"Letting the Sun Shine on Patient Voices: Perspectives about Medications for Opioid Use Disorder in Florida"

Article Authors, Publication and Date: Amanda Sharp, Melissa Carlson, Veronica Howell, Kathleen Moore, Zev Schuman-Olivier. April 2021 in Journal of Substance Abuse Treatment

Write-up by IRIS team member: Eunsong Park

This article explored the perceptions of medications for opioid use disorder (MOUD; methadone, buprenorphine, and naltrexone) from twelve individuals in treatment at a Florida detoxification facility. The authors described systemic challenges to making MOUD widely available in this state, including delays in harm reduction efforts, the availability of MOUD at less than half of treatment facilities, a shortage of buprenorphine prescribers, and difficulties accessing treatment in rural areas. Additionally, MOUD has not been fully accepted as a desirable treatment option by many patients and providers despite a wide evidence base drawn from research and practice that strongly supports their effectiveness.

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The study used qualitative data analysis to theme or “code” participant interviews, with findings that demonstrated both positive and negative perceptions of MOUD.

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Codes for the positive perceptions of MOUD:

1. Effective MOUD – Participants shared, “it helps the cravings go down a bunch, and it’s safe” and “the withdrawals from Suboxone are not as bad as opiate withdrawals.”

2. Natural highs – “I didn’t have the urges throughout the day that I would normally… when I was on methadone.”

3. Network supports – Family or social supports of participants were supportive of the use of MOUD.

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Codes for the negative perceptions of MOUD:

1. MOUD as a substitute – One participant shared, “you’re trading one for another, and you’re still on a leash”

2. Adverse effects – People cited MOUD’s high cost and worse physical withdrawal symptoms when tapering off MOUD than when tapering off nonprescription opioids.

3. Recovery values – MOUD was seen as contrary to the recovery value of pursuing something essential and dependable. “What if the clinic disappears? What if you can’t afford your daily dose?”

4. External influences (social stigma) – Participants stated that MOUD is not supported by their family or other social supports. ‘I was changing out one drug for another one,’ is how they [my family] looked at it.

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This study identified structural barriers at the root of negative perceptions of MOUD, such as inconvenience of the dosing procedures, absence/lack of external supports, and inconsistency in the treatment system. Prior research literature indicated that those structural barriers may stem from stigma, conflicts, and discrepancies in service delivery.

The authors offered their recommendations in hopes of expanding MOUD programs. First, programs should study structural barriers, such as stigma, specific to the setting, population, and region and provide tailored education/training to mitigate these barriers. Second, programs should honor the patient’s experiences, preferences, and needs when developing a treatment plan that will help motivate the patient to follow recommended MOUD treatment. Third, programs should develop and utilize a variety of delivery systems for the MOUD treatment, depending on the patient’s experiences, preferences, and needs.

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The authors’ recommendations align well with IRIS’s mission and activities, including our funded projects. On Our Own provides training to reduce behavioral health stigma, and its IRIS funded project is to pilot an adapted version of this workshop that aims to reduce stigma towards people who use opioids, including around their utilization of MOUD.

Another project, led by Maryland Peer Advisory Council (MPAC) and entitled “Peers that Count,” has been studying the presence of peers and benefits of their services. MPAC and their academic partners at IRIS understand the vital importance of integrating individuals with lived experience into both people’s recovery and recovery research.