“Don’t Judge a Book by Its Cover”: A Qualitative Study of Methadone Patients’ Experiences of Stigma

Woo, Julia; Bhalerao, Anuja; Bawor, Monica; Bhatt, Meha; Dennis, Brittany B.; Mouravska, Natalia; Zielinski, Laura; Samaan, Zainab

doi:10.1177/1178221816685087

Cited by 101 publications

(118 citation statements)

References 40 publications

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“…Explanations regarding why it was necessary to open up reflected participants' prior experiences of discrimination in the healthcare system. Examples of similar narratives are replete in qualitative research conducted in other settings, including MAT with oral opioids [39][40][41]. For instance, participants have previously described concerns about dose decisions being based on a "one size fits all approach" [42,43], guided by the results of street heroin urinalysis [42,44], and offered in inflexible spaces that perpetuate stigma and limit recovery [42,[44][45][46][47][48].…”

Section: Discussionmentioning

confidence: 99%

Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment

Marchand

Foreman

Macdonald

et al. 2020

Subst Abuse Treat Prev Policy

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Background: Injectable opioid agonist treatment (iOAT) was designed as a pragmatic and compassionate approach for people who have not benefitted from medication assisted treatment with oral opioids (e.g., methadone). While, a substantial body of clinical trial evidence has demonstrated the safety and effectiveness of iOAT, considerably less is known about the patient-centered aspects of this treatment and their role in self-reported treatment goals and outcomes. The aim of this study was to explore participants' experiences in iOAT as they broadly relate to the domains of patient-centered care. A secondary goal was to explore how these experiences affected participants' self-reported treatment outcomes.Methods: A qualitative methodology, and constructivist grounded theory approach, was used to guide sampling, data collection and analysis. A total of 30 in-depth interviews were conducted with people receiving iOAT in North America's first clinic. Audio-recordings for each semi-structured interview were transcribed and read repeatedly. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved. Results: "Building healthcare provider relationships for patient-centered care in iOAT" was the emergent core concept. Healthcare provider relationships were established through two interrelated processes: 'Opening up' was attributed to the positive environment, and to feeling understood and supported by healthcare providers. 'Being a part of care' emerged as participants felt safe to ask for what was needed and had opportunities to collaborate in treatment decisions. These processes established a foundation in which participants experienced care that was responsive to their individual dose, health and psychosocial needs.

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Section: Discussionmentioning

confidence: 99%

Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment

Marchand

Foreman

Macdonald

et al. 2020

Subst Abuse Treat Prev Policy

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“…While research on MMT stigma is limited, prior work has predominantly studied it as a continuation of substance use stigma among people in treatment versus stigma uniquely related to methadone . Our findings indicate that PLWOUD receiving MMT are probably contending with substance use and MMT stigma as two distinct but intersecting forces versus merely a continuation of one stigmatized identity.…”

Section: Discussionmentioning

confidence: 72%

“…The literature on stigma and MMT is primarily qualitative, and documents perceptions of MMT as an extension of substance use stigma into substance use treatment . Among people in substance use treatment and people receiving MMT, experiencing greater substance use stigma has been found to be associated with having more previous treatment experiences, receiving MMT for longer periods of time, engaging in injection (versus non‐injection) drug use and more frequent heroin use .…”

Section: Introductionmentioning

confidence: 99%

“…Among people in substance use treatment and people receiving MMT, experiencing greater substance use stigma has been found to be associated with having more previous treatment experiences, receiving MMT for longer periods of time, engaging in injection (versus non‐injection) drug use and more frequent heroin use . In addition, MMT stigma may hinder people from seeking or adhering to treatment . However, the individual manifestations of stigma associated with receiving MMT among PLWOUD may be distinct from substance use stigma, and remains underexplored.…”

Section: Introductionmentioning

confidence: 99%

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Factor structure, internal reliability and construct validity of the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT‐SMS)

et al. 2019

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Background and aim Experience of stigma towards methadone maintenance treatment (MMT) may be a barrier to the use of this treatment by people with opioid use disorder. We evaluated the factor structure, internal reliability, construct and criterion validity of a theory-based stigma measure, the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT-SMS) and compared this with the Substance Use Stigma Mechanism Scale (SU-SMS). Design Surveys at the beginning and end of a prospective study together with records of drug use and treatment attendance during that study. Setting Community methadone clinic in the Northeastern USA. Participants Ninety-three participants who were receiving MMT; the average daily methadone dose was 84.8 mg/day (standard deviation = 28.39 mg/day).Measurements The MMT-SMS uses a self-report questionnaire to assess three dimensions reflecting experiences of anticipated (nine items), enacted (nine items) and internalized stigma (seven items) specifically related to receiving MMT. Anticipated and enacted scales include three stigma source subscales (family, employers, health care workers; three items each). Responses are recorded on a five-point Likert-type scale, then averaged to produce the MMT-SMS scale/subscale scores. The SU-SMS is a self-report questionnaire to assess experiences of anticipated, enacted and internalized stigma regarding substance use history. Both scales were administered at the final parent study visit. Other measures included were assessed in the parent study and used to assess life-time and recent MMT (e.g. current MMT dose) and drug use experiences (e.g. past 30-day heroin injection). Findings The MMT-SMS demonstrated good internal reliability (α = 0.806-0.952 for components). Confirmatory factor analysis supported the seven-factor scale structure, distinguishing between experiences of anticipated, enacted and internalized stigma, and anticipated and enacted stigma source subscales (family, employers, health care workers) [root mean square error of approximation (RMSEA) = 0.076, 90% confidence interval (CI) = 0.061-0.090, P-close = 0.003; confirmatory fit index (CFI) = 0.974; Tucker-Lewis index (TLI) = 0.971]. Construct validity helped to distinguish the MMT-SMS from established substance use stigma constructs. Criterion validity observed associations with substance use experiences while on MMT, likely to predict future MMT success. Internalized MMT stigma was uniquely associated with daily MMT dose. Regarding criterion validity: anticipated MMT and enacted substance use stigma were associated with past 30-day heroin injection, MMT stigma uniquely associated with opioid use behaviors while receiving MMT, and substance use stigma broadly associated with injection-related behaviors. Conclusions The Methadone Maintenance Treatment Stigma Mechanisms Scale appears to be a reliable measure of methadone maintenance treatment stigma with robust validity in a sample of people with opioid use disorders receiving methadone maintenance treatment.

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“…Provision of HIV, OAT, and other health services at one location can increase access to services for HIV‐positive PWID by improving accessibility, user‐friendliness, and comprehensiveness of care [20‐23]. However, negative attitudes about methadone or buprenorphine (OAT medications) can stigmatize patients using OAT services [24‐26]. Notably, little is known about the effect of care co‐location on patients’ perceived stigma.…”

Section: Introductionmentioning

confidence: 99%

Stigma and quality of co‐located care for HIV‐positive people in addiction treatment in Ukraine: a cross‐sectional study

et al. 2020

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Introduction Co‐located treatment for HIV and opioid use disorder has been shown to improve care outcomes for HIV‐positive people who inject drugs (PWID) in Ukraine. However, patients continue to be stigmatized for both HIV and substance use. This study aimed to assess whether co‐located care for HIV‐positive PWID receiving opioid agonist treatment (OAT) services in Ukraine is associated with less stigma and better perceived quality of HIV services. Methods This cross‐sectional study enrolled 191 HIV‐positive PWID who received OAT services at three healthcare facilities providing substance use treatment (OAT only) and at four facilities that provided co‐located care (both OAT and HIV treatment) in six regions in Ukraine during July‐September, 2017. Primary outcomes were HIV stigma (Berger scale), substance use stigma (Substance Abuse Stigma Scale) and intersectional stigma (both stigma forms above 75th percentile). Secondary outcome was quality of HIV care, a composite score based on a package of received services. Linear and ordinal regressions were used to assess the predictors of selected outcomes. Results Study participants were 75% male, mean age 40 ± 7 years; 47% received co‐located care, and 10.5% had both high HIV and substance use stigma. Co‐located care was neither associated with HIV nor substance use stigma but it was linked to better quality of HIV care (adjusted odds ratio: 4.13; 95% CI: 2.31, 7.54). HIV stigma was associated with suicide attempts (adjusted beta (aβ): 5.90; 95% CI: 2.05, 9.75), and substance use stigma was linked to poor mental health (aβ: −0.26; 95% CI: −0.44, −0.08) and lower likelihood of receipt of services from non‐governmental organization (NGO; aβ: −6.40; 95% CI: −10.23, −2.57). Conclusion One in ten people with HIV in this cohort who received OAT services experienced high levels of both HIV and substance use stigma, which was associated with poorer mental health and less NGO support. Co‐located HIV and OAT services were linked to better perceived quality of HIV care, but did not seem to reduce stigma for this key population. Stigma interventions for PWID, possibly delivered involving NGOs, may be an approach to mitigate this challenge.

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“Don’t Judge a Book by Its Cover”: A Qualitative Study of Methadone Patients’ Experiences of Stigma

Cited by 101 publications

References 40 publications

Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment

Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment

Factor structure, internal reliability and construct validity of the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT‐SMS)

Stigma and quality of co‐located care for HIV‐positive people in addiction treatment in Ukraine: a cross‐sectional study

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