A Mixed Methods Exploration of Stigma, Discrimination, and Sleep Among Those on Medication for Opioid Use Disorder

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PROJECT SUMMARY Sleep deficiency occurs in as many as 65% of people with OUD. The prevalence of sleep deficiency is attributable to concurrent factors such as mental health disorders, chronic pain, and medication use (e.g., benzodiazepine abuse), however the contribution of social factors are not well understood. Persistent social factors and concerns within this population are stigma and discrimination. People on MOUD are stigmatized and discriminated against for a number of reasons including OUD itself, treatment status and possibly other personal characteristics or social issues (e.g., race, gender, socioeconomic status, and incarceration history) that may contribute to intersectional stigma and intersectional discrimination. However, the relationship between stigma and discrimination with sleep deficiency and intersectional experiences and perceptions of stigma and discrimination among patients on MOUD are not well understood. The purpose of the proposed convergent mixed methods study, nested within the NIH HEAL funded mechanistic study (CLOUDS STUDY- Collaboration Linking Opioid Use Disorder and Sleep) is to examine the relationship between OUD-related stigma, and intersectional discrimination with sleep deficiency among patients on MOUD. We will address the following aims: Aim 1: Examine the relationships between (1a) OUD-related stigma; (1b) intersectional discrimination; (1c) self-reported and objectively measured (wrist actigraph) sleep deficiency; among patients on MOUD [quantitative]. Hypothesis: OUD-related stigma and intersectional discrimination are associated with increased sleep deficiency among patients on MOUD while controlling for pain, perceived stress, and mental health. Aim 2: Describe (1) how individuals perceive issues of stigma, discrimination, and sleep; (2) the intersectional phenomena of stigma and discrimination; (3) how experiences and perceptions associate with sleep [qualitative]. Aim 3: Gain a comprehensive understanding of the relationship between stigma and discrimination with sleep deficiency among patients on MOUD through integration of quantitative and qualitative data from Aims 1 and 2 [mixed methods]. Aligned with NIDA's strategic priority of understanding complex interactions of factors influencing drug use trajectories, the proposed research training proposal will provide an essential foundation for a sustained research career focused on investigating modifiable psychosocial factors influence on health among those who suffer from drug addiction.