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How do we combat stigma? How does stigma surrounding medication-assisted treatments (i.e., methadone and buprenorphine) hinder recovery?
In preparation for this week's discussion, I wanted to share some resources that might be of interest. We encourage you to share additional resources on this important topic, as well as any questions you'd like to see our panel address over the course of the week. Looking forward to a great discussion!All resources for this Expert Panel can be found at ghdonline.org/opioid-epidemic/resources
Link leads to: https://cdn1.sph.harvard.edu/wp-content/uploads/sites/94/2016/03/STAT-Harvard-Poll-Mar-2016-Prescription-Painkillers.pdf
Link leads to: http://tps.sagepub.com/content/53/4/465
Link leads to: http://pcssmat.org/opioid-resources/barriers-to-treatment/
Link leads to: http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page
I see the impact of stigma on my patients with opioid use disorders every day. I often work with patients who are reluctant to pursue evidence-based medication treatment such as buprenorphine-naloxone or methadone maintenance, because they feel that those medications would simply perpetuate their addiction, and they feel that they should be able to stop using through will-power alone. These views (summarized in the PCSS resource above) reflect how stigmatized the disease of addiction is. Addiction has roots in not only behavior, but in enduring biological changes that follow repeated behaviors; up to half of an individual's vulnerability to addiction stems from his or her genetic makeup, while environmental factors also contribute. In this complexity, addiction resembles many other chronic diseases. Yet many patients feel the stigma that surrounds them and feel that they "should" recover without the help of medication, rather than making whatever choice it is that they feel would help them be most successful. Just as concerningly, stigma from healthcare providers and the healthcare system has contributed to the limitations of our response to the opioid epidemic, for example, preventing providers from diagnosing substance use disorders, or from becoming waivered to provide buprenorphine. Additionally, many payers don't reimburse highly evidence-based forms of treatment, such as methadone maintenance--and they get away with it. I'd love to hear from others about where you see stigma holding us back and what interventions have been helpful in your work with patients, providers and communities.
We healthcare providers are also waking up to the impact of stigmatizing language that we use to talk about substance use disorders. Terms such as "clean" and "dirty" are used to describe the results of urine drug testing--or even worse, to describe a human being. Terms such as "habit" and "abuse" allude to addiction as a casual choice, rather than a brain disease. Fortunately, ONDCP Director Michael Botticelli is leading the charge to try to reform our language and stop blaming our patients for their disease and worsening the stigma that they endure. See the attached links and documents about the ONCDP initiative and other related materials.
Thank you!Here's a review of interventions to combat stigma (including"self-stigma", social stigma, and "structural stigma" which includes stigma by medical professionals): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272222/And, stigma may have a disproportionate impact on subgroups of our patients. This an interesting qualitative study of the experience of a group of pregnant women with substance use disorders, exploring their responses to stigma:http://link.springer.com/article/10.1186/s40352-015-0015-5