Variation in intervention stigma among medications for opioid use disorder
Variation in intervention stigma among medications for opioid use disorder
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DOI：
10.1016/j.ssmqr.2022.100161
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发表时间：
2022-12-01
期刊：
影响因子：
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通讯作者：
Sulzer, Sandra H.
中科院分区：
文献类型：
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作者：
Madden, Erin F.;Barker, Kristin K.;Sulzer, Sandra H.
尽管有大量证据表明阿片类药物使用的有效性，但治疗阿片类药物使用障碍（mod）的药物经常被污名化。甚至从事药物使用治疗的医疗保健专业人员也可能将这些药物描述为不受欢迎的医疗干预形式。许多人认为他们更喜欢“以节制为基础”的治疗方法，而不是药物治疗。尽管如此，在美沙酮、丁丙诺啡和纳曲酮这三种以证据为基础的美国治疗药物之间，有迹象表明，在每种干预措施中，羞耻感的作用是不同的。通过对新墨西哥州和德克萨斯州的59名美国治疗专业人员进行深入的半结构化访谈，本研究显示了“干预耻辱感”的驱动因素，或对使用或提供医疗治疗或程序的耻辱感，对每种类型的mod。参与者描述了一个耻辱层次结构，将纳曲酮视为最可接受的，其次是丁丙诺啡，最后是美沙酮，这颠倒了每种药物的相对临床疗效。药理学和监管方面的差异、社会心理干预的优先次序、对利润动机的怀疑，以及对他们作为前治疗客户的个人经历的重视，以及专业轶事而不是科学证据，导致了对三种药物的不同程度的耻辱感。越来越多的人认识到耻辱感对吸毒者的有害影响，包括对吸毒成瘾如何也受到耻辱感影响的关注。这项研究提供了对不同治疗药物的耻辱感的多种驱动因素的详细描述，这些因素可能作为未来去耻辱感努力的关键杠杆点。
Despite a substantial evidence base for effectiveness, medications for opioid use disorder (MOUD) are often stigmatized. Even healthcare professionals working in substance use treatment may describe these medications as undesirable forms of medical intervention. Many argue they prefer an "abstinence-based" approach to treatment, free of pharmacotherapy. Nonetheless, between the three evidence-based U.S. treatment medications, which include methadone, buprenorphine, and naltrexone, there are signs of variation in how stigma operates toward each intervention. Using in-depth semi-structured interviews with 59 U.S. treatment professionals based in New Mexico and Texas, this study shows the drivers of "intervention stigma," or stigma toward the use or provision of a medical treatment or procedure, toward each type of MOUD. Participants describe a stigma hierarchy framing naltrexone as most acceptable, followed by buprenorphine, and finally methadone, which inverts the relative clinical efficacy of each medication. Pharmacological and regulatory differences, prioritization of psychosocial interventions, suspicion regarding profit motives, and the value placed on their personal experiences as former clients in treatment in tandem with professional anecdote over scientific evidence, contribute to different levels of stigma towards each of the three medications. Acknowledgement of the deleterious effects of stigma toward people who use drugs is growing, including attention to how MOUD is also subject to stigma. This study provides detailed descriptions of the multiple drivers of stigma toward different treatment medications that may serve as key leverage points for future destigmatization efforts.