Non-prescribing clinicians' treatment orientations and attitudes toward treatments for opioid use disorder: Rural differences

Brown, Aaron R.; Walters, Jayme E.; Harmer, Beth; Cates, Lara; Jones, Aubrey E.

doi:10.1016/j.josat.2023.209153

Cited by 2 publications

(5 citation statements)

References 63 publications

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“…Some evidence suggests that naltrexone may be stigmatized less than buprenorphine and methadone due pharmacological and regulatory differences ( 19 ). Overall, our findings align with previous qualitative work with SUD counselors and supports the idea that MOUD stigma presents differently across MOUD types ( 20 , 38 ).…”

Section: Discussionsupporting

confidence: 89%

“…Training requirements of substance use disorder counselors vary widely by state and Pennsylvania’s licensure requirements are among the most stringent for both undergraduate and graduate-level SUD counselors ( 44 , 45 ). In addition, abstinence-oriented treatment facilities are more common in rural regions, limiting exposure to MOUD ( 20 ). Nonetheless, we expect that our results may help leaders to anticipate and prepare for stigma when MOUD is implemented in their agency.…”

Section: Discussionmentioning

confidence: 99%

“…MOUD stigma among counselors is concerning considering that, in outpatient settings, counselors have frequent touchpoints with clients, give advice and direction during client interactions, and help plan and connect them to MOUD treatment ( 20 , 21 ). Counselors help people with OUD navigate recovery, yet there is little information about how they talk about MOUD during client interactions ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder

Cardamone,

Stewart,

Kampman

et al. 2024

Preprint

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Background: Medications for opioid use disorder (MOUD) are among the best tools we have to combat the opioid epidemic. Yet, use of MOUD among people with opioid use disorder (OUD) remains low. Interventions to increase MOUD access in the United States have largely focused on improving organizational capacity and addressing funding barriers, yet stigma toward MOUD may inhibit uptake even where MOUD is readily available. Substance use disorder (SUD) treatment counselors likely have considerable influence on a client’s choice to initiate and adhere to MOUD, but beliefs that counselors convey about MOUD in interaction with clients are understudied. The current study explores what advantages and disadvantages that SUD treatment counselors communicate about buprenorphine, methadone, and naltrexone. Methods: From June to December 2021, we surveyed counselors from publicly-funded SUD treatment agencies under a municipality-wide mandate to offer MOUD to all clients with OUD. Counselors were asked to describe, in a free-response format, the most important advantages and disadvantages to communicate to their clients about taking buprenorphine, methadone, and naltrexone. Counselor responses were coded for one or more advantage and disadvantage. Results: A total of 271 SUD counselors from 29 agencies completed the survey, generating 1,995 advantages and disadvantages across three types of MOUD. The most frequently reported advantage across all three types of MOUD was their ability to reduce cravings and illicit drug use. The most frequently reported disadvantage related to the potential for some types of MOUD to develop long-term medication dependence. Conclusions: As the availability and variety of MOUD treatment options continue to expand, it is important that SUD counselors are equipped with evidence-based recommendations for OUD care. We identified misalignments with the MOUD-prescribing evidence base and stigmatizing language toward MOUD within counselors’ responses, highlighting the potential to refine training materials for MOUD and mitigate stigmatizing beliefs.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder

Cardamone,

Stewart,

Kampman

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Prior research that has examined rural-specific MOUD barriers identified both availability and acceptability barriers; there are few MOUD providers and providers have negative attitudes about substance use intervention [ 46 ]. However, other research has found that substance use treatment clinic providers in rural clinics endorsed more positive perceptions of naltrexone than less rural providers [ 30 ], and non-prescribing providers in rural communities endorsed more favorability of MOUD-only treatment compared to combined medication and psychosocial interventions [ 35 ]. The role of rurality on MOUD attitudes may be dependent on numerous factors (e.g., access/availability) not examined in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…Taken together, focusing on CMHC and YLS professionals is crucial in understanding potential upstream effects on youth substance use treatment. CMHC and YLS professionals may affect whether youth are referred for treatment [ 34 ], as well as youth attitudes toward MOUDs, willingness to engage in treatment, and adherence to medication once prescribed [ 26 , 31 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

Attitudes toward and training in medications for opioid use disorders: a descriptive analysis among employees in the youth legal system and community mental health centers

O’Reilly,

Schwartz,

Brown

et al. 2024

Subst Abuse Treat Prev Policy

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Background Research demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth. Methods Using survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training). Results Wilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD. Conclusions These results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.

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Non-prescribing clinicians' treatment orientations and attitudes toward treatments for opioid use disorder: Rural differences

Cited by 2 publications

References 63 publications

Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder

Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder

Attitudes toward and training in medications for opioid use disorders: a descriptive analysis among employees in the youth legal system and community mental health centers

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