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

项目摘要 2020年，阿片类药物过量死亡人数估计比前一年增加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。药物 阿片类药物使用障碍，包括美沙酮维持治疗（MMT），具有长期的疗效史， 治疗阿片类药物使用障碍（OUD），但保留是一个持续的挑战。少数种族/族裔个人 OUD不成比例地证明了不良结局，包括更差的MMT保留。迫切需要 更好地了解保留现代市场管理理论的障碍，以便为有针对性的有效干预提供信息，特别是 在患有OUD的黑人/非裔美国人中。柱头在多个水平，围绕两个物质 使用障碍（SUD）和MMT是MMT结果不佳、社会贬值和不平等的关键驱动因素。内 “自我”污名化的程度可以根据个人如何应对和处理污名化而进一步分类。 内化污名是指来自自我的针对自我的污名。预期的耻辱（期望成为 歧视目标）和制定的污名（过去遭受歧视的经历）反映了针对 从他人（家庭，雇主，医疗保健提供者等）的自我。此外，患有OUD的少数种族个体 在日常社会生活中也经常遭受与种族/族裔有关的耻辱和歧视， 已被发现与不良的精神和身体健康结果广泛相关，并可能进一步 恶化OUD结果。定量评估种族歧视、团结和民主 MMT的污名是令人惊讶的稀疏，很少测试与MMT的结果。拟议的研究建立在 我们的团队的形成定性工作，由本提案的PI（Kleinman）领导，它描述了普遍的 在一个以社区为基础的社区， 该计划在巴尔的摩市，其中有一个最高的过量死亡率在该国和最大的 低收入、种族/少数民族个人的OUD负担。在这项研究中，我们将评估 种族歧视的经历以及内化、预期和制定的SUD和MMT污名 在确定为黑人/非裔美国人的开始MMT的患者人群中（N=180）。然后我们将 前瞻性地检查污名和种族歧视对随后的MMT保留90天的影响 治疗开始后。最后，我们将利用适度模型来评估种族之间的互动效应 歧视和污名措施的MMT保留。这项研究的结果有可能为理论提供信息 和数据驱动的干预措施，以提高MMT的依从性和保留率，特别是对于这种服务不足的人， 不成比例地影响人口。本研究将作为PI（Kleinman）从 她的研究生训练，她有前途的早期职业生涯作为一个临床研究人员，致力于减少健康 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.