Understanding the Opioid Epidemic in Rural Ohio: A Mixed-Methods Analysis of Moral Values, Stigma, and Medication for Opioid Use Disorder (MOUD)

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Abstract Opioid-related mortality in the U.S continues to rise, particularly in the rural Appalachian region of the country. Increased availability of and access to evidence-based treatment for opioid use disorder, such as medication for opioid use disorder (MOUD) is needed to successfully address the epidemic; however, stigma among healthcare providers and community members as well as internalized stigma among people who use drugs (PWUD) are substantial barriers to MOUD availability and uptake in rural Appalachia. While public health efforts to address opioid use and treatment have often focused on stigma reduction, there is a need for interdisciplinary work to understand the forces underlying this stigma in rural Appalachian communities. In particular, cultural factors such as moral views may have critical consequences for drug- and MOUD-related stigma in these areas. The goal of the proposed research is to understand the relationship between moral views, stigma, and uptake of MOUD among people who use drugs in rural Appalachian Ohio, as well as to explore moral views and perceptions of MOUD among healthcare providers and community stakeholders. An understanding of the moral perceptions underlying or driving stigma in this region is critical for implementing more successful stigma reduction interventions and increasing access to evidence-based care for opioid use. Two theoretical frameworks from the emerging field of moral psychology, Moral Foundations Theory (MFT) and the Theory of Dyadic Morality (TDM), offer explanations for the potential pathway between moral worldview, stigma, and approval of MOUD. Testing these theories in the field of opioid research will strengthen interdisciplinary work between the fields of psychology and public health, contributing novel, valuable knowledge to both areas and forging connections for increased collaborative work in the future. Study aims will be completed within the context of a larger NIDA-funded Rural Opioid Initiative in rural Appalachian Ohio (Implementing a Community-Based Response to the Opioid Epidemic in Rural Ohio, UG3/UH3DA044822). Aim 1 will utilize Confirmatory Factor Analysis testing to assess the validity of instruments associated with MFT and TDM constructs in a rural Appalachian population of PWUD. Aim 2 will utilize structural equation modeling to examine the relationship between moral views and uptake of MOUD among PWUD, and explore potential mediation by internalized stigma. Aim 3 will involve qualitative interviews with treatment providers, PWUD, and other community stakeholders, to further understand moral perceptions and conceptualization of addiction and how these shape attitudes toward drug use and treatment. Through this proposed mixed-methods study, the applicant's background in biological sciences and public health will be strengthened and expanded to include expertise in social and moral psychology. Furthermore, mentorship experience with renowned faculty in health behavior, epidemiology, and moral psychology, as well as training opportunities to expand communication and dissemination skills will prepare the applicant for an independent academic research career.