Evaluating the role of stigma in polysubstance use and medication for opioid use disorder treatment in an underserved, rural setting

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Project Summary/Abstract Overdose rates related to opioid and stimulant use have been steadily increasing in underserved, rural areas of the U.S. for over 10 years. Addressing this gap in care, our team has successfully increased access to buprenorphine care through telemedicine aboard a mobile treatment unit (MTU) in rural Maryland. However, retention aboard the MTU remains a challenge, similar to other medication for opioid use disorder (MOUD) programs across the nation. Furthermore, polysubstance use, which is heavily prevalent in the MTU populations, has been found to exacerbate MOUD retention challenges. Stigma around substance use (SU) and MOUD is an established barrier to engagement in opioid use disorder and MOUD care. However, little is known regarding how SU and MOUD stigmas manifest and impact patients in rural settings. Given their shared, lived experience, peer recovery specialists (PRSs) may be a unique solution to shifting stigma barriers. Yet, few studies have examined if and how PRS engagement shifts stigma, particularly in underserved, rural communities. Thus, this study aims to: (1) use a qualitative approach to understand how substance use and MOUD stigmas impact patients and their treatment, as well as perspectives on the role of PRSs in shifting stigma, in an underserved, rural setting; (2) evaluate if and how baseline levels of stigmas impact six-month MOUD retention rates in this sample; and (3) assess if engagement in a PRS-delivered BA intervention shifts stigma.