Overcoming Stigma and Improving Outcomes for Substance Use Disorders Through Education, Engagement, and Empowerment

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PROJECT SUMMARY The United States is amid an opioid epidemic. The overall annual cost to society is more than $1 trillion. The COVID-19 pandemic appears to have accelerated the problem, with more than 81,000 individuals dying from overdose in the year ending May 2020. Astonishingly, while more than 2 million individuals have opioid use disorder (OUD), fewer than 35% of these adults received treatment in 2019. Stigma is one major reason for this treatment gap. For individuals with OUD, internalized negative beliefs may limit their engagement with healthcare systems. Furthermore, stigma among clinicians may limit implementation of lifesaving treatment. For all the tactics tried to deal with the opioid epidemic, one greatly underused element is contemporary approaches to teaching and learning. Although COVID-19 massively disrupted educational systems, the pandemic has highlighted the importance of and opportunity for innovation through technology. C4 Innovations (C4) and partners at Yale University (Yale) and the West Haven VA Medical Center (WHVA) propose to develop and test OASIS (Overcoming and Addressing Stigma in Substance Use Disorders). OASIS is a web-based educational platform for primary care clinicians and individuals with OUD. We believe that OASIS will decrease barriers to care and enhance OUD treatment outcomes. Our team includes experts in education, the neuroscience and treatment of OUD, the effect and management of stigma, and product development and testing. The platform will help patients and clinicians to engage with a diverse set of high-quality educational materials according to their personal needs, including synchronous and asynchronous opportunities to interact with experts and peers. We designed the platform to assist individuals in the pre-contemplative or contemplative stages of addiction, targeting the stigma that limits engagement with care, and helping initiate evidence-based treatment. Two specific aims guide our Phase I pilot study: AIM 1: Develop a prototype of OASIS for patients with OUD and primary care clinicians; conduct usability testing. AIM 2: Pilot OASIS with a small sample of individuals with untreated OUD and their clinicians to determine feasibility, acceptability, and preliminary product effectiveness for a Phase II effectiveness trial. The C4–Yale–WHVA team will test OASIS with patients (N = 30) and clinicians (N = 5) using validated measures and qualitative interviews. The team will assess usability, satisfaction, knowledge, empowerment, and stigma. A future Phase II project would include a controlled trial of the final product demonstrating its efficacy for empowering patients to engage in dialogues with their primary care clinicians and initiate OUD treatment, with the ability to expand the tool for future products addressing a broader array of substances. Our team is confident that healthcare systems will be interested in purchasing a tool for patients and clinicians that reduces stigma, improves outcomes, and reduces high costs associated with untreated OUD.