The Intersecting Effect of Substance Use Stigma, Methadone Treatment Stigma, and Racial Discrimination on Methadone Treatment Outcomes

Abstract

Methadone treatment (MT) has demonstrated efficacy for treating opioid use disorder (OUD), but adequate engagement in treatment is a persistent challenge. Racially minoritized individuals with OUD disproportionately evidence poor outcomes. Stigma surrounding both substance use disorder (SUD) and MT negatively impact MT engagement. Racially minoritized individuals with OUD also routinely experience race-related stigma. This study aims to evaluate experiences of stigma in a population of patients receiving MT who identify as Black/African American and assess the impact on MT engagement. Participants (N=76) were recruited from an outpatient addiction treatment center in Baltimore City. Self-reported perception of enacted (experience of discrimination from others) and internalized (negative beliefs applied to self) stigma related to MT, SUD, and race were measured using the MT Stigma Mechanism Scale, SU Stigma Mechanism scale, Everyday Discrimination Scale, and an adapted internalized racism scale. Dosing data were collected from medical records over the subsequent 30 days. Correlations between stigma scores were calculated and negative binomial regressions conducted predicting MT engagement by individual stigma measures as well as moderation models looking at the impact of racial stigma on relationship between MT/SUD stigma and MT engagement. All stigma measures were positively correlated with one another. Longitudinal models indicated significant association between higher SU stigma enacted by healthcare providers and lower MT engagement, but no other direct relationships between stigma measures and MT engagement. In moderation models, across all significant moderating effects observed between racial stigma and MT/SU stigma, lower racial stigma appeared to heighten the negative effect of MT/SU stigma on MT engagement. This finding contradicts our original hypothesis based on an expected compounding effect of multiple sources of stigma. Attribution theory, especially related to perceived controllability and blame associated with stigmatized identities, may explain these findings and warrants further exploration in future research within this population. Shame associated with perceived controllability of substance use or need for methadone treatment may cause some patients to engage in avoidance coping strategies, such as disengaging in healthcare or treatment. Better understanding the role of racial identity in this context could help inform integration of intervention strategies to best support MT in the future.