Stigma is hindering treatment of opioid addictions. States can change that.
Jessica Rinaldi/The Boston Globe via Getty Images A woman reached for a dose of methadone at the Behavioral Health Network opioid treatment clinic in Orange, Massachusetts.
The health care workforce is key to treating patients' opioid use disorders, but experts say stigma toward drug use and treatment among medical professionals remains a barrier to treatment access and positive outcomes.
Earlier this year, the federal government eased restrictions regarding how methadone—one of the three federally approved medications used to treat opioid use disorders—can be administered to patients. The new guidelines from the Substance Abuse and Mental Health Services Administration allow patients to take home methadone prescriptions after a month of treatment, down from two years, and removes the requirement for individuals to receive counseling before receiving the drug.
The updated rules aim to increase access to methadone amid a nationwide opioid crisis that killed an estimated 107,543 Americans last year. But experts say enacting change doesn’t happen overnight, and the gap between the number of people in need of medicine and those who actually receive it is still gaping.
It’s not just the cost of medication and treatment programs that keep patients from accessing them, said Noa Krawczyk, an assistant professor in the Department of Population Health at the NYU Grossman School of Medicine. Stigma surrounding drug use and treatment is still prevalent at virtually every step of one’s recovery journey.
It exists “at the individual level of a person choosing not to use those treatments because of negative perceptions around them, to the policies that regulate these treatments [and] to the protocols that exist in treatment programs for how these medications are delivered,” Krawczyk said. Stigma is “ingrained in every single aspect of these treatments” and “plays a huge role as in terms of a barrier to care.”
Policymakers, particularly at the state level, have the ability to influence the work done both by the “substance use treatment workforce [and] the health care workforce more broadly,” she said.
A recent analysis from The Pew Charitable Trusts suggests normalizing methadone treatment could help expand its accessibility. In fact, some states are moving to align their methadone-related regulations to mirror the federal government’s efforts, including California where policymakers are considering a bill that would allow doctors—not just methadone clinics—to prescribe take-home doses of the medicine, increase the allowable dosage for patients to receive and remove treatment-related requirements for accessing methadone, among other changes.
“The [state-level] rulemaking process is very lengthy, and can be quite a process to go through, but it does seem that there is interest from state policymakers in revising their rules in response to the new SAMHSA regulation,” said Frances McGaffey, associate manager of Pew’s substance use prevention and treatment initiative.
Health leaders can also confront stigma by addressing barriers to holistic care in health systems, Krawczyk said.
In at least 12 states, for instance, medical licensing boards have changed licensing applications to remove potentially stigmatizing language that inquire about a physician’s history with substance use disorders and mental health conditions. States can take that further, Krawczyk said, by also amending training and education requirements to call for more person-centered and trauma-informed opioid use disorder treatment, baking destigmatizing practices and values into the health care landscape.
Examples of this include an effort in Massachusetts, where policymakers are considering a bill that would ease mandatory reporting requirements to state officials if a baby is born with a drug dependency. Under current law, hospital workers are required to notify state officials about babies whose blood tests indicate substance use from their parent. The new policy would only mandate such reporting if the infant was at imminent risk of abuse or neglect, WBUR reported. The bill also directs health officials to establish a plan for new parents managing their substance use disorder.
“The updated policy reflects our focus on providing safe and equitable care for all patients,” Allison Bryant, chief health equity officer at the Massachusetts hospital Mass General Brigham, said in a statement. “The process allowed us to turn our lens to understand our own contributions to stigma and inequity and strive to fix them.”
The New York Office of Addiction Services and Supports offers guidelines and training resources for medical professionals to practice more compassionate, client-centered treatment approaches. Individuals can enroll in learning programs that educate them on, for instance, trauma-informed responses and cultural competency in behavioral health.
Ultimately, curbing the opioid crisis largely depends on a competent workforce, McGaffey said. Otherwise, “there is a mismatch between the community the provider aims to serve and the population actually getting care.”
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