Opioid Use Disorder Stigma Mechanisms in the Context of Buprenorphine Treatment

丁丙诺啡治疗背景下的阿片类药物使用障碍耻辱机制

• 批准号: 10176016
• 负责人: Suzette V Glasner-Edwards
• 金额: $ 14.52万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-28 至 2021-06-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10176016
• 关键词: Address; Adherence; Administrative Supplement; Adult; Affect; Aftercare; Award; Behavior; Buprenorphine; Clinical; Data; Data Collection; Development; Dimensions; Effectiveness; Feedback; Feeling; Freedom; Funding; Gold; Grant; HIV; Health; Health behavior outcomes; Individual; Intervention; Light; Literature; Measures; Mediator of activation protein; Medical; Mental Health; Mental disorders; Methadone; Morbidity - disease rate; Nature; Opiate Addiction; Outcome; Overdose; Pain management; Parents; Participant; Patients; Pharmaceutical Preparations; Pharmacological Treatment; Phase; Population; Preparation; Protocols documentation; Psychometrics; Public Health; Qualitative Methods; Recommendation; Reporting; Research; Research Personnel; Series; Stigmatization; Subgroup; Testing; Thinking; Validity and Reliability; base; behavioral adherence; buprenorphine treatment; comorbidity; cost effective; effectiveness trial; experience; follow-up; implementation strategy; intersectionality; mHealth; methadone treatment; mortality; novel; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; overdose prevention; overdose risk; patient population; programs; recruit; resilience; response; social stigma; standard care; theories; therapy development; tool; treatment adherence; usability

Abstract 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.

抽象的 阿片类药物流行已成为美国对健康和生存最普遍的威胁之一 阿片类药物使用障碍（MOUD）治疗的药物是金标准治疗 减少阿片类药物使用，阿片类药物过量风险和与阿片类药物相关的死亡的有效性的证据。尽管如此， 保留和遵守MOUD治疗，尤其是丁丙诺啡（BUP），令人沮丧地低。 这种新颖，成本效益，可扩展的干预方法可以增加和维持保留和依从性 迫切需要进行BUP治疗。虽然围绕使用丁丙诺啡（BUP）的污名 OUD的处理尚未表征，与Metagadone维护处理相关的污名是 非常强大，并删除了对治疗保留和结果的影响。考虑到快速扩张 BUP的可访问性及其与Methodadone一起出现，作为Oud治疗的黄金标准，研究 需要了解与BUP治疗相关的污名的性质，其对参与，保留的影响， bup的结果治疗了个体，并最终使以污名为中心的干预措施。与NCCIH 支持，PI的父母R61奖的重点是Imfree的开发和可用性测试（Interactive） 从阿片类药物成瘾中自由的消息传递），这是一种基于CBT的MHealth干预措施，可解决关键 保留和遵守BUP治疗的障碍，为在有效试验中做准备 在拟议的补充应用中，基于HIV污名理论， 我们建议：（a）从艾滋病毒文献中适应了评估内部化的艾滋病毒文献的措施， 预期和制定的HIV污名，用于评估阿片类药物使用障碍（OUD）污名，以及（b）与用户 输入，开发干预内容针对OUD污名，将纳入我们的最终MHealth干预措施中 在随后的R33阶段开始我们的有效性试验之前，母体R61的细化阶段。 该应用程序非常适合对NOT-OD-20-101的回应，“行政补充以支持 减少疼痛管理和阿片类药物使用障碍（OUD）和治疗中的污名的策略，“ 鼓励使用“现有的心理验证工具来衡量其他人群的污名（例如，艾滋病毒） 以及它们对这些人群的应用”以及“现有卫生理论的适应和应用 相关的污名与……减少污名化的污名。”与NOSI的目标一致 补充研究基于父母R61，扩大了我们的MHealth干预措施 满足保留并遵守BUP的内容。通过提供支持以解决污名和最大bup 治疗依从性，补充研究可能会为 减少受Oud影响的个人层面的污名，从而支持预防 过量的死亡。