“You’re Not Supposed to be on it Forever”: Medications to Treat Opioid Use Disorder (MOUD) Related Stigma Among Drug Treatment Providers and People who Use Opioids

Abstract

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.

“I’m Clean and Sober, But Not Necessarily Free”: Perceptions of Buprenorphine Among Patients in Long-Term Treatment

“…These findings align with past research, including the perceived benefits of the medication for promoting stability and recovery, 23,27 -29 perceptions of medication side effects, 30,31 as well as patients’ stigmatized medication beliefs and desires to discontinue treatment despite overall positive perceptions. 11,12,32…”

“…[24][25][26] Others have documented patients' enhanced feelings of normalcy, stability, and quality of life stemming from engagement in buprenorphine treatment. 24,[26][27][28][29] Other research has documented patient concerns with the medication, including the need for greater structure and support, 24,29 unwanted sideeffects, 27,30,31 "intervention stigma" associated with the use of buprenorphine, 32 and ambivalence about opioid substitution therapy more generally. 10,12,26,32 As most studies have not explicitly sampled patients engaged in long-term treatment, it remains unknown how these findings align with the perspectives of patients in long-term recovery.…”

Suboxone: History, controversy, and open questions

“…According to the study author, this was an example of intervention stigma in the sense that it viewed drugs like Suboxone as medicine but not as a medicine that can be taken for extended periods of time ( 100 ). Another study followed up on Madden’s findings with similar evidence of intervention stigma in providers who saw MAT as a temporary tool, one that should be weaned off as soon as possible in order to achieve the goal of being “drug free” ( 101 ). Outside of formal treatment professionals there are collectives like the 12-step community which are fundamental in many recovering patients’ lives.…”

Medical Opioid Disposal in Fukuoka and Kumamoto Cities

“…In the United States, various research reported opioid overuse and related accidents. [3][4][5] The rules on opioid disposal are different in across countries. The frequency of opioid related accidents may depend on the degree of strictness of the rules.…”