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健康和生存最普遍的威胁之一。 治疗阿片类药物使用障碍 (MOUD) 的药物是金标准治疗，具有强大的疗效 减少阿片类药物使用、阿片类药物过量风险和阿片类药物相关死亡的有效性的证据。 MOUD 治疗（尤其是丁丙诺啡 (BUP)）的保留率和依从性低得令人沮丧； 这种新颖、具有成本效益、可扩展的干预方法可以提高和维持保留率和依从性 尽管丁丙诺啡 (BUP) 的使用存在耻辱，但迫切需要 BUP 治疗。 OUD 的治疗尚未确定，与美沙酮维持治疗相关的耻辱感是 相当强，并且对治疗保留和结果产生有害影响。 BUP 的可及性及其与美沙酮一起成为 OUD 治疗、研究的黄金标准 需要了解与 BUP 治疗相关的耻辱的本质、其对参与度、保留率的影响， BUP 治疗个体的结果，并最终为 NCCIH 的耻辱干预措施提供信息。 支持，PI 的母 R61 奖项专注于 imFREE（交互式 摆脱阿片类药物成瘾的消息传递），这是一种基于 CBT 的移动医疗干预措施，可解决关键问题 保留和坚持 BUP 治疗的障碍，为一项有效性试验做准备 正在启动 BUP 的个人 在拟议的补充申请中，基于 HIV 耻辱理论， 我们建议：（a）采用来自艾滋病毒文献的心理测量验证的措施来评估内化， 预期和实施的 HIV 耻辱，用于评估阿片类药物使用障碍 (OUD) 耻辱，以及 (b) 与使用者 投入，制定针对 OUD 耻辱的干预内容，并将其纳入我们最终的移动医疗干预中 在随后的 R33 阶段开始有效性试验之前，先对母体 R61 进行细化阶段。 此应用程序非常适合作为对 NOT-OD-20-101“支持的行政补充”的回应 减少疼痛管理和阿片类药物使用障碍 (OUD) 和治疗中的耻辱感的策略”， 鼓励使用“现有的心理测量验证工具来衡量其他人群的耻辱感（例如艾滋病毒） 及其对这些人群的应用”以及“现有健康理论的改编和应用” 与减少耻辱有关的 OUD 与 NOSI 的目标一致，拟议的 补充研究以母版 R61 为基础，扩大了我们与耻辱相关的移动健康干预措施 通过提供支持来消除耻辱并最大限度地提高 BUP 的保留率和遵守率。 治疗依从性，补充研究可以提供一种具有成本效益、易于部署的策略 减少受 OUD 影响的人在个人层面上的耻辱，从而促进预防 过量死亡。