Stigma Associated with Opioid Use Disorder and Medication Assisted Treatment

2019 ◽  
Author(s):  
Dr. Harry Holt
Keyword(s):  
Primary Care ◽  
Maintenance Therapy ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Negative Stereotypes ◽  
Medication Assisted Treatment

<b>Purpose</b>: This paper reviews and integrates the literature on the stigma associated with opioid use disorder (OUD) and how this acts as a barrier for patients seeking Medication Assisted Treatment (MAT). Implications for patients in rural areas who face stigma for opioid use disorder are reviewed. <b>Methods: </b>We examine the extant literature since 2007, reviewing studies focused on the stigma against patients suffering from OUD and MAT. <b>Findings</b>: The review identifies five categories of sources of stigma that research has addressed: Stigma against the patient; stigma by nurses; stigma by primary care physicians; stigma from counselors; stigma by pharmacy and dispensary staff; stigma against MAT by drug courts, stigma by family members, coworkers, and employers. <b>Conclusions</b>: Stigma exists as prejudice, negative stereotypes and associations, and labels. Despite widespread evidence supporting Methadone Maintenance Therapy (MMT) and Buprenorphine Maintenance Therapy (BMT) effectiveness, stigma abounds within the medical community and society at large. Discriminatory practices, poor relationships with dispensing staff, pharmacists, counselors, and doctors, and a feeling of being separate or “alien” from others are cited as barriers to involvement and participation in MAT. This has created disparities in health care outcomes as well as the access and availability of MAT services. Rural patients experience these sources of stigma and face a heightened barrier to access for MAT services. However, the primary care setting along with delivery of care through primary care physicians, physician assistants, and nurse practitioners offers a means to increase care in rural areas.

Stigma Associated with Opioid Use Disorder and Medication Assisted Treatment

2019 ◽  
Author(s):  
Dr. Harry Holt
Keyword(s):  
Primary Care ◽  
Maintenance Therapy ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Negative Stereotypes ◽  
Medication Assisted Treatment

<b>Purpose</b>: This paper reviews and integrates the literature on the stigma associated with opioid use disorder (OUD) and how this acts as a barrier for patients seeking Medication Assisted Treatment (MAT). Implications for patients in rural areas who face stigma for opioid use disorder are reviewed. <b>Methods: </b>We examine the extant literature since 2007, reviewing studies focused on the stigma against patients suffering from OUD and MAT. <b>Findings</b>: The review identifies five categories of sources of stigma that research has addressed: Stigma against the patient; stigma by nurses; stigma by primary care physicians; stigma from counselors; stigma by pharmacy and dispensary staff; stigma against MAT by drug courts, stigma by family members, coworkers, and employers. <b>Conclusions</b>: Stigma exists as prejudice, negative stereotypes and associations, and labels. Despite widespread evidence supporting Methadone Maintenance Therapy (MMT) and Buprenorphine Maintenance Therapy (BMT) effectiveness, stigma abounds within the medical community and society at large. Discriminatory practices, poor relationships with dispensing staff, pharmacists, counselors, and doctors, and a feeling of being separate or “alien” from others are cited as barriers to involvement and participation in MAT. This has created disparities in health care outcomes as well as the access and availability of MAT services. Rural patients experience these sources of stigma and face a heightened barrier to access for MAT services. However, the primary care setting along with delivery of care through primary care physicians, physician assistants, and nurse practitioners offers a means to increase care in rural areas.

scholarly journals 3543 Translating the complex medical jargon of opioid use disorder and medication assisted treatment into locally relevant messages in rural Colorado using Boot Camp Translation

2019 ◽  
Vol 3 (s1) ◽  
pp. 97-98
Author(s):  
Mary Fisher ◽  
Donald E. Nease ◽  
Linda Zittleman ◽  
Jack Westfall ◽  
Jennifer Ancona
Keyword(s):  
Primary Care ◽  
Local Community ◽  
Boot Camp ◽  
Opioid Use Disorder ◽  
Research Network ◽  
High Plains ◽  
Opioid Use ◽  
Community Members ◽  
Medication Assisted Treatment ◽  
South Central

OBJECTIVES/SPECIFIC AIMS: Opioid use disorder (OUD) is a national epidemic and identified as a top priority by the practices and communities in rural Colorado. Until recently, few resources existed to address OUD in rural communities. In addition to training primary care and behavioral health practice teams in medication assisted treatment (MAT), Implementing Technology and Medication Assisted Treatment and Team Training and in Rural Colorado (IT MATTTRs Colorado) engaged local community members to alter the community conversation around OUD and treatment. For IT MATTTRs, the High Plains Research Network and the Colorado Research Network engaged community members in a 8-10 month process known as Boot Camp Translations (BCT) to translate medical information and jargon around OUD and MAT into concepts, messages, and materials that are meaningful and actionable to community members. The resulting community interventions are reported here. METHODS/STUDY POPULATION: IT MATTTRs conducted separate BCTs in Eastern Colorado and the south central San Luis Valley. Community partners included non-health professionals with diverse backgrounds, public health and primary care professionals, law enforcement, and others. The BCT process includes a comprehensive education on OUD and MAT and facilitated meetings and calls to develop messages and dissemination strategies. Each BCT lasted around 8-10 months. RESULTS/ANTICIPATED RESULTS: The BCT process elicited unique contextual ideas and constructs for messages, materials, and dissemination strategies. Themes common to both BCTs include the prevalence of OUD and that help is available in the local primary care office. Community-tailored messages are distributed through posters and flyer inserts, drink coasters, newspaper articles, letters to local judges, restaurant placemats, and websites. Examples of the materials and messages will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: Local community members are eager to help address the OUD crisis. Built on community-based participatory research principles, BCT can be used to translate complex information and guidelines around OUD and MAT into messages and materials that reflect local culture and community needs.

Knowledge gaps and practice patterns of clinicians treating patients with opioid use disorder

2019 ◽  
Vol 15 (6) ◽  
pp. 455-468 ◽  
Author(s):  
Maziar Rasulnia, PhD ◽  
Billy Stephen Burton, MS ◽  
Dhiren Patel, PharmD
Keyword(s):  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Practice Patterns ◽  
Physician Assistants ◽  
Opioid Use Disorder ◽  
Audit And Feedback ◽  
Primary Study ◽  
Opioid Use ◽  
Knowledge Gaps ◽  
Survey Tool

Objective: The goal of the study was to assess knowledge gaps and practice patterns of US-based addiction specialists, primary care physicians (PCPs), nurse practitioners (NPs), and physician assistants (PAs) who treat patients with opioid use disorder (OUD).Design: As part of a prospective study, the authors developed a survey tool consisting of case-vignettes and questions designed to reveal practice patterns and highlight gaps in clinician knowledge.Setting: The primary study setting included clinicians practicing in outpatient care.Participants: The surveys were distributed via email between August and September 2017 to a national sample of addiction specialists, PCPs, and NPs/Pas that see at least one patient per week and at least 1 percent of their patient population had to be diagnosed with OUD.Results: The knowledge assessment results varied among the clinicians surveyed. Addiction specialists saw more patients with OUD than PCPs, NPs, or PAs. They also demonstrated a higher level of understanding and knowledge of the various domains assessed.Conclusions: There are multiple educational intervention strategies that can support the clinicians; including reducing restrictions to access treatment for OUD, care coordination programs for patients to improve early access to treatment and education, and frequent chart audit and feedback programs to support clinician decision making and education.

Primary Care and Physician Extenders in Affluent Countries

1977 ◽  
Vol 7 (4) ◽  
pp. 545-555 ◽  
Author(s):  
Milton I. Roemer
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
The United States ◽  
Industrialized Countries ◽  
Major Response ◽  
Urban And Rural Areas ◽  
Physician Extenders

The worldwide growth of specialization in medicine has led to a perceived shortage of primary care. A major response in the United States has been the training of physician extenders (both physician assistants and nurse practitioners). Other industrialized countries have rejected this approach, in favor of strengthening general medical practice through continuing education, provision of ancillary personnel, use of health centers, and by other methods. Developing countries use doctor-substitutes as a reasonable adjustment to their lack of economic resources. All countries use ancillary personnel for selected procedures, such as midwifery, which involve only limited judgment and decision making. The American strategy on use of doctor-substitutes for primary care, however, follows from unwillingness to train greater numbers of primary care physicians and to require them to serve in places of need. This results in an inequitable concentration of doctor-substitutes on service to the poor in both urban and rural areas.

The role of stigma in U.S. primary care physicians’ treatment of opioid use disorder

2021 ◽  
Vol 221 ◽  
pp. 108627
Author(s):  
Elizabeth M. Stone ◽  
Alene Kennedy-Hendricks ◽  
Colleen L. Barry ◽  
Marcus A. Bachhuber ◽  
Emma E. McGinty
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Opioid Use Disorder ◽  
Opioid Use

scholarly journals Harm Reduction Service Utilization Among People Who Inject Drugs in Tajikistan: Prevalence and Precipitating Factors

2020 ◽  
Author(s):  
Mary M. Tate ◽  
Daniel J. Bromberg ◽  
Kamiar Alaei ◽  
Saifuddin Karimov ◽  
Dilshod Saidi ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Methadone Maintenance Therapy ◽  
People Who Use Drugs ◽  
People Living With Hiv ◽  
Opioid Use ◽  
Needle And Syringe Programs

Abstract Tajikistan is in a unique geopolitical location along the global heroin trade route, exacerbating its own opioid use disorder and HIV epidemics. With one of the highest rates of opioid use disorder in the world, and 20,000-30,000 people who inject drugs in the country, Tajikistan’s government and international actors have provided harm reduction measures for people who use drugs, like narcology centers, needle and syringe programs, and methadone maintenance therapy. No implementation science studies have been conducted in Tajikistan and the current implementation gaps in service uptake are unknown. The purpose of this paper is to determine the prevalence of harm reduction service uptake among people who use drugs in Tajikistan, and determine which factors are associated with service uptake. Methods This paper uses data from the National AIDS Registry, subset to patients who use drugs (n=11,029) and cross-sectional data from a bio-behavioral survey conducted in 2017 (n=2,390). Univariate and multivariate logistic regression were used to assess associations between study variables and probably of uptake of narcology center registration, uptake of needle and syringe programs, and registration into methadone maintenance therapy. Results Fewer than half of all people who inject drugs (42.4%) were registered with the narcology center , most people who inject drugs (88.6%) reported always having access to clean syringes, and only 5.3% of PWID had ever engaged in methadone treatment in Tajikistan. There were ethnic differences in service uptake – with ethnic Russians and Uzbeks less likely to use services than ethnic Tajiks. Men who have sex with men and people living with HIV were also more likely to access services than heterosexual or seronegative individuals. Conclusion Narcology center registration and clean needle coverage are high in Tajikistan. Methadone maintenance therapy uptake, however, is low, like in other countries in Eastern Europe and Central Asia. NGO and government initiatives that target risk groups (like LGBTQ+ people and people living with HIV) seem to have been somewhat effective at recruiting their clientele into services. Future research might focus on the “positive deviancy” of these subgroups of people who use drugs to learn how to increase service uptake generally.

Responding to the Opioid Epidemic

2021 ◽  
pp. 77-91
Keyword(s):  
Rural Areas ◽  
Complex Disease ◽  
Opioid Use Disorder ◽  
Opioid Addiction ◽  
Rural Populations ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Medication Assisted Treatment ◽  
Correctional Settings ◽  
Opioid Use Disorders

Chapter 6 examines the complex disease of opioid use disorder and the barriers that exist within the very system designed to help. It also highlights some promising pockets of progress, focusing especially on two environments hit hard by opioid addiction: correctional settings and rural areas. Elizabeth Connolly argues that medication-assisted treatment (MAT) improves outcomes for incarcerated individuals with opioid use disorders and presents examples of successful MAT programs in Massachusetts and Colorado. John Gale explains the complex factors that contribute to opioid addiction among rural populations and why those communities are disproportionately impacted by this epidemic. The chapter concludes with a look at why more progress has not been made.

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