Underutilization of medications to treat opioid use disorder: What role does stigma play?

Abstract

There is consensus in the scientific literature that the opioid agonist medications methadone and buprenorphine are the most effective treatments for opioid use disorder. Despite increasing opioid overdose deaths in the United States, these medications remain substantially underutilized. For no other medical conditions for which an effective treatment exists is that treatment used so infrequently. In this commentary, we discuss the potential role of stigma in the underutilization of these opioid agonist medications for addiction treatment. We outline stigma toward medications for addiction treatment and suggest that structural and policy barriers to methadone and buprenorphine may contribute to this stigma. We offer pragmatic public health solutions to reduce stigma and expand access to these effective treatments.

Keywords:

• Opioid use disorder
• stigma
• health policy
• methadone
• buprenorphine

Acknowledgments

The authors wish to thank Dr. Hillary Kunins and Dr. Alex Harocopos of the New York City Department of Health and Mental Hygiene for their thoughtful critiques of this manuscript.

Author contributions

B. Allen conceptualized the commentary, drafted the manuscript, and provided critical edits to the manuscript. M. L. Nolan conceptualized the commentary, analyzed the data presented in the manuscript, and provided critical edits to the manuscript. D. Paone conceptualized the commentary, provided critical edits to the manuscript, and supervised the project.

Notes

1 Both Krawczyk et al.’s (2017) and DOHMH’s (2018) analyses used the Substance Abuse and Mental Health Service Administration’s Treatment Episode Dataset (TEDS). The dataset includes demographic and substance use characteristics for drug treatment admissions to all facilities licensed by the state to provide treatment for substance use disorder as well as facilities receiving public funding. The dataset is at the level of drug treatment admissions, and therefore may contain several admissions for the same person. When we talk about medications for addiction treatment in TEDS, we are primarily talking about methadone; TEDS does not capture office-based buprenorphine treatment.

2 Siena College Research Institute, as part of the coalition, Prescription for Progress. Survey conducted online February 8–14, 2018 through a proprietary panel of 1,384 New York State residents age 18 and older in English.

Additional information

Funding

All authors are employed by the New York City Department of Health and Mental Hygiene.