Innovative Efforts for OUD Patients Continue to Battle Stigma

Improving engagement of individuals with opioid use disorders served as the focus of presentations on pharmacy-based medication strategies and harm reduction approaches on Wednesday at the Rx Drug Abuse & Heroin Summit.

Two New England researchers described how a collaborative practice agreement involving prescribers and community pharmacies in Rhode Island has offered some patients a preferred alternative to receiving medication-assisted treatment (MAT) in a clinic. After a small pilot effort that demonstrated continuity of care and high patient satisfaction, the researchers now will be comparing outcomes for 125 patients receiving pharmacy-based buprenorphine or naltrexone and 125 receiving usual care.

A significant advantage that Rhode Island has experienced in the effort involves the presence in the state of Genoa Pharmacy, often co-located in community mental health centers and with highly trained staff that welcomes patients with behavioral health challenges, said Traci Green, PhD, associate professor of emergency medicine and community health sciences at Boston University School of Medicine.

“The word 'respect' came up so many times,” Green said of comments from participating patients. It led the researchers to wonder about the kinds of experiences patients had been exposed to in more traditional medication treatment settings.

Some patients made comments such as, “I felt embarrassed at the opioid treatment program,” or that the community pharmacy was “less of a factory” for receiving buprenorphine or extended-release naltrexone doses, Green said.

Co-presenter Jeffrey Bratberg, PharmD, clinical professor at the University of Rhode Island, emphasized that a program in pharmacy-based addiction care often must address hesitancy among some pharmacists about working more closely with individuals with substance use disorders. “We tell pharmacists, 'You will not hurt people, you will help people with this,'” Bratberg said.

Nineteen pharmacists are now partnering with MAT prescribers in the Rhode Island initiative. Bratberg suggested he looks forward to the day when pharmacists can become waivered providers for buprenorphine treatment, as nurse practitioners and physician assistants have.

Expanding awareness of harm reduction

A conference session on Vermont drug users' and stakeholders' perspective on harm reduction suggested that even in a state that has tried more of these approaches than the average jurisdiction, the fight against stigma continues to rage.

Presenters Jessica Edwards, PhD, program evaluator at the Pacific Institute for Research and Evaluation, and Abby Rudolph, PhD, associate professor of epidemiology at Temple University, showed results of interviews with clinicians, harm reduction program staff, government officials and opioid users in three rural counties in Vermont. The stakeholders generally said that opioid users were aware of harm reduction services and strategies, but that stigma manifested in areas such as inconvenient daily dosing of MAT and concern about being judged harshly by first responders to an overdose call, Edwards said.

Rudolph said the majority of interviewed individuals had used MAT as well as assistance from a syringe services program. Interview results suggested some perceived shortcomings in MAT, such as doses too low to combat patient cravings.

Also, conflicting views on harm reduction overall persisted, with some users even saying that a more tough-minded approach might prove to be more helpful in leading them to sobriety, the researchers found.