Experiences of substance use and medication for opioid use disorder stigmas in an underserved, rural community

Abstract

Overdose rates related to opioid and stimulant use have been steadily increasing in underserved, rural areas of the U.S. for over 10 years. Access to and retention in medication for opioid use disorder (MOUD) care are persistent challenges nationally and in underserved rural communities. Stigma around substance use (SU) and MOUD specifically are barriers to engagement in opioid use disorder and MOUD care. However, little is known regarding how SU and MOUD stigmas manifest and affect patients in rural settings. Given their shared lived experiences, peer recovery specialists (PRSs), individuals with lived substance use and recovery experience who are formally trained to support others’ recovery, may be unique resources to shifting stigma barriers. Yet, few studies have examined if and how PRS engagement shifts stigma, particularly in underserved, rural communities. This qualitative study sought to understand: 1) how substance use and MOUD stigmas manifest in a low-resource, rural community; 2) how these stigmas influence patients’ treatment experiences and preferences; 3) if and how PRS-delivered intervention may shift these stigmas and improve MOUD outcomes. Patients (n = 25) and staff (n = 5) at a telemedicine-mobile treatment unit (MTU) in an underserved, rural community completed semi-structured qualitative interviews. Transcripts were analyzed using thematic analysis, guided by the interview guide and Stigma Mechanisms Framework. Study findings demonstrated the pervasive role of multiple forms of stigma in a rural community, negatively impacting substance use treatment outcomes. Experiences of these stigmas were found to be uniquely influenced by rural living conditions. Additionally, results revealed that PRS-delivered interventions have potential in shifting these stigmas and improving MOUD outcomes by leveraging PRSs’ shared lived experiences. Identifying and understanding patient experiences of substance use and MOUD stigmas are vital in developing innovative solutions to target stigma reduction and support recovery. Future research may continue to develop and evaluate how PRS interventions can reduce stigma and support positive recovery outcomes.