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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new training program designed to reduce stigma around prescribing buprenorphine, a medication used to treat opioid use disorder and reduce the risk of HIV transmission. The goal is to increase healthcare providers' comfort in rural areas with prescribing this effective treatment. The trial will compare those who receive the stigma-reduction training with those who do not. It seeks doctors, nurse practitioners, or physician assistants working in rural primary care who are eligible to prescribe buprenorphine but are not doing so at full capacity. As an unphased trial, this study offers healthcare providers a unique opportunity to enhance their prescribing practices and improve patient outcomes in rural communities.

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 prior data suggests that this stigma-reduction training is safe?

A previous study on stigma reduction training showed that this training can help reduce negative attitudes toward people with opioid use disorder. The research reported no harmful effects from the training, suggesting it is safe for participants. The training aims to improve how healthcare providers view and treat people with opioid use disorder, increasing the likelihood of prescribing helpful treatments like buprenorphine. While this study does not provide direct safety data, the absence of reported negative effects indicates that the training is well-tolerated. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about stigma-reduction training for opioid use disorder because it tackles the social barriers that often prevent individuals from seeking or receiving effective treatment. Unlike standard treatments that focus primarily on the biological aspects of addiction, such as medication-assisted therapies (e.g., methadone, buprenorphine), this approach aims to change the perceptions and attitudes surrounding opioid use disorder. By reducing stigma, the training could improve access to care and enhance the effectiveness of existing treatments, ultimately helping more people on their path to recovery.

What evidence suggests that this stigma-reduction training is effective for increasing buprenorphine prescribing in rural areas?

Research has shown that training to reduce stigma can lessen negative views about people with opioid use disorder (OUD). In this trial, participants in the intervention arm will receive stigma-reduction training. One study found that online training, which included stories from patients, successfully reduced stigma among primary care providers. Another study noted that this training improved scores on a test measuring attitudes toward people who use drugs. However, while these studies showed a decrease in stigma, they did not find a change in the providers’ willingness to prescribe treatments like buprenorphine. These findings suggest that while the training can improve attitudes, additional steps might be needed to change prescribing habits. ^{4 5 6 7 8}

Who Is on the Research Team?

Berkeley Franz, Ph.D.

Principal Investigator

Ohio University Heritage College of Osteopathic Medicine

Are You a Good Fit for This Trial?

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.

Currently practices in a primary care setting

Exclusion Criteria

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

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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 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]

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]

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]

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]

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]

Citations

1. cdn.clinicaltrials.gov cdn.clinicaltrials.gov/large-docs/82/NCT04867382/Prot_SAP_ICF_001.pdf

Reducing Stigma toward People with Opioid Use Disorder ... The overall goal of this project is to determine whether stigma reduction training reduces PCC stigma, increases intention to get waivered to ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9922036/

A randomized controlled trial of an intervention to reduce ... This study examined whether an online training incorporating patient narratives reduced PCCs' stigma toward people with OUD (primary) and increased intentions ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9970664/

Impact of Stigma on Clinician Training for Opioid Use ... We undertook a study to examine how stigma influences the uptake of training on medication for opioid use disorder (MOUD) in primary care academic programs.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S2949875925001274

Reducing stigma in primary care toward people who use ... Training reduced stigmatizing attitudes toward PWUD (e.g., improvement in the Medical Condition Regard Scale d = 0.499, p = 0.007), but did not change intention ...

5. journals.lww.com journals.lww.com/pain/fulltext/2025/06000/breaking_barriers__addressing_opioid_stigma_in.7.aspx

Breaking barriers: addressing opioid stigma in chronic pain ... This perspective paper describes opioid stigma relating to OUD and medications for OUD (MOUD) among patients with comorbid chronic pain.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8800858/

The Impact of Stigma on People with Opioid Use Disorder ... The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential ...

7. cdc.gov cdc.gov/overdose-prevention/media/pdfs/OD2A-Case-Studies-Stigma-Reduction-case-study-508.pdf

Case Studies: Stigma Reduction Expected outcomes of this training are increased referrals to harm reduction services, reduced ... Opioid Use Disorder—and Its Treatment. JAMA, 311(14), 1393-.

8. sciencedirect.com sciencedirect.com/science/article/pii/S0955395925002221

Understanding opioid use disorder stigma and the role ... This study aims to advance our understanding of: 1) how stigma surrounding both substance use, including opioid and other polysubstance use, and MOUD uniquely ...