Sage Journals: Discover world-class research

Abstract

Harm reduction and pharmacotherapy approaches to addressing substance use disorder are evidence-based practices for reducing adverse health outcomes. However, professional stigma toward these approaches impedes implementation. In this pilot study, professionals working in substance use treatment services received a 4-hour asynchronous online harm reduction and pharmacotherapy training. Pre- and post-training surveys used Likert-scale questions to assess attitudes and planned actions. Four of the 23 survey items demonstrated a significant change in pre- to post-attitudes and planned actions relating to harm reduction or pharmacotherapy. These items included less attitudinal stigma towards: methadone and buprenorphine (p = .021), overdose prevention sites/“drug consumption facilities” (p = .025), and naloxone distribution (p = .017), as well as lower intent to primarily promote abstinence-based interventions (p = .007). This study demonstrated that online asynchronous educational interventions show promise for reducing stigmatizing attitudes towards evidence-based practices among substance use treatment professionals.

Keywords

stigma medications for opioid use disorder methadone buprenorphine treatment professionals harm reduction overdose prevention sites naloxone education online learning

Get full access to this article

View all access options for this article.

References

Adams

J. M.

Volkow

N. D.

(2020). Ethical imperatives to overcome stigma against people with substance use disorders. AMA Journal of Ethics, 22(1), 702–708. https://doi.org/10.1001/amajethics.2020.702

Ahmad

F. B.

Cisewski

J. A.

Rossen

L. M.

Sutton

(2023). Provisional drug overdose death counts. National Center for Health Statistics. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Aletraris

Edmond

M. B.

Paino

Fields

Roman

P. M.

(2016). Counselor training and attitudes toward pharmacotherapies for opioid use disorder. Substance Abuse, 37(1), 47–53. https://doi.org/10.1080/08897077.2015.1062457

American Society of Addiction Medicine (ASAM) . (2015). National practice guideline for the use of medications in the treatment of addiction Involving Opioid Use (p. 66). https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf

American Society of Addiction Medicine (ASAM) . (2020). National practice guideline for the use of medications in the treatment of addiction involving opioid use: 2020 focused update. https://www.asam.org/quality-care/clinical-guidelines/national-practice-guideline

Arredondo

Beletsky

Baker

Abramovitz

Artamonova

Clairgue

Morales

Mittal

M. L.

Rocha-Jimenez

Kerr

Banuelos

Strathdee

S. A.

Cepeda

(2019). Interactive versus video-based training of police to communicate syringe legality to people who inject drugs: The SHIELD study, Mexico, 2015-2016. American Journal of Public Health, 109(6), 921–926. https://doi.org/10.2105/AJPH.2019.305030

Avery

Knoepflmacher

Mauer

Kast

K. A.

Greiner

Avery

Penzner

J. B.

(2019). Improvement in residents’ attitudes toward individuals with substance use disorders following an online training module on stigma. HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery, 15(1), 31–36. https://doi.org/10.1007/s11420-018-9643-3

Beetham

Saloner

Gaye

Wakeman

S. E.

Frank

R. G.

Barnett

M. L.

(2020). Therapies offered at residential addiction treatment programs in the United States. JAMA, 324(8), 804–806. https://doi.org/10.1001/jama.2020.8969

Behar

Bagnulo

Coffin

P. O.

(2018). Acceptability and feasibility of naloxone prescribing in primary care settings: A systematic review. Preventive Medicine, 114, 79–87. https://doi.org/10.1016/j.ypmed.2018.06.005

10.

Bielenberg

Swisher

Lembke

Haug

N. A.

(2021). A systematic review of stigma interventions for providers who treat patients with substance use disorders. Journal of Substance Abuse Treatment, 131(7), 108486. https://doi.org/10.1016/j.jsat.2021.108486

11.

Brunson

J. C.

Read

Q. D.

(2023). ggalluvial: Alluvial Plots in “ggplot2”. [R package version 0.12.5]. https://corybrunson.github.io/ggalluvial/

12.

Centers for Disease Control and Prevention (CDC) . (2023). CDC WONDER online database multiple cause of death files, 1999–2021. https://wonder.cdc.gov/mcd-icd10-expanded.html

13.

Clark

A. K.

Wilder

C. M.

Winstanley

E. L.

(2014). A systematic review of community opioid overdose prevention and naloxone distribution programs. Journal of Addiction Medicine, 8(3), 153–163. https://doi.org/10.1097/ADM.0000000000000034

14.

Colledge-Frisby

Ottaviano

Webb

Grebely

Wheeler

Cunningham

E. B.

Hajarizadeh

Leung

Peacock

Vickerman

Farrell

Dore

G. J.

Hickman

Degenhardt

(2023). Global coverage of interventions to prevent and manage drug-related harms among people who inject drugs: A systematic review. Lancet Global Health, 11(5), Artice e673–e683. https://doi.org/10.1016/S2214-109X(23)00058-X

15.

Crapanzano

Vath

R. J.

Fisher

(2014). Reducing stigma towards substance users through an educational intervention: Harder than it looks. Academic Psychiatry: The Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 38(4), 420–425. https://doi.org/10.1007/s40596-014-0067-1

16.

Dickson-Gomez

Spector

Weeks

Galletly

McDonald

Green Montaque

H. D.

(2022). “You’re not supposed to be on it forever”: Medications to treat opioid use disorder (MOUD) related stigma among drug treatment providers and people who use opioids. Substance Abuse: Research and Treatment, 16. https://doi.org/10.1177/11782218221103859

17.

Fernandes

R. M.

Cary

Duarte

Jesus

Alarcão

Torre

Costa

Carneiro

A. V.

(2017). Effectiveness of needle and syringe programmes in people who inject drugs – an overview of systematic reviews. BMC Public Health, 17(1), 309. https://doi.org/10.1186/s12889-017-4210-2

18.

Friedmann

P. D.

Wilson

Knudsen

H. K.

Ducharme

L. J.

Welsh

W. N.

Frisman

Knight

Lin

H.-J.

James

Albizu-Garcia

C. E.

Pankow

Hall

E. A.

Urbine

T. F.

Abdel-Salam

Duvall

J. L.

Vocci

F. J.

(2015). Effect of an organizational linkage intervention on staff perceptions of medication-assisted treatment and referral intentions in community corrections. Journal of Substance Abuse Treatment, 50, 50–58. https://doi.org/10.1016/j.jsat.2014.10.001

19.

Goffman

(1963). Stigma: Notes on the management of spoiled identity, Prentice Hall.

20.

Knudsen

H. K.

Ducharme

L. J.

Roman

P. M.

Link

(2005). Buprenorphine diffusion: The attitudes of substance abuse treatment counselors. Journal of Substance Abuse Treatment, 29(2), 95–106. https://doi.org/10.1016/j.jsat.2005.05.002

21.

Levengood

T. W.

Yoon

G. H.

Davoust

M. J.

Ogden

S. N.

Marshall

B. D.

Cahill

S. R.

Bazzi

A. R.

(2021). Supervised injection facilities as harm reduction: A systematic review. American Journal of Preventive Medicine, 61(5), 738–749. https://doi.org/10.1016/j.amepre.2021.04.017

22.

Lim

Farhat

Douros

Panagiotoglou

(2022). Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials. PLoS One, 17(3), Article e0266142. https://doi.org/10.1371/journal.pone.0266142

23.

Livingston

J. D.

Milne

Fang

M. L.

Amari

(2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.x

24.

Livingston

J. D.

Adams

Jordan

MacMillan

Hering

(2018). Primary care physicians’ views about prescribing methadone to treat opioid use disorder. Substance Use & Misuse, 53(2), 344–353. https://doi.org/10.1080/10826084.2017.1325376

25.

Luty

Umoh

Sessay

Sarkhel

(2007). Effectiveness of Changing Minds campaign factsheets in reducing stigmatised attitudes towards mental illness. Psychiatric Bulletin, 31(10), 377–381. https://doi.org/10.1192/pb.bp.106.012443

26.

Madden

E. F.

(2019). Intervention stigma: How medication-assisted treatment marginalizes patients and providers. Social Science & Medicine, 232, 324–331. https://doi.org/10.1016/j.socscimed.2019.05.027

27.

Madden

E. F.

Prevedel

Light

Sulzer

S. H.

(2021). Intervention stigma toward medications for opioid use disorder: A systematic review. Substance Use & Misuse, 56(14), 2181–2201. https://doi.org/10.1080/10826084.2021.1975749

28.

Mattick

R. P.

Breen

Kimber

Davoli

(2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, 2014(2), CD002207. https://doi.org/10.1002/14651858.CD002207.pub4

29.

Mattson

C. L.

Tanz

L. J.

Quinn

Kariisa

Patel

Davis

N. L.

(2021). Trends and geographic patterns in drug and synthetic opioid overdose deaths — United States, 2013–2019. MMWR. Morbidity and Mortality Weekly Report, 70(6), 202–207. https://doi.org/10.15585/mmwr.mm7006a4externalicon

30.

Mauro

P. M.

Gutkind

Annunziato

E. M.

Samples

(2022). Use of medication for opioid use disorder among US adolescents and adults with need for opioid treatment, 2019. JAMA Network Open, 5(3), Article e223821. https://doi.org/10.1001/jamanetworkopen.2022.3821

31.

McGinty

E. E.

Barry

C. L.

Stone

E. M.

Niederdeppe

Kennedy-Hendricks

Linden

Sherman

S. G.

(2018). Public support for safe consumption sites and syringe services programs to combat the opioid epidemic. Preventive Medicine, 111, 73–77. https://doi.org/10.1016/j.ypmed.2018.02.026

32.

McKinney

W. P.

(2017). Assessing the evidence for the educational efficacy of webinars and related internet-based instruction. Pedagogy in Health Promotion, 3(1_suppl), 47S–51S. https://doi.org/10.1177/2373379917700876

33.

Paquette

C. E.

Syvertsen

J. L.

Pollini

R. A.

(2018). Stigma at every turn: Health services experiences among people who inject drugs. International Journal of Drug Policy, 57, 104–110. https://doi.org/10.1016/j.drugpo.2018.04.004

34.

Pasman

Lee

Kollin

Rodriguez

Agius

Madden

E. F.

Resko

S. M.

(2022). Attitudes toward medication for opioid use disorder among substance use treatment providers. Substance Use & Misuse, 57(12), 1828–1836. https://doi.org/10.1080/10826084.2022.2115853

35.

R Core Team . (2020). R: A language and environment for statistical computing. [Computer software]. https://www.R-project.org/

36.

Reeves

Fletcher

McLoughlin

Yim

Patel

K. D.

(2017). Interprofessional online learning for primary healthcare: Findings from a scoping review. BMJ Open, 7(8), Article e016872. https://doi.org/10.1136/bmjopen-2017-016872

37.

Ritter

Cameron

(2006). A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs. Drug and Alcohol Review, 25(6), 611–624. https://doi.org/10.1080/09595230600944529

38.

Sjoberg

Whiting

Curry

Lavery

Larmarange

(2021). Reproducible summary tables with the gtsummary package. The R Journal, 13(1), 570–580. https://doi.org/10.32614/RJ-2021-053

39.

Strickland

J. C.

Victor

Ray

(2022). Perception of resource allocations to address the opioid epidemic. Journal of Addiction Medicine, 16(5), 563–569. https://doi.org/10.1097/ADM.0000000000000971

40.

Sulzer

S. H.

Prevedel

Barrett

Voss

M. W.

Manning

Madden

E. F.

(2022). Professional education to reduce provider stigma toward harm reduction and pharmacotherapy. Drugs: Education, Prevention & Policy, 29(5), 576–586. https://doi.org/10.1080/09687637.2021.1936457

41.

Victor

Lee

Pozo

B. del

Silverstein

Zettner

Cason

Ray

(2022). Medications for opioid use disorder in the criminal/legal system: Knowledge, beliefs, and attitudes among rural community-based stakeholders. Journal of Drug Issues, 52(3), 389–405. https://doi.org/10.1177/00220426221076800

42.

Wakeman

S. E.

Larochelle

M. R.

Ameli

Chaisson

C. E.

McPheeters

J. T.

Crown

W. H.

Azocar

Sanghavi

D. M.

(2020). Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Network Open, 3(2), Article e1920622. https://doi.org/10.1001/jamanetworkopen.2019.20622

43.

Wakeman

S. E.

Rich

J. D.

(2018). Barriers to medications for addiction treatment: How stigma kills. Substance Use & Misuse, 53(2), 330–333. https://doi.org/10.1080/10826084.2017.1363238

44.

Wickham

Averick

Bryan

Chang

McGowan

L. D.

François

Grolemund

Hayes

Henry

Hester

Kuhn

Pedersen

T. L.

Miller

Bache

S. M.

Müller

Ooms

Robinson

Seidel

D. P.

Spinu

Yutani

(2019). Welcome to the tidyverse. Journal of Open Source Software, 4(43), 1686. https://doi.org/10.21105/joss.01686

45.

Winograd

R. P.

Werner

K. B.

Green

Phillips

Armbruster

Paul

(2020). Concerns that an opioid antidote could “make things worse”: Profiles of risk compensation beliefs using the Naloxone-Related Risk Compensation Beliefs (NaRRC-B) scale. Substance Abuse, 41(2), 245–251. https://doi.org/10.1080/08897077.2019.1616348

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.39 MB

Pilot Testing an Asynchronous Online Harm Reduction and Pharmacotherapy Stigma Reduction Training for Substance Use Treatment Professionals

Abstract

Keywords

Get full access to this article

References

Supplementary Material