Abstract

Introduction

Medications for opioid use disorder (MOUD) are evidence-based treatments, yet can be controversial among some populations. This study provides a systematic review of prejudice and discrimination toward MOUD, a form of “intervention stigma,” or stigma associated with a particular medical treatment.

Methods

A systematic search strategy was used in PsychInfo and PubMed to identify studies published between 1998 and 2018. Studies that empirically examined stigma toward MOUD were included if the manuscript was of moderate or high quality. Studies were analyzed using thematic synthesis.

Results

The search yielded 972 studies, of which 28 were included. Most studies utilized qualitative methods to examine intervention stigma toward methadone or buprenorphine, with one including naltrexone. Studies demonstrated that intervention stigma among healthcare providers was influenced by lack of training and abstinent treatment preferences. Providers equated MOUD with illicit substance use and at times refused to care for MOUD patients. Stigma among peer patients seeking treatment was also influenced by abstinent treatment preferences, and among the general public stigma was influenced by lack of MOUD knowledge. Intervention stigma was also driven at the policy level by high regulation of methadone, which fueled diversion and hindered social functioning among patients. Few studies indicated how to reduce intervention stigma toward MOUD.

Conclusions

Intervention stigma affects both provision and perceptions of methadone and buprenorphine, decreasing access and utilization of MOUD. Future research should further develop and test MOUD stigma reduction interventions in a variety of social contexts to improve access to care and reduce patient barriers.

中文翻译：

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对阿片类药物使用障碍药物的干预污名：系统评价

摘要

介绍

阿片类药物使用障碍 (MOUD) 的药物是循证治疗，但在某些人群中可能存在争议。本研究系统回顾了对 MOUD 的偏见和歧视，MOUD 是一种“干预污名”或与特定医疗相关的污名。

方法

PsychInfo 和 PubMed 使用了系统搜索策略来识别 1998 年至 2018 年间发表的研究。如果手稿质量中等或高质量，则包括实证检验对 MOUD 的污名的研究。使用主题综合分析研究。

结果

搜索产生了 972 项研究，其中包括 28 项。大多数研究使用定性方法来检查对美沙酮或丁丙诺啡的干预污名，其中包括纳曲酮。研究表明，医疗保健提供者的干预污名受到缺乏培训和禁欲治疗偏好的影响。提供者将 MOUD 等同于非法物质使用，有时拒绝照顾 MOUD 患者。寻求治疗的同行患者的污名也受到戒断治疗偏好的影响，而公众的污名受到缺乏 MOUD 知识的影响。对美沙酮的高度监管也在政策层面推动了干预污名化，这助长了患者的分流并阻碍了患者的社会功能。很少有研究表明如何减少对 MOUD 的干预污名。

结论

干预污名影响美沙酮和丁丙诺啡的供应和认知，减少 MOUD 的获取和利用。未来的研究应在各种社会背景下进一步开发和测试减少 MOUD 污名的干预措施，以改善获得护理的机会并减少患者的障碍。