Opioid Use Disorder Stigma Mechanisms in the Context of Buprenorphine Treatment

丁丙诺啡治疗背景下的阿片类药物使用障碍耻辱机制

• 批准号: 10176016
• 负责人: Suzette V Glasner-Edwards
• 金额: $ 14.52万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-28 至 2021-06-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10176016
• 关键词: Address; Adherence; Administrative Supplement; Adult; Affect; Aftercare; Award; Behavior; Buprenorphine; Clinical; Data; Data Collection; Development; Dimensions; Effectiveness; Feedback; Feeling; Freedom; Funding; Gold; Grant; HIV; Health; Health behavior outcomes; Individual; Intervention; Light; Literature; Measures; Mediator of activation protein; Medical; Mental Health; Mental disorders; Methadone; Morbidity - disease rate; Nature; Opiate Addiction; Outcome; Overdose; Pain management; Parents; Participant; Patients; Pharmaceutical Preparations; Pharmacological Treatment; Phase; Population; Preparation; Protocols documentation; Psychometrics; Public Health; Qualitative Methods; Recommendation; Reporting; Research; Research Personnel; Series; Stigmatization; Subgroup; Testing; Thinking; Validity and Reliability; base; behavioral adherence; buprenorphine treatment; comorbidity; cost effective; effectiveness trial; experience; follow-up; implementation strategy; intersectionality; mHealth; methadone treatment; mortality; novel; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; overdose prevention; overdose risk; patient population; programs; recruit; resilience; response; social stigma; standard care; theories; therapy development; tool; treatment adherence; usability

Abstract The opioid epidemic has become one of the most pervasive threats to health and survival in the U.S. Medications for the treatment of opioid use disorders (MOUD) are the gold standard treatment, with robust evidence of effectiveness in reducing opioid use, opioid overdose risk and opioid-related deaths. Nevertheless, retention and adherence to MOUD treatment, particularly buprenorphine (BUP), are discouragingly low; as such, novel, cost-effective, scalable intervention approaches to increase and sustain retention and adherence to BUP treatment are urgently needed. Although stigma surrounding the use of buprenorphine (BUP) for the treatment of OUD has yet to be characterized, stigma associated with methadone maintenance treatment is quite strong, and has deleterious effects on treatment retention and outcomes. Given the rapid expansion of BUP's accessibility and its emergence alongside methadone as a gold standard for OUD treatment, research is needed to understand the nature of stigma related to BUP treatment, its impact on engagement, retention, and outcomes of BUP treated individuals, and ultimately, to inform stigma focused interventions. With NCCIH support, the PI's parent R61 award focuses on development and usability testing of imFREE (Interactive Messaging for Freedom from Opioid Addiction), a CBT-based mHealth intervention that addresses critical barriers to retention and adherence to BUP treatment, in preparation for an effectiveness trial among individuals who are initiating BUP. In the proposed supplement application, based upon HIV Stigma Theory, we propose to: (a) adapt psychometrically validated measures from the HIV literature assessing internalized, anticipated, and enacted HIV stigma, for use in assessing opioid use disorder (OUD) stigma, and (b) with user input, develop intervention content targeting OUD stigma, to be incorporated in our final mHealth intervention refinement phase of the parent R61, prior to initiation of our effectiveness trial in the subsequent R33 phase. This application is an excellent fit as a response to NOT-OD-20-101, “Administrative Supplements to Support Strategies to Reduce Stigma in Pain Management and Opioid Use Disorders (OUD) and Treatment,” which encourages use of “existing psychometrically validated tools to measure stigma in other populations (e.g., HIV) and their application to these populations” as well as “the adaption and application of existing theories of health related stigma to…OUD in reducing stigma.” Consistent with the objectives of the NOSI, the proposed supplemental research builds upon the parent R61, expanding our mHealth intervention with stigma relevant content to bolster retention and adherence to BUP. By providing support to address stigma and maximize BUP treatment adherence, the supplemental research may provide a cost-effective, easily deployable strategy for reducing stigma at the individual level among those affected by OUD, thereby facilitating prevention of overdose deaths.

摘要 阿片类药物流行病已成为美国健康和生存的最普遍威胁之一。 治疗阿片类药物使用障碍（MOUD）的药物是金标准治疗，具有稳健的 减少类阿片使用、类阿片过量风险和类阿片相关死亡的有效证据。然而，尽管如此， 保留和坚持MOUD治疗，特别是丁丙诺啡（BUP），是令人沮丧的低; 这种新颖的、具有成本效益的、可扩展的干预方法， BUP治疗是迫切需要的。虽然围绕使用丁丙诺啡（BUP）的耻辱， OUD的治疗尚未被描述，与美沙酮维持治疗相关的耻辱感， 相当强烈，并对治疗保留和结果产生有害影响。鉴于快速扩张的 BUP的可及性及其与美沙酮一起作为OUD治疗的黄金标准，研究 需要了解与BUP治疗相关的耻辱的性质，其对参与，保留， 和结果的BUP治疗的个人，并最终，告知耻辱为重点的干预措施。关于NCCIH 支持，PI的父R61奖侧重于开发和可用性测试的imFREE（互动 信息自由从阿片类药物成瘾），基于CBT的移动健康干预，解决关键的 保留和坚持BUP治疗的障碍，为在以下人群中进行有效性试验做准备 正在启动BUP的个人。在拟议的补充申请中，根据艾滋病毒耻辱理论， 我们建议：（a）从艾滋病文献中采用心理测量学验证的方法评估内化， 预期，并制定了艾滋病毒的耻辱，用于评估阿片类药物使用障碍（OUD）的耻辱，和（B）与用户 投入，开发针对OUD污名的干预内容，并将其纳入我们最终的移动健康干预措施中 在随后的R33阶段开始我们的有效性试验之前， 此应用程序非常适合作为对NOT-OD-20-101“支持的管理补充“的响应 减少疼痛管理和阿片类药物使用障碍（OUD）和治疗中的耻辱的策略，” 鼓励使用“现有的心理测量验证工具来衡量其他人群中的耻辱感（例如，艾滋病毒） 以及现有健康理论的适应和应用 相关的耻辱. OUD在减少耻辱。”根据NOSI的目标，建议 补充研究建立在母公司R61的基础上，扩大了我们与耻辱相关的移动健康干预措施 内容，以加强保留和坚持BUP。通过提供支持，解决污名化问题，最大限度地提高BUP 治疗依从性，补充研究可以提供一个具有成本效益的，易于部署的策略， 在个人层面上减少受OUD影响的人的耻辱感，从而促进预防 过量死亡