Opioid Use Disorder Stigma Mechanisms in the Context of Buprenorphine Treatment

摘要 阿片类药物的流行已经成为美国对健康和生存最普遍的威胁之一。 治疗阿片类药物使用障碍(MOUD)的药物是治疗的金标准，具有强大的 在减少阿片类药物使用、阿片类药物过量风险和阿片类药物相关死亡方面有效的证据。不过， 对Moud治疗，特别是丁丙诺啡(BUP)的保留率和依从性低得令人沮丧； 这种新颖的、具有成本效益的、可扩展的干预方法，以增加和维持保留率和依从性 对BUP的治疗是迫切需要的。尽管围绕使用丁丙诺啡(BUP)治疗 OUD的治疗尚未确定，与美沙酮维持治疗相关的耻辱是 相当强，对治疗保留和结果有有害影响。考虑到快速扩张的 BUP的可及性及其与美沙酮并驾齐驱成为OUD治疗、研究的黄金标准 需要了解与BUP治疗相关的耻辱的性质，它对参与、保留、 和接受BUP治疗的个人的结果，并最终告知以污名为重点的干预措施。与NCCIH合作 支持，PI的父级R61奖专注于imFREE(交互)的开发和可用性测试 为摆脱阿片成瘾而发消息)，这是一项基于CBT的mHealth干预措施，旨在解决关键问题 保留和坚持BUP治疗的障碍，为以下有效性试验做准备 发起BUP的个人。在拟议的补充剂申请中，根据艾滋病毒污名理论， 我们建议：(A)采用来自艾滋病毒文献的心理测量学验证的措施，评估内部化， 预期和颁布艾滋病毒污名，用于评估阿片使用障碍(OUD)污名，以及(B)与吸毒者 输入，开发针对OUD污名的干预内容，并将其纳入我们最终的mHealth干预 在随后的R33阶段开始我们的有效性试验之前，父R61的精炼阶段。 此应用程序非常适合作为对NOT-OD-20-101《支持的管理补充》的响应 减少疼痛管理和阿片类药物使用障碍(OUD)和治疗中的耻辱的战略，“ 鼓励使用“现有的心理测量学验证工具来衡量其他人群(如艾滋病毒)的污名” 以及它们对这些人群的应用，以及对现有健康理论的适应和应用 与…相关的耻辱乌德在减少耻辱方面发挥了作用。与国家安全倡议的目标相一致，拟议的 补充研究建立在父母R61的基础上，扩大了我们与耻辱相关的mHealth干预 内容，以支持保留和对BUP的坚持。通过提供支持来解决污名问题并最大限度地提高BUP 治疗依从性，补充研究可能提供一种成本效益高、易于部署的策略 减少受艾滋病影响的人在个人层面上的耻辱，从而促进预防 服药过量死亡。

Abstract The opioid epidemic has become one of the most pervasive threats to health and survival in the U.S. Medications for the treatment of opioid use disorders (MOUD) are the gold standard treatment, with robust evidence of effectiveness in reducing opioid use, opioid overdose risk and opioid-related deaths. Nevertheless, retention and adherence to MOUD treatment, particularly buprenorphine (BUP), are discouragingly low; as such, novel, cost-effective, scalable intervention approaches to increase and sustain retention and adherence to BUP treatment are urgently needed. Although stigma surrounding the use of buprenorphine (BUP) for the treatment of OUD has yet to be characterized, stigma associated with methadone maintenance treatment is quite strong, and has deleterious effects on treatment retention and outcomes. Given the rapid expansion of BUP's accessibility and its emergence alongside methadone as a gold standard for OUD treatment, research is needed to understand the nature of stigma related to BUP treatment, its impact on engagement, retention, and outcomes of BUP treated individuals, and ultimately, to inform stigma focused interventions. With NCCIH support, the PI's parent R61 award focuses on development and usability testing of imFREE (Interactive Messaging for Freedom from Opioid Addiction), a CBT-based mHealth intervention that addresses critical barriers to retention and adherence to BUP treatment, in preparation for an effectiveness trial among individuals who are initiating BUP. In the proposed supplement application, based upon HIV Stigma Theory, we propose to: (a) adapt psychometrically validated measures from the HIV literature assessing internalized, anticipated, and enacted HIV stigma, for use in assessing opioid use disorder (OUD) stigma, and (b) with user input, develop intervention content targeting OUD stigma, to be incorporated in our final mHealth intervention refinement phase of the parent R61, prior to initiation of our effectiveness trial in the subsequent R33 phase. This application is an excellent fit as a response to NOT-OD-20-101, “Administrative Supplements to Support Strategies to Reduce Stigma in Pain Management and Opioid Use Disorders (OUD) and Treatment,” which encourages use of “existing psychometrically validated tools to measure stigma in other populations (e.g., HIV) and their application to these populations” as well as “the adaption and application of existing theories of health related stigma to…OUD in reducing stigma.” Consistent with the objectives of the NOSI, the proposed supplemental research builds upon the parent R61, expanding our mHealth intervention with stigma relevant content to bolster retention and adherence to BUP. By providing support to address stigma and maximize BUP treatment adherence, the supplemental research may provide a cost-effective, easily deployable strategy for reducing stigma at the individual level among those affected by OUD, thereby facilitating prevention of overdose deaths.