Disparities in access to buprenophine maintenance for opioid dependence by ethnicity and socioeconomic status in the U.S. [1] raise the question of whether unrecognized stigma and marginalization within systems of care will intensify inequities in treatment, as addiction is clinically treated as a chronic medical illness in the priate sector, and integrated into office-based practices [2]. This project investigates the influence of mainstreaming buprenophine maintenance treatment for opioid dependence into general medicine clinics on the perceived stigma and social networks of patients. Focusing on public clinics that serve low income and ethnic minority patients, but have been slow to adopt buprenophine treatment, it also examines institutional and professional influences on buprenophine adoption by providers. The project uses mixed social science research methods, and will involve observational case studies of clinics, semi-structured interviews, longitudinal measures of perceived stigma, and social network analysis. These will be undertaken in five clinics that vary by setting (general medicine versus substance abuse specialty), patient demographics (ethnicity and socioeconomic status), and the speed with which clinic staff adopt buprenophine maintenance. Disparities in access to buprenophine in the U.S. are predicted by studies of technology dissemination of treatment for a wide range of health conditions, which demonstrate that improved technologies often widen treatment gaps between advantaged and disadvantaged patient groups[3], and in the case of mental health and addiction, affect stigma differently among disadvantaged groups[4,5,6]. This project seeks to illuminate institutional and socioeconomic determinants of treatments and outcomes, with a focus on the relationship of stigma and social resources to clinical setting (general medicine versus substance abuse clinic) and patient demographics. This project thereby addresses a core NIH goal of reducing disparities in access to health care.
The proposed program of research and training for this career award are relevant to three public health goals of the National Institute of Drug Abuse: 1) it prepares an interdisciplinary investigator with a unique background in sociocultural research and clinical psychiatry for independent research that will bring social science to bear on health services research problems. This advances the goal of the K01 Mentored Research Scientist Development Award program by enhancing the supply of health researchers that are qualified to address complex health problems as future principal investigators. 2) The interdisciplinary nature of the investigator's proposed methods, advisory committee, research training and coursework, which draw from anthropology, sociology, and health services research, will advance a core missions of NIDA: to bring science from a broad range of disciplines to bear on addiction. 3) Findings from this project will be geared toward health services administrators and policy makers, as a result of the investigator's advising and training from health services researchers. This will advance a second core mission of NIDA: to ensure dissemination of research findings to improve addiction treatment.
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