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Ambivalence and Stigma Beliefs About Medication Treatment Among Young Adults With Opioid Use Disorder: A Qualitative Exploration of Young Adults’ Perspectives

      Abstract

      Purpose

      Young adults with opioid use disorder (OUD) have low engagement in treatment with medication for opioid use disorder (MOUD). The objective of this study is to explore the beliefs and attitudes about MOUD among young adults.

      Methods

      We conducted a single-site qualitative study of 20 young adults ages 18–29 years with a diagnosis of OUD receiving care at an outpatient program and who spoke English. We used a flexible interview guide with the following domains: experience with MOUD, sources and impact of stigma, and interactions with family, healthcare professionals, and social networks. We conducted a thematic analysis based on deductive codes related to the domains and emergent codes from the interviews.

      Results

      We identified three themes. First, participants perceived being on MOUD as stigmatizing. They regarded MOUD as lifesaving but ultimately as a “crutch” hindering their full recovery. Second, young adults expressed ambivalence, distinct from stigma, about MOUD. This ambivalence was related to fear of withdrawal symptoms and concerns about their ability to live independent lives, side effects, and unknown treatment duration. Third, participants felt that MOUD was more than just a means to reduce risk of overdose, it was a means to become fully functioning in their lives.

      Discussion

      In this study of young adults in treatment for OUD, we found that stigma and ambivalence concerning MOUD could explain young adults’ low engagement in care. Interventions addressing concerns about the stigmatizing effects of MOUD and the ambivalence young adults experience related to MOUD could improve engagement and retention of young adults.

      Keywords

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      References

        • Ahmad F.
        • Rossen L.
        • Sutton P.
        Provisional drug overdose death Counts.
        National Center for Health Statistics, 2021
        • Barocas J.A.
        • White L.F.
        • Wang J.
        • et al.
        Estimated prevalence of opioid use disorder in Massachusetts, 2011–2015: A capture–recapture analysis.
        Am J Public Health. 2018; 108: 1675-1681
        • Substance Abuse and Mental Health Services Administration
        Key substance Use and mental health Indicators in the United States: Results from the 2019 national survey on drug use and health.
        Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 2020
        • CDC WONDER
        (Available at:)
        https://wonder.cdc.gov/
        Date accessed: March 7, 2019
        • National Academies of Sciences Engineering, and Medicine
        Medications for Opioid Use Disorder Save Lives.
        The National Academies Press, Washington, DC2019
        • LaBelle C.T.
        • Han S.C.
        • Bergeron A.
        • Samet J.H.
        Office-based opioid treatment with buprenorphine (OBOT-B): Statewide implementation of the Massachusetts collaborative care model in community health Centers.
        J Subst Abuse Treat. 2016; 60: 6-13
        • Rhee T.G.
        • Rosenheck R.A.
        Buprenorphine prescribing for opioid use disorder in medical practices: Can office-based out-patient care address the opiate crisis in the United States?.
        Addiction. 2019; 114: 1992-1999
        • O’Malley P.
        Medication assisted therapy (MAT) for opioid use disorder (OUD) in youth improves outcomes and saves lives.
        Evid Based Nurs. 2020; 23: 77
        • Mericle A.A.
        • Arria A.M.
        • Meyers K.
        • et al.
        National Trends in Adolescent substance Use disorders and treatment availability: 2003-2010.
        J Child Adolesc Subst Abuse. 2015; 24: 255-263
        • Olfson M.
        • Zhang V.S.
        • Schoenbaum M.
        • King M.
        Trends in buprenorphine treatment in the United States, 2009-2018.
        JAMA. 2020; 323: 276-277
        • Bagley S.M.
        • Larochelle M.R.
        • Xuan Z.
        • et al.
        Characteristics and receipt of medication treatment among young adults who experience a Nonfatal opioid-related overdose.
        Ann Emerg Med. 2020; 75: 29-38
        • Wu L.T.
        • Zhu H.
        • Swartz M.S.
        Treatment utilization among persons with opioid use disorder in the United States.
        Drug Alcohol Depend. 2016; 169: 117-127
        • Schuman-Olivier Z.
        • Weiss R.D.
        • Hoeppner B.B.
        • et al.
        Emerging adult age status predicts poor buprenorphine treatment retention.
        J Subst Abuse Treat. 2014; 47: 202-212
        • Shin S.H.
        • Lundgren L.
        • Chassler D.
        Examining drug treatment entry patterns among young injection drug users.
        Am J Drug Alcohol Abuse. 2007; 33: 217-225
        • Krawczyk N.
        • Williams A.R.
        • Saloner B.
        • Cerdá M.
        Who stays in medication treatment for opioid use disorder? A national study of outpatient specialty treatment settings.
        J Subst Abuse Treat. 2021; 126: 108329
        • Kissin W.
        • McLeod C.
        • Sonnefeld J.
        • Stanton A.
        Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence.
        J Addict Dis. 2006; 25: 91-103
        • Walley A.Y.
        • Alperen J.K.
        • Cheng D.M.
        • et al.
        Office-based management of opioid dependence with buprenorphine: Clinical practices and barriers.
        J Gen Intern Med. 2008; 23: 1393-1398
        • West J.C.
        • Kosten T.R.
        • Wilk J.
        • et al.
        Challenges in increasing access to buprenorphine treatment for opiate addiction.
        Am J Addict. 2004; 13: S8-S16
        • Ostrach B.
        • Leiner C.
        “I didn’t want to be on suboxone at first…” - ambivalence in perinatal substance use treatment.
        J Addict Med. 2019; 13: 264-271
        • Allen B.
        • Nolan M.L.
        • Paone D.
        Underutilization of medications to treat opioid use disorder: What role does stigma play?.
        Subst Abuse. 2019; 40: 459-465
        • Hall N.Y.
        • Le L.
        • Majmudar I.
        • Mihalopoulos C.
        Barriers to accessing opioid substitution treatment for opioid use disorder: A systematic review from the client perspective.
        Drug Alcohol Depend. 2021; 221: 108651
      1. Available at: https://dictionary.apa.org/stigma. Accessed October 01, 2022.

        • Madden E.F.
        • Prevedel S.
        • Light T.
        • Sulzer S.H.
        Intervention stigma toward medications for opioid use disorder: A systematic review.
        Subst Use Misuse. 2021; 56: 2181-2201
        • Hadland S.E.
        • Park T.W.
        • Bagley S.M.
        Stigma associated with medication treatment for young adults with opioid use disorder: A case series.
        Addict Sci Clin Pract. 2018; 13: 15
        • Yin R.
        Qualitative research from Start to finish.
        2nd ed. The Guildford Press, New York City, New York2015
        • Hewell V.M.
        • Vasquez A.R.
        • Rivkin I.D.
        Systemic and individual factors in the buprenorphine treatment-seeking process: A qualitative study.
        Subst Abuse Treat Prev Policy. 2017; 12: 3
        • Woo J.
        • Bhalerao A.
        • Bawor M.
        • et al.
        “Don’t Judge a Book by its cover”: A qualitative study of methadone patients’ experiences of stigma.
        Subst Abuse Res Treat. 2017; 11117822181668508
        • Frank D.
        • Mateu-Gelabert P.
        • Perlman D.C.
        • et al.
        “It’s like ‘liquid handcuffs”: The effects of take-home dosing policies on Methadone Maintenance Treatment (MMT) patients’ lives.
        Harm Reduct J. 2021; 18: 88
        • Schoenberger S.F.
        • Park T.W.
        • dellaBitta V.
        • et al.
        “My life Isn’t defined by substance Use”: Recovery perspectives among young adults with substance Use disorder.
        J Gen Intern Med. 2022; 37: 816-822
        • Samet J.H.
        • Botticelli M.
        • Bharel M.
        Methadone in primary care — one small step for congress, one giant leap for addiction treatment.
        N Engl J Med. 2018; 379: 7-8
        • Nguemeni Tiako M.J.
        Addressing racial & socioeconomic disparities in access to medications for opioid use disorder amid COVID-19.
        J Subst Abuse Treat. 2021; 122: 108214
        • Andrilla C.
        • Patterson D.
        Tracking the geographic distribution and growth of clinicians with a DEA waiver to prescribe buprenorphine to treat opioid use disorder.
        J Rural Health. 2022; 38: 87-92