Exploring stigma in opioid agonist treatment journeys

Should I stay or should I go?, a new paper exploring stigma and other factors influencing opioid agonist treatment journeys, has been published in the International Journal of Environmental Research and Public Health. Opioid agonist treatment (OAT) includes taking methadone or similar medication, along with additional support such as motivational interviewing.

The study, part of Dr Vicky Carlisle’s PhD, was supported by the National Institute for Health and Care Research (NIHR). It involved interviews with 12 people using OAT, and 13 service providers. Key findings include:

• The OAT journeys were influenced by a broad range of individual, social and structural factors, with stigma a particularly important barrier to staying in treatment and recovery
• Pharmacies were a particularly strong source of stigma, both actual and perceived
• Recovery from opioid dependency is about more than simply abstinence: it is a complex, self-defined and circuitous process

The researchers identified three themes from the interviews:

• The system is broken
• Power struggles
• Filling the void

The team concluded prioritising long-term treatment – rather than focusing on the single goal of recovery – was important to make the most of OAT’s harm reduction benefits. Stigma was a systemic issue, which stopped people using OAT from leading fulfilling lives. The researchers identified an urgent need to develop targeted interventions to address stigma towards people using OAT.

Dr Vicky Carlisle, Senior Research Associate at the University of Bristol, said:

“We know that opioid agonist treatment is a successful way of managing and eventually overcoming opioid dependency. But the treatment journey for many people is fraught with difficulty. Research has shown that about 57% of people are still using OAT after a year, and just 38% after three years.

“These statistics are heavily influenced by the stigma that people using OAT experience. Our study has shown that people often feel that the system is stacked against them, and that health services and wider society are judging them.”

Dr Jo Kesten, Research Fellow at NIHR Applied Research Collaboration West and NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, was one of Vicky’s PhD supervisors. She said:

“Stigma has a powerful role in shaping opioid agonist treatment journeys and whether people can remain in treatment or not. This study has shed light on where and how stigma, alongside other factors, affects these journeys.”