Intervention Stigma toward Medications for Opioid Use Disorder: A Systematic Review

Madden, Erin Fanning; Prevedel, Suzanne; Light, Timothy D.; Sulzer, Sandra H.

doi:10.1080/10826084.2021.1975749

Cited by 96 publications

(55 citation statements)

References 62 publications

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“…This study reaffirms the importance of addressing misconceptions and negative attitudes toward people with OUD (as well as stigma toward SUD interventions themselves 28 ) throughout clinical training programs to increase access to buprenorphine and improve retention in buprenorphine treatment long-term. Considering we found a relationship between OUD attitudes and treatment behaviors in a population that skews positive in their perceptions of people with OUD (i.e., the average OUD Attitudes score was 7.57 out of 10), one can presume these effects would be more pronounced in larger, more diverse samples.…”

Section: Clinical Implications and Applicationssupporting

confidence: 68%

The Association of Medical Providers’ Attitudes About Naloxone and People with Opioid Use Disorder and Their Self-Reported “Low-Barrier” Treatment Practices

Winograd¹,

Coffey²,

Nance³

et al. 2022

Preprint

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Opioid-involved overdose deaths continue to climb, in part because of suboptimal access to and retention on medications for opioid use disorder (MOUD), including buprenorphine. “Low barrier” buprenorphine treatment aims to reduce or eliminate the threshold for getting and staying on medication by providing immediate and long-term access to buprenorphine without strict rules or requirements. This study examines associations between medical providers’ beliefs about people with opioid use disorder (OUD) and naloxone access with their self-reported “low-barrier” buprenorphine prescribing practices. We surveyed providers (N=123) who completed X-waiver courses in Missouri between March 2017 and September 2019. The survey included questions about buprenorphine prescribing behaviors as well as the Naloxone-Related Risk Compensation Beliefs (NaRCC-B) scale and Attitudes toward Patients with OUD scale. Analyses consisted of a series of linear and logistic regressions with the NaRCC-B and OUD Attitudes scales predicting various domains of “low-threshold” prescribing behaviors (such as length of buprenorphine treatment and requirements for drug testing). Findings indicate medical providers’ beliefs about people with OUD are associated with their practice of addiction medicine, with individuals with more favorable views being more likely to endorse “low-threshold” buprenorphine prescribing practices than those with less favorable views. Providers’ beliefs about naloxone being enabling were less related to their buprenorphine practices but strongly related to their likelihood of providing naloxone. Though findings are correlational and not causal, these associations suggest future prescriber trainings aiming to increase positive interactions with and attitudes toward people with OUD, as well as encouragement of flexible and “low barrier” buprenorphine prescribing practices, may help increase patients’ access to and retention on maintenance buprenorphine.

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Section: Clinical Implications and Applicationssupporting

confidence: 68%

The Association of Medical Providers’ Attitudes About Naloxone and People with Opioid Use Disorder and Their Self-Reported “Low-Barrier” Treatment Practices

Winograd¹,

Coffey²,

Nance³

et al. 2022

Preprint

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show abstract

“…Patients deemed non adherent to medications or who test positive for other drugs can then be subjected to dose reductions, required to attend treatment more frequently, or even terminated from care altogether [ 141 ]. The tight restrictions on both methadone and buprenorphine, combined with the oversight of the DEA, create obstacles for prescribers and stigmatise these medications by conveying that they cannot be used like other medications in routine healthcare [ 142 ]. These policies have also contributed to striking racial disparities in who receives buprenorphine versus methadone due to costly co-pays and insurance coverage issues [ 143 ].…”

Section: Substance Use Treatment Systemmentioning

confidence: 99%

“…However, research suggests that people with SUDs are often deterred from seeking healthcare to address their medical needs due to prior negative and stigmatising experiences with providers, and that having experienced discrimination in healthcare is associated with greater risk behaviours, psychological distress, and negative health outcomes among people who use drugs [ 147–149 ]. Some of these challenges are due to a lack of training on how to work with patients with SUDs, in addition to pre-existing personal biases and stigmatising views held by healthcare professionals, which impacts the type of care they provide [ 142 ].…”

Section: Healthcare Systemmentioning

confidence: 99%

How the war on drugs impacts social determinants of health beyond the criminal legal system

et al. 2022

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“…These statements are likely re ective of stigma associated with addiction, even among those who are educated to treat patients with a wide array of medical illnesses. A recent review detailed the existence of stigma between January 1, 1998 to December 31, 2018, nding that signi cant stigma among providers of medications for OUD was in uenced by lack of training and a belief that abstinence is preferred as well as negative perceptions of OUD patients (23).…”

Section: Attitudes and Feelings About Opioid Use And Treatmentmentioning

confidence: 99%

Barriers and Facilitators of Managing Opioid Use Disorder in Primary Care and the Potential of Using a Software-based Measurement-Based Care Program: A Qualitative Study

Cruz

Karns-Wright

Kahalnik

et al. 2022

Preprint

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Background: Opioid use disorder (OUD) is a deadly disease that remains undertreated, despite effective pharmacological treatments. Barriers, such as stigma and affordability, and a lack of training and prescribing within medical practices result in low access to treatment. Software-delivered measurement-based care (MBC) is one way to increase treatment access. MBC uses systematic participant symptom assessments to inform an algorithm to provide support for physicians at critical decision points. Method: A qualitative study using focus groups of faculty clinicians (N = 33) from 3 clinics were conducted to understand perceptions of OUD diagnosis and treatment and whether a computerized MBC model might assist with diagnosis and treatment. Themes from the transcribed focus groups were identified in two phases: 1) content analysis focused on uncovering general themes; and 2) systematic coding and interpretation of the data. Results: Analysis revealed six major themes utilized to develop the coding terms: “perceptions of opioid use,” “current practices with patients using prescribed or illicit opioids or other drugs,” “attitudes and feelings about providing screening or treatment for OUD in your practice,” “perceived resources needed for treating OUD,” “primary care physician role in patient care not specific to OUD,” and “reactions to implementation of proposed clinical decision support tool.” Conclusion: Results revealed systemic and attitudinal barriers for screening, diagnosing, and treating OUD that could be alleviated with the implementation of a software-based MBC program. Providers tended to view the software-based MBC program favorably, indicating that it may be a solution to increasing accessibility to OUD treatment.

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Intervention Stigma toward Medications for Opioid Use Disorder: A Systematic Review

Cited by 96 publications

References 62 publications

The Association of Medical Providers’ Attitudes About Naloxone and People with Opioid Use Disorder and Their Self-Reported “Low-Barrier” Treatment Practices

The Association of Medical Providers’ Attitudes About Naloxone and People with Opioid Use Disorder and Their Self-Reported “Low-Barrier” Treatment Practices

How the war on drugs impacts social determinants of health beyond the criminal legal system

Barriers and Facilitators of Managing Opioid Use Disorder in Primary Care and the Potential of Using a Software-based Measurement-Based Care Program: A Qualitative Study

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