Intervention Stigma toward Medications for Opioid Use Disorder: A Systematic Review

Abstract

Introduction

Medications for opioid use disorder (MOUD) are evidence-based treatments, yet can be controversial among some populations. This study provides a systematic review of prejudice and discrimination toward MOUD, a form of “intervention stigma,” or stigma associated with a particular medical treatment.

Methods

A systematic search strategy was used in PsychInfo and PubMed to identify studies published between 1998 and 2018. Studies that empirically examined stigma toward MOUD were included if the manuscript was of moderate or high quality. Studies were analyzed using thematic synthesis.

Results

The search yielded 972 studies, of which 28 were included. Most studies utilized qualitative methods to examine intervention stigma toward methadone or buprenorphine, with one including naltrexone. Studies demonstrated that intervention stigma among healthcare providers was influenced by lack of training and abstinent treatment preferences. Providers equated MOUD with illicit substance use and at times refused to care for MOUD patients. Stigma among peer patients seeking treatment was also influenced by abstinent treatment preferences, and among the general public stigma was influenced by lack of MOUD knowledge. Intervention stigma was also driven at the policy level by high regulation of methadone, which fueled diversion and hindered social functioning among patients. Few studies indicated how to reduce intervention stigma toward MOUD.

Conclusions

Intervention stigma affects both provision and perceptions of methadone and buprenorphine, decreasing access and utilization of MOUD. Future research should further develop and test MOUD stigma reduction interventions in a variety of social contexts to improve access to care and reduce patient barriers.

Keywords:

• Stigma
• medications for addiction treatment
• pharmacotherapy
• opioid use disorder
• methadone
• buprenorphine

Notes

1 Stigma categories based on Pescosolido and Martin’s (2015) stigma category typology

2 Studies ranked on the rigor of their methods, which is assessed by the CASP standards: https://casp-uk.net/casp-tools-checklists/

Additional information

Funding

This work was supported by the U.S. Department of Agriculture (USDA) National Institute of Food and Agriculture (NIFA) [award 2018-46100-28782].