Stigma-Reduction Training for Opioid Use Disorder

Overseen By Lindsay Dhanani, Ph.D.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ohio University

Disqualifiers: Prescribing buprenorphine at full capacity

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

400 Participants Needed

Trial Summary

What is the purpose of this trial?

Buprenorphine is an evidence-based treatment for opioid use disorder that also has strong potential to reduce HIV transmission in people who use drugs. Rural health care professionals are eligible and critically needed to provide these medications, but stigma currently limits provider willingness to prescribe buprenorphine, especially in regions where mortality and HIV transmission secondary to opioid use are high. In this developmental trial, the investigators will adapt, refine, and test the feasibility of a prototype brief stigma-reduction training intervention aimed at increasing buprenorphine prescribing in the rural primary care setting.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of stigma-reduction training for opioid use disorder?

Research shows that stigma is a major barrier to accessing treatment for opioid use disorder. Training programs that focus on reducing stigma and improving attitudes towards substance use disorders can help increase access to medications and improve treatment outcomes. ^{1 2 3 4 5}

Is stigma-reduction training for opioid use disorder safe for humans?

The research does not provide specific safety data for stigma-reduction training or related treatments like buprenorphine, but these treatments are generally used in medical settings to help manage opioid use disorder, suggesting they are considered safe under professional supervision. ^{1 2 4 6 7}

How does stigma-reduction training for opioid use disorder differ from other treatments?

Stigma-reduction training for opioid use disorder is unique because it focuses on reducing stigma through education and non-judgmental interactions, which can improve access to medications like buprenorphine by changing clinician and community attitudes. ^{1 2 3 4 8}

Research Team

Berkeley Franz, Ph.D.

Principal Investigator

Ohio University Heritage College of Osteopathic Medicine

Eligibility Criteria

This trial is for rural healthcare professionals who can legally prescribe buprenorphine, are at least 18 years old, and work in primary care as physicians, nurse practitioners, or physician assistants. It's not for those already prescribing buprenorphine to the maximum number of patients.

Inclusion Criteria

Currently practices in a rural-designated county

I am legally allowed to prescribe buprenorphine.

I am 18 years old or older.

Exclusion Criteria

I am currently prescribing buprenorphine to the maximum number of patients allowed.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention Development

Develop a prototype narrative-based stigma reduction intervention tailored to the rural primary care setting using HCP feedback

8-12 weeks

Pilot Study

Assess the feasibility and acceptability of the stigma-reduction intervention in a pilot study among rural HCPs

6 months

Multiple visits (in-person and virtual)

Follow-up

Participants are monitored for adoption, appropriateness, feasibility, and acceptability of the intervention

6 months

Treatment Details

Interventions

• Placebo
• Stigma-reduction training

Trial Overview The study is testing a stigma-reduction training program designed to encourage more rural health care providers to prescribe buprenorphine for opioid use disorder. The goal is to see if this training can change attitudes and increase prescription rates.

Participant Groups

Group I: Intervention Active Control 1 Intervention

Group II: Control Placebo Group 1 Intervention

Stigma-reduction training is already approved in United States, European Union for the following indications:

Approved in United States as Buprenorphine for:

• Opioid use disorder
• Severe pain

Approved in European Union as Buprenorphine for:

• Opioid dependence
• Severe pain

Who Is Running the Clinical Trial?

Ohio University

Lead Sponsor

Trials

73

Recruited

17,800+

Ohio State University

Collaborator

Trials

891

Recruited

2,659,000+

Rutgers University

Collaborator

Trials

127

Recruited

2,814,000+

University of North Carolina

Collaborator

Trials

174

Recruited

1,457,000+

Findings from Research

The REACH Medical practice in Ithaca, NY, successfully implemented a low-threshold, harm reduction model for buprenorphine treatment, which emphasizes equitable and non-judgmental healthcare for individuals with opioid use disorder.

Key themes identified include the importance of a low-stigma approach to care, the challenges of ensuring safe prescribing practices, and the need for a supportive workforce to maintain effective treatment delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Harm Reduction Approach to Treating Opioid Use Disorder in an Independent Primary Care Practice: a Qualitative Study. Kapadia, SN., Griffin, JL., Waldman, J., et al.[2021]

Training healthcare providers with a biopsychosocial approach significantly improved their attitudes towards substance use disorders, as shown by a notable increase in overall attitude scores from pre-training to post-training among 140 participants.

The enriched training not only enhanced treatment optimism but also addressed stigma, potentially leading to increased access to lifesaving medications for opioid use disorder by encouraging more providers to prescribe them.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attending a Biopsychosocially Focused Buprenorphine Training Improves Clinician Attitudes. Russell, HA., Smith, B., Sanders, M., et al.[2021]

A survey of 361 individuals in a rural community revealed that 69% believe opioid use disorder (OUD) is a real illness, which correlates with more positive attitudes towards treatment and individuals with OUD.

Those who recognized OUD as a real illness were significantly less likely to view individuals with OUD as dangerous and more likely to support the effectiveness of medication for opioid use disorder (MOUD) and the use of naloxone in overdose situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Community Attitudes Toward Opioid Use Disorder and Medication for Opioid Use Disorder in a Rural Appalachian County. Beachler, T., Zeller, TA., Heo, M., et al.[2021]

A study of 252 rural Pennsylvanians revealed four distinct stigma profiles regarding opioid use disorder (OUD), with those exhibiting high stigma showing significantly less support for harm reduction strategies like safe injection sites and Naloxone distribution.

Individuals with lower stigma levels were more supportive of harm reduction programs, indicating that addressing stigma is crucial for the successful implementation of these strategies in rural communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Opioid Use Disorder Stigma and Support for Harm Reduction in Rural Counties. Whipple, CR., Kaynak, Ö., Kruis, NE., et al.[2023]

In a study involving 30 individuals with experience in both medications for opioid use disorder (MOUD) and 12-step groups, significant stigma against MOUD was identified, including prohibiting MOUD users from speaking at meetings and refusing to acknowledge their recovery time.

Responses to this stigma included feelings of shame and anger, as well as actions like leaving groups or advocating for MOUD, highlighting the need for healthcare systems to address this stigma and provide alternative support options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stigmatization of medications for opioid use disorder in 12-step support groups and participant responses. Andraka-Christou, B., Totaram, R., Randall-Kosich, O.[2022]

A survey of 228 medical students revealed that 27.2% were interested in buprenorphine waiver training, indicating a significant willingness among students to learn about treatment for opioid use disorder (OUD).

The pilot test showed that combining online training with in-person discussions could enhance students' likelihood of prescribing buprenorphine, with 88.9% of those attending the discussion feeling more confident compared to 69.2% after the online course alone.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing Medical Student Interest in Training About Medications for Opioid Use Disorder: A Pilot Intervention. Thomas, J., Slat, S., Woods, G., et al.[2022]

A study involving 24 adults in buprenorphine treatment revealed that negative perceptions and stigma surrounding opioid use disorder (OUD) significantly hinder individuals' willingness to seek and maintain treatment.

Addressing stigmatizing language and perceptions related to different medications and treatment programs could improve access to evidence-based support for OUD, ultimately enhancing treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perceptions of medications, program settings, and drug use histories among individuals engaged in treatment for opioid use disorder. Scherzer, C., Jiménez Muñoz, P., Ramsey, S., et al.[2023]

In a study of 328 patients with opioid use disorder (OUD) admitted for infections, stigmatizing language like 'abuse' was frequently used, while more appropriate terms like 'use disorder' were less common.

Using the term 'use disorder' in discharge summaries significantly increased the likelihood of patients receiving ongoing treatment plans for OUD and referrals for specialized addiction care, highlighting the impact of language on clinical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of nonstigmatizing language is associated with improved outcomes in hospitalized people who inject drugs. Carpenter, JE., Catalanotti, J., Notis, M., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

A Harm Reduction Approach to Treating Opioid Use Disorder in an Independent Primary Care Practice: a Qualitative Study. [2021]

2. Switzerland pubmed.ncbi.nlm.nih.gov

Attending a Biopsychosocially Focused Buprenorphine Training Improves Clinician Attitudes. [2021]

3. England pubmed.ncbi.nlm.nih.gov

Community Attitudes Toward Opioid Use Disorder and Medication for Opioid Use Disorder in a Rural Appalachian County. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Opioid Use Disorder Stigma and Support for Harm Reduction in Rural Counties. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Stigmatization of medications for opioid use disorder in 12-step support groups and participant responses. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Assessing Medical Student Interest in Training About Medications for Opioid Use Disorder: A Pilot Intervention. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Perceptions of medications, program settings, and drug use histories among individuals engaged in treatment for opioid use disorder. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Use of nonstigmatizing language is associated with improved outcomes in hospitalized people who inject drugs. [2023]