The opioid epidemic has become one of the most pervasive threats to health and survival in the U.S. Medications for the treatment of opioid use disorders (MOUD) are the gold standard treatment, with robust evidence of effectiveness in reducing opioid use, opioid overdose risk and opioid-related deaths. Nevertheless, retention and adherence to MOUD treatment, particularly buprenorphine (BUP), are discouragingly low; as such, novel, cost-effective, scalable intervention approaches to increase and sustain retention and adherence to BUP treatment are urgently needed. Although stigma surrounding the use of buprenorphine (BUP) for the treatment of OUD has yet to be characterized, stigma associated with methadone maintenance treatment is quite strong, and has deleterious effects on treatment retention and outcomes. Given the rapid expansion of BUP's accessibility and its emergence alongside methadone as a gold standard for OUD treatment, research is needed to understand the nature of stigma related to BUP treatment, its impact on engagement, retention, and outcomes of BUP treated individuals, and ultimately, to inform stigma focused interventions. With NCCIH support, the PI's parent R61 award focuses on development and usability testing of imFREE (Interactive Messaging for Freedom from Opioid Addiction), a CBT-based mHealth intervention that addresses critical barriers to retention and adherence to BUP treatment, in preparation for an effectiveness trial among individuals who are initiating BUP. In the proposed supplement application, based upon HIV Stigma Theory, we propose to: (a) adapt psychometrically validated measures from the HIV literature assessing internalized, anticipated, and enacted HIV stigma, for use in assessing opioid use disorder (OUD) stigma, and (b) with user input, develop intervention content targeting OUD stigma, to be incorporated in our final mHealth intervention refinement phase of the parent R61, prior to initiation of our effectiveness trial in the subsequent R33 phase. This application is an excellent fit as a response to NOT-OD-20-101, ?Administrative Supplements to Support Strategies to Reduce Stigma in Pain Management and Opioid Use Disorders (OUD) and Treatment,? which encourages use of ?existing psychometrically validated tools to measure stigma in other populations (e.g., HIV) and their application to these populations? as well as ?the adaption and application of existing theories of health related stigma to?OUD in reducing stigma.? Consistent with the objectives of the NOSI, the proposed supplemental research builds upon the parent R61, expanding our mHealth intervention with stigma relevant content to bolster retention and adherence to BUP. By providing support to address stigma and maximize BUP treatment adherence, the supplemental research may provide a cost-effective, easily deployable strategy for reducing stigma at the individual level among those affected by OUD, thereby facilitating prevention of overdose deaths.
The proposed research is of considerable public health significance as it will provide information to facilitate implementation of strategies to reduce stigma among individuals with Opioid Use Disorders (OUD) who are initiating treatment with buprenorphine. In light of the known association between stigma and treatment adherence in other stigmatized populations such as those with HIV, the use of measures and intervention strategies to understand and reduce stigma among individuals with OUD, a disproportionately affected subgroup of substance users for whom overdose fatalities are increasing, has the potential to increase the effectiveness of pharmacological treatment for this high need population.