Societal Biases, Institutional Discrimination, and Trends in Opioid Use in the USA

Fine, Danielle R.; Herzberg, David; Wakeman, Sarah E.

doi:10.1007/s11606-020-05974-0

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…More recently, a 2021 systematic review 9 of interventions targeting HCPs (excluding trainees) identified 6 studies in the United States and Canada that found that interventions, including interactions (contact) with persons in recovery, showed beneficial effects. Given that stigma as a barrier to health care for people with SUDs is an area of increasing concern in medicine and medical training, 10,11 the paucity of intervention studies and inconsistent findings of previous systematic reviews, and the exclusion of trainees in the most recent review of interventions, we conducted an updated systematic review of both the prevalence and extent of stigmatizing attitudes against patients with SUDs among HCPs and trainees and the interventions to mitigate these attitudes.…”

Section: Discussionmentioning

confidence: 99%

Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review

Magnan,

Weyrich,

Miller

et al. 2023

Acad Med

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Purpose In this systematic review, the authors examine the prevalence and extent of stigmatizing attitudes among health care professionals (HCPs) and trainees against patients with substance use disorders (SUDs), including research on interventions to reduce stigma. Method The authors searched 7 databases for articles published from January 1, 2011, through February 15, 2023, that quantified SUD stigma among HCPs or trainees. Inclusion criteria allowed both observational and intervention studies from the United States or Canada to be included in this review. Quality assessment was applied to all included studies; studies were not excluded based on quality. Results A total of 1,992 unique articles were identified of which 32 articles (17 observational studies and 15 intervention studies), all conducted in the United States, met the inclusion criteria. Half of the included studies (16 of 32) were published in 2020 or later. Most of the intervention studies (13 of 15) used a single-group pre-post design; interventions involved didactics and/or interactions with persons with SUDs. The 32 included studies used a total of 19 different measures of stigma. All 17 observational studies showed some degree of HCP or trainee stigma against patients with SUDs. Most intervention studies (12 of 15) found small but statistically significant reductions in stigma after intervention. Conclusions SUD stigma exists among HCPs and trainees. Some interventions to reduce this stigma had positive impacts, but future studies with larger, diverse participants and comparison groups are needed. Heterogeneity among studies and stigma measures limits the ability to interpret results across studies. Future rigorous research is needed to determine validated, consensus measures of SUD stigma among HCPs and trainees, identify stigma scores that are associated with clinical outcomes, and develop effective antistigma interventions for HCPs and trainees.

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Section: Discussionmentioning

confidence: 99%

Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review

Magnan,

Weyrich,

Miller

et al. 2023

Acad Med

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“…However, given existing literature on provider bias and structural racism in prescribing opioids, an important area for future research is to understand if patients from under-represented racial/ethnic groups are given similar opportunities to continue opioids or if they are tapered or discontinued more often than white patients. [47][48][49] Understanding bias and structural racism in how providers perceive benefits and harms associated with continuing, tapering, or discontinuing LTOT is critical for providing equitable pain management for diverse patients.…”

Section: Discussionmentioning

confidence: 99%

Patient and Provider Perspectives on Benefits and Harms of Continuing, Tapering, and Discontinuing Long-Term Opioid Therapy

et al. 2022

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BACKGROUND: Given efforts to taper patients off longterm opioid therapy (LTOT) because of known harms, it is important to understand if patients and providers align in LTOT treatment goals. OBJECTIVE: To investigate patient and provider perceptions about the harms and benefits of continuing and discontinuing LTOT. DESIGN: Qualitative study PARTICIPANTS: Patients and providers with experiences with LTOT for pain in two Veterans Health Affairs regions. APPROACH: We conducted semi-structured interviews and analyzed data using rapid qualitative analysis to describe patient and provider preferences about LTOT continuation and discontinuation and non-opioid pain treatments. KEY RESULTS: Participants (n=43) included 28/67 patients and 15/17 providers. When discussing continuing LTOT, patients emphasized the benefits outweighed the harms, whereas providers emphasized the harms. Participants agreed on the benefits of continuing LTOT for improved physical functioning. Provider-reported benefits of continuing LTOT included maintaining the status quo for patients without opioid alternatives or who were at risk for illicit drug use. Participants were aligned regarding the harms of negative side-effects (e.g., constipation) from continued LTOT. In contrast, when discussing LTOT tapering and discontinuation, providers underscored how benefits outweighed the harms, citing patients' improved well-being and pain management with tapering or alternatives. Patients did not foresee benefits to potential LTOT tapers or discontinuation and were worried about pain management in the absence of LTOT. When discussing non-opioid pain treatments, participants emphasized that they were adjunctive to opioid therapy rather than a replacement (except for cannabis). Providers described the importance of mental health services to manage pain, which differed from patients who focused on treatments to improve strength and mobility and reduce pain.CONCLUSIONS: Patients emphasized the benefits of continuing LTOT for pain management and well-being, which differed from providers' emphasis on the benefits of discontinuing LTOT. Patient and provider differences are important for informing patient-centered care and decisions around continuing, tapering, or discontinuing LTOT.

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“…The roughly 16% of Americans who have mental health disorders are responsible for roughly half of all opioids that are prescribed in the United States [98]. In the context of racial/ethnic minorities, opioids may be used to provide relief and distraction from recurrent experiences of racial oppression and disenfranchisement [99,100], acting as a maladaptive form of coping [101]. In general, while Black, Latino and Indigenous individuals have lower overall rates of mental illnesses, they are underdiagnosed for conditions such as depression and anxiety [102,103] and tend to have disproportionately high diagnoses (and overdiagnoses) of serious mental illnesses (schizophrenia, bipolar disorder, etc.)…”

Section: The Pronounced Role Of Acculturative Stress Mental Illness A...mentioning

confidence: 99%

Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model

Ezell,

Pho,

Ajayi

et al. 2024

Drug and Alcohol Review

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IssuesTo date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors.ApproachUsing the “risk environment” framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer‐reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual‐level risk factors.Key FindingsResults from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder.ImplicationsThere has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk‐phenomena tied to multi‐level forms of entrenched disenfranchisement.ConclusionThere is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.

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Societal Biases, Institutional Discrimination, and Trends in Opioid Use in the USA

Cited by 8 publications

References 25 publications

Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review

Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review

Patient and Provider Perspectives on Benefits and Harms of Continuing, Tapering, and Discontinuing Long-Term Opioid Therapy

Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model

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