Many of our patients express concerns about being judged by others for using Suboxone (buprenorphine and naloxone) to help overcome their opioid addiction. And many other patients experience this stigma but stay silent about it. Perhaps the most dangerous outcome of the stigma around MOUD treatment is that it discourages people from seeking help and getting better using the method that works best for them.
To overcome the stigma of using medication for opioid use disorder (MOUD)—also called medication-assisted treatment (MAT)—we need to understand why this stigma exists and know the facts about MOUD so we can help others better understand it.
The stigma of opioid use disorder and MOUD
Opioid use disorder (all called OUD), and indeed any neuropsychiatric disorder, in itself carries a stigma. Unfortunately, some people judge patients with this problem, and on top of this, rather than giving patients credit for getting help, they judge them for entering a MOUD treatment program instead of being abstinent.
Despite convincing evidence that MOUD is an effective and safe way to treat opioid use disorder, many individuals—including some physicians—stigmatize people who use MAT to overcome addiction.
Certain organizations also deter people from seeking MOUD treatment. For example, Narcotics Anonymous (NA) considers MOUD treatment a form of drug use; therefore, anyone using MOUD cannot be abstinent in the eyes of NA. Although some NA chapters will welcome those in a MOUD program, most will not let MOUD users begin the program until they are abstinent from all drugs, including drugs meant to help in recovery. Patients entering 12-step programs should work with advisors who understand how buprenorphine works.
Where does this stigma come from?
Researchers Yngvild Olsen and Joshua Sharfstein cite four factors that contribute to the stigma around opioid use disorder and its treatment:
- Opioid use disorder is labeled as a “moral weakness” when it is in fact a medical illness.
- The healthcare system tends to separate opioid use disorder from other health issues a patient may be experiencing; therefore, symptoms of nonopioid disorders are blamed on opioid use disorder.
- The language we use when talking about opioid use disorder is often judgmental. Terms like clean/dirty, detox, and junkie paint those seeking treatment in a negative light.
- Our criminal justice system fails to rely on medical judgment in the treatment of opioid use disorders. For example, people in prison are rarely given buprenorphine like they would be given medications for other medical conditions.
A common argument against MOUD treatment is that is merely trades one drug for another. Because many people don’t understand how buprenorphine works, they remain fearful of its use and potential misuse.
Can buprenorphine be abused/misused?
Although buprenorphine (the active ingredient in Suboxone) is a partial opioid agonist, it is not used for obtaining feelings of euphoria. It is designed to eliminate withdrawal symptoms, giving patients a better chance to recover. In fact, while it has some opioid activity, it is also an anti-opioid (opioid antagonist) activity, preventing overdoses and getting “high.” Some people believe that buprenorphine patients just want to get opioids with insurance companies paying for it. In reality, experience shows that the vast majority of MOUD patients want to be free of opioids, and do not use this medication for “fun.”
Is buprenorphine dangerous?
There is a misconception that MOUD treatment could lead to death from opioids, but buprenorphine has been shown to decrease the incidence of overdose and death when trying to take other opioids. And an overdose of buprenorphine rarely leads to death, unless combined with other substances.
Why is buprenorphine diverted?
There is some concern that patients will divert their MOUD drugs. Since buprenorphine has a low significant potential for misuse, diversion cannot significantly contribute to the opioid epidemic. When patients do divert their buprenorphine, it is usually to help family members and friends who want to recover from opioid use disorder or are in an acute withdrawal state. These individuals want to stop their opioid use but have no access to MOUD for one of several reasons:
- Few physicians are trained in MOUD treatment, and those who are trained are limited in the number of patients they are allowed to treat (x-waiver limit), so finding a program is not always easy.
- For some, financial concerns can be limiting.
- Some states have limitations on how long patients can be on medication legally, and since the disease can return, patients sometimes seek illegal means of getting the help they need.
- Some states require patients to try less effective methods of treatment before buprenorphine, and patients wanting early recovery do not want to bother with less effective treatments.
What do doctors say about buprenorphine?
The majority of physicians favor the use of MOUD because of its effectiveness. Getting support from other MOUD patients and noting progress along the way are great ways to avoid feeling the stigma. No one should have to deal with a stigma while getting medical care and getting sober. Entering a MOUD program is an individual health decision belonging only to the patient, and each patient who overcomes opioid use disorder with MOUD is more evidence that the stigma should be put to rest.
Where can I find MOUD treatment?
QuickMD is the largest tele-MOUD provider in the United States, treating tens of thousands of patients with opioid use disorder every month—without the stigma or judgment many patients are used to. Get in touch with a QuickMD provider to discuss your tele-MOUD options.
References:
Olsen, Y. & Sharfstein, J. Confronting the stigmas of opioid use disorder—and its treatment. doi: 10.1011/jama/2014.2147