NorthStar Node of the Clinical Trials Network

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Title: Reducing Stigma toward People with Opioid Use Disorder among Primary Care Clinicians Abstract Text: Opioid use disorder (OUD) is a significant public health problem that leads to tens of thousands of overdose deaths every year. Medications to treat OUD (MOUD), including buprenorphine and naltrexone, reduce risks of overdose and mortality and can be prescribed in primary care settings. However, relatively few primary care clinicians (PCCs) prescribe MOUDs. One potential barrier is that PCCs may hold common stigmatizing beliefs towards people with OUD, decreasing their likelihood of treating patients with MOUDs. Interventions to address stigma among healthcare providers are rare; however, limited research suggests that contact with people who have OUD is one of the best approaches to reduce stigma. Our team has created a clinical decision support (CDS) tool in the electronic health record designed to help PCCs identify, screen, diagnose, and treat OUD (“OUD CDS”). This project uses a randomized clinical trial design to examine whether an online training for the OUD CDS, infused with patient narratives, reduces stigma towards people with OUD among PCCs compared to an attention-control training. In the intervention group, clinicians complete an online training where they are presented with four patient scenarios representing clinical scenarios for which they might use the OUD CDS. PCCs watch videos of patients with OUD (patient actors) telling their stories while simultaneously learning how they might use the OUD CDS in each scenario. The patient narratives are designed to humanize the patients, demonstrate appropriate person-first language, reduce the use of labels (“addict”), encourage PCCs to learn a patient’s story before making assumptions (e.g., that the patient is “drug-seeking”), and dispel stigma of using buprenorphine to treat OUD by showing patients who have successfully been treated using the medication. The attention-control training walks PCCs through the same four clinical scenarios; however, they do not see the patient videos or hear their stories. PCCs complete surveys immediately after the training and 3 months later; their use of the CDS and MOUD referrals and prescriptions are monitored for 6-months. It is hypothesized that the intervention, compared to the attention-control training without patient narratives, reduces stigma towards people with OUD among PCCs, increases intention to get waivered to prescribe buprenorphine among non-waivered clinicians, and increases intention to prescribe buprenorphine if a waiver was not required. Further, it is hypothesized that clinicians who receive the intervention training are more likely to use the OUD CDS tool and ultimately treat patients with OUD compared to PCCs who receive the attention control training. If shown to be effective, the intervention can be disseminated widely and could be used as a model to reduce stigma towards people with OUD among PCCs more broadly.