the family (Rudolph et al, 2012).…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis

Culbert

Earnshaw

Wulanyani

et al. 2015

Journal of the Association of Nurses in AIDS Care

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In Indonesia, the syndemic nature of HIV, drug use, and incarceration may influence experiences of stigma for HIV-infected prisoners. This mixed method study explores HIV stigma in prisoners living with HIV in Indonesia. Randomly selected male HIV-infected prisoners (n = 102) from two large prisons in Jakarta completed in-depth interviews and a structured HIV stigma survey. Quantitative results found 4 groups of HIV-infected prisoners with significantly higher HIV stigma levels, including those: (a) with drug-related offenses, (b) seeking help to decrease drug use, (c) diagnosed with HIV before the current incarceration, and (d) who had not disclosed their HIV status to family members or friends. Qualitative results highlighted the prominent role of HIV stigma in decisions to disclose HIV status to family members, partners, and other prisoners. Interventions should address HIV stigma in HIV-infected prisoners in Indonesia to achieve HIV treatment as prevention goals.

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Section: Theoretical Frameworkmentioning

confidence: 99%

Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis

Culbert

Earnshaw

Wulanyani

et al. 2015

Journal of the Association of Nurses in AIDS Care

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“…25,26 Unfortunately, referral is an inadequate plan for many. Patients often shun methadone clinics because of stigma 27 and inconvenience (particularly outside urban areas), 28 and the need for buprenorphine prescribers far outstrips the supply. 29 This report adds a new dimension to the sparse literature on primary care clinics using populationbased opioid safety initiatives.…”

Section: Discussionmentioning

confidence: 99%

Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

Grande¹,

Thompson²,

Au³

et al. 2016

The Journal of the American Board of Family Medicine

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Purpose: Problem drug-related behavior (PDB) among patients on chronic opioid therapy may reflect an opioid use disorder. This study assessed PDB prevalence and the relationship between PDB and ongoing prescription of opioids at a primary care clinic that implemented a multifaceted opioid management program.Methods: A chart review of patients in a chronic opioid registry assessed prevalence of different types of PDB over 2 years, and whether opioids were prescribed during the last 3 months of the 2-year study period among patients with different levels of PDB.Results: Among 233 registry patients, 84.1% exhibited PDB; 45.5% exhibited >3 types of PDB. At the end of 2 years, most registry patients were still prescribed opioids, though patients with >3 types of PDB were less likely than those without PDB to be prescribed opioids (62.3% vs. 78.4%, P ‫؍‬ 0.016).Conclusions: PDB was pervasive in this population of patients on chronic opioid therapy. Those with the most PDB, and thus with the greatest likelihood of opioid use disorder and its social and medical consequences, were the least likely to be prescribed opioids by the clinic after 2 years. Given the rising rates of illicit opioid use in the U.S., it is important that clinics work closely with their patients who display PDB, systematically assess them for opioid use disorder, and offer evidence-based treatment.

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“…These results are not surprising because of the stigma attached to injection drug use and methadone 34 : prescription opioids are more socially acceptable than heroin 35 , and office-based buprenorphine therapy in the U.S is closer to other chronic disease management practices than methadone maintenance treatment, especially in the early stages of treatment. 36 The implications of these preferences creates a paradox in that, all else equal, conditions with lower burden offer commensurately less benefit from cure—so treatment of one prescription opioid misuser for one year provides less social benefit than treatment of one injection opioid misuser for one year, just as treatment for one case of the flu, for example, would provide less social benefit than treatment for one case of meningitis.…”

Section: Discussionmentioning

confidence: 99%

Measuring benefits of opioid misuse treatment for economic evaluation: health‐related quality of life of opioid‐dependent individuals and their spouses as assessed by a sample of the US population

Wittenberg¹,

Bray

Aden

et al. 2015

Addiction

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Aims To understand how the general public views the quality of life effects of opioid misuse and opioid use disorder on an individual and his/her spouse, measured in terms used in economic evaluations. Design Cross-sectional internet survey of a US-population-representative respondent panel conducted December 2013-January 2014. Setting USA. Participants 2,054 randomly-selected adults; 51% male (before weighting). Measurements Mean (95% CI) and median health “utility” for 6 opioid misuse and treatment outcomes: active injection misuse; active prescription misuse; methadone maintenance therapy at initiation, and when stabilized in treatment; and buprenorphine therapy at initiation, and when stabilized. Utility is a numerical representation of health-related quality of life used in economic evaluations to “adjust” estimated survival to include peoples' preferences for health states. Utilities are determined by surveying the general population to estimate the value they assign to particular health states—on a scale where 0=the value of being dead, and 1.0=the value of being in perfect health. Spouse spillover utility is assigned to a spouse of an individual who is in a particular health state. Findings Mean individual utility ranged from 0.574 (95%CI: 0.538, 0.611) for active injection opioid misuse to 0.766 for stabilized buprenorphine therapy (95%CI: 0.738, 0.795), with other states in between. Female respondents assigned higher utility to the active prescription misuse and buprenorphine therapy at initiation states than did males (p<0.05); all other states did not differ by respondent gender. Mean spousal utilities were significantly lower than 1.0 but mostly higher than individual utility, and were similar between male and female respondents. Conclusions In the opinion of the US public, injection opioid misuse results in worse health-related quality of life than prescription misuse, and methadone therapy results in worse health-related quality of life than buprenorphine therapy. Spouses are negatively affected by their partner's opioid misuse and early treatment.

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Drug Addiction Stigma in the Context of Methadone Maintenance Therapy: An Investigation into Understudied Sources of Stigma

Cited by 221 publications

References 26 publications

Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis

Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis

Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

Measuring benefits of opioid misuse treatment for economic evaluation: health‐related quality of life of opioid‐dependent individuals and their spouses as assessed by a sample of the US population

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