Variation in intervention stigma among medications for opioid use disorder

Despite a substantial evidence base for effectiveness, medications for opioid use disorder (MOUD) are often stigmatized. Even healthcare professionals working in substance use treatment may describe these medications as undesirable forms of medical intervention. Many argue they prefer an "abstinence-based" approach to treatment, free of pharmacotherapy. Nonetheless, between the three evidence-based U.S. treatment medications, which include methadone, buprenorphine, and naltrexone, there are signs of variation in how stigma operates toward each intervention. Using in-depth semi-structured interviews with 59 U.S. treatment professionals based in New Mexico and Texas, this study shows the drivers of "intervention stigma," or stigma toward the use or provision of a medical treatment or procedure, toward each type of MOUD. Participants describe a stigma hierarchy framing naltrexone as most acceptable, followed by buprenorphine, and finally methadone, which inverts the relative clinical efficacy of each medication. Pharmacological and regulatory differences, prioritization of psychosocial interventions, suspicion regarding profit motives, and the value placed on their personal experiences as former clients in treatment in tandem with professional anecdote over scientific evidence, contribute to different levels of stigma towards each of the three medications. Acknowledgement of the deleterious effects of stigma toward people who use drugs is growing, including attention to how MOUD is also subject to stigma. This study provides detailed descriptions of the multiple drivers of stigma toward different treatment medications that may serve as key leverage points for future destigmatization efforts.