The Intersecting Effect of Substance Use Stigma, Methadone Treatment Stigma, and Racial Discrimination on Methadone Treatment Outcomes

项目总结 2020年，阿片类药物过量死亡人数估计比前一年增加了20%。 黑人/非裔美国人社区与阿片类药物有关的死亡人数急剧增加。用药 对于阿片使用障碍，包括美沙酮维持治疗(MMT)，对 治疗阿片使用障碍(OUD)，但滞留是一个持久的挑战。种族/少数民族个人 OUD有不成比例的不良结果，包括更差的MMT保持。有一个迫切的需要 为了更好地了解MMT保留的障碍，以便提供有针对性和有效的干预措施，特别是 在黑人/非裔美国人中，有OUD。在多个层面上的污名，围绕着两种物质 使用障碍(SUD)和MMT是导致MMT结果不佳、社会贬值和不平等的关键驱动因素。在 “自我”污名的程度可以根据个人对污名的反应和处理方式进行进一步的分类。 内在化污名是指来自自我的针对自我的污名。预期污名(期望成为 歧视的目标)和制定的污名(过去的歧视经历)反映了针对 来自他人(家庭、雇主、医疗保健提供者等)的自我。此外，少数族裔人士也不例外 还经常在日常社交场合中经历与种族/族裔有关的耻辱和歧视，这 已被发现与不良的心理和身体健康结果广泛相关，并可能进一步 让我们的结果变得更糟。定量评估种族歧视、SUD和 MMT耻辱出人意料地稀少，而且很少与MMT结果相关的测试。拟议的研究是建立在 我们团队的形成性定性工作，由该提案的PI(Kleinman)领导，它描述了普遍存在的 社区MMT人群中的SUD和MMT耻辱和种族歧视的经历 巴尔的摩市的一项计划，该市是全国服药过量死亡率最高的城市之一，也是 低收入、种族/族裔少数人的生活负担。在拟议的研究中，我们将评估 种族歧视的经历以及内在化、预期化和制定的SUD和MMT耻辱 在一组开始进行MMT的患者中，他们认为自己是黑人/非裔美国人(N=180)。到时候我们会的 前瞻性检查耻辱和种族歧视对90天后MMT保留的影响 治疗开始后。最后，我们将利用缓和模型来评估种族之间的互动效果。 关于MMT保留的歧视和污名措施。这项研究的结果有可能为理论提供参考 和数据驱动的干预措施，以提高MMT的遵从性和保留率，特别是对于服务不足和 不成比例的受影响人口。这项研究将为PI(Kleinman)从 她接受了研究生培训，成为一名致力于减少健康的临床研究员，这是她早期充满希望的职业生涯 吸毒者之间的差异。

PROJECT SUMMARY In 2020 there was an estimated 20% increase in opioid overdose deaths from the previous year, and Black/African American communities are experiencing drastic increases in opioid-related fatalities. Medication for opioid use disorder, including methadone maintenance treatment (MMT), has a long history of efficacy for treating opioid use disorder (OUD), but retention is a persistent challenge. Racial/ethnic minority individuals with OUD disproportionately evidence poor outcomes, including worse MMT retention. There is an urgent need to better understand barriers to MMT retention in order to inform targeted and efficient interventions, especially among Black/African American individuals with OUD. Stigma at multiple levels, surrounding both substance use disorder (SUD) and MMT, is a key driver of poor MMT outcomes, social devaluation, and inequality. Within the level of “self,” stigma can be further categorized based on how individuals respond to and process stigma. Internalized stigma refers to stigma directed at the self from the self. Anticipated stigma (expectation to be the target of discrimination) and enacted stigma (past lived experience of discrimination) reflect stigma directed at the self from others (family, employer, health care provider, etc). Further, racial minority individuals with OUD also routinely experience race/ethnicity-related stigma and discrimination in everyday social situations, which has been found to be broadly associated with poor mental and physical health outcomes, and may further worsen OUD outcomes. Research quantitatively evaluating the intersection of racial discrimination, SUD and MMT stigma is surprising sparse, and rarely tested in relation to MMT outcomes. The proposed study builds on our team’s formative qualitative work, led by this proposal’s PI (Kleinman), which describes the pervasive experience of SUD and MMT stigma and racial discrimination among people in MMT at a community-based program in Baltimore City, which has one of the highest overdose-fatality rates in the country and greatest burdens of OUD among low-income, racial/ethnic minority individuals. In the proposed study, we will evaluate the experience of racial discrimination as well as internalized, anticipated, and enacted SUD and MMT stigma in a population of patients starting MMT who identify as Black/African American (N=180). We will then prospectively examine the effects of stigma and racial discrimination on subsequent MMT retention at 90 days after treatment initiation. Finally, we will utilize moderation models to evaluate interactive effects between racial discrimination and stigma measures on MMT retention. Results of this study have the potential to inform theory and data driven interventions to improve MMT adherence and retention, particularly for this underserved and disproportionately affected population. This study will serve as an important bridge for the PI (Kleinman) from her graduate training to her promising early career as a clinical researcher working towards reducing health disparities among people who use drugs.