between patient and provider. Goals should be framed functionally, for example maintaining employment, Misconceptions about OUD Treatment Stigma and misunderstanding surround the issues of addiction in general and OUD in particular. 147 These include counterproductive ideologies that portray addiction as a failure of will or a moral weakness, as opposed to understanding OUD as a chronic disease of the brain requiring medical management, which is no different, in principle, from the approach used to
avoiding using illicit opioids or other drugs, continuing with social/emotional support programs, etc.
manage other chronic diseases such as diabetes or hypothyroidism. Some stigma and misunderstanding may arise from a lack of awareness of how treatment of OUD has evolved in the past 15 years.170 Table 8 summarizes some common misconceptions about OUD treatment.
Table 8. Misconceptions vs. realities of OUD treatment 171
Misconceptions
Reality
Buprenorphine treatment is more dangerous than other chronic disease management.
Buprenorphine treatment is less risky than many other routine treatments, such as titrating insulin or starting anticoagulation and easier to administer. It is also safer than prescribing many opioids (e.g., oxycodone, morphine). Addiction is compulsive use of a drug despite harm. When taken as prescribed, methadone and buprenorphine improve function, autonomy, and quality of life and patients using these drugs do not meet the definition of addiction. No data show that detoxification programs are effective for OUD, and, in fact, such interventions may increase the risk of overdose death by eliminating tolerance. Buprenorphine treatment can be readily managed in a primary care setting, and in-office induction or intensive behavioral therapy are not required for effective treatment.
Using methadone or buprenorphine is simply a “replacement” addiction.
Detoxification for OUD is effective.
Prescribing buprenorphine is time consuming and burdensome.
Addressing stigma High levels of stigma persist toward people with OUD and medications used to treat OUD. 147 An opinion survey titled “A National Portrait of Public Attitudes toward Opioid Use in the US: A Latent Class Analysis” published in 2023 found that 37% of respondents belonged to a “High Stigma/High Punitive Policy” class. An updated survey showed three-fourths of physicians believed that OUD was a chronic medical condition. Few physicians endorsed beliefs that people with OUD lack willpower for using medication (13%), have only themselves to blame (12%), or have poor moral character (6%). Most PCPs endorsed the belief that people with OUD could return to productive lives with treatment (92%). 174 Health care professionals can combat stigma by examining their own attitudes and beliefs and by consciously and consistently using neutral, “person- first,” and non-stigmatizing language such as “being in recovery” instead of “being clean” or “person with opioid use disorder” rather than “addict,” “user,” or “drug abuser.” 175 Pregnancy and OUD Pregnant women with untreated OUD have up to six times more maternal complications than women without OUD, including low birth weight and fetal distress, while neonatal complications among babies born to mothers with OUD range from neonatal
abstinence syndrome and neurobehavioral problems to a 74-fold increase in sudden infant death syndrome. 177 Both methadone and buprenorphine are recommended for treating OUD in pregnancy to improve outcomes for both mother and newborn. 141 The efficacy and safety of methadone treatment for OUD in pregnant women was established in the 1980s, showing that maternal and neonatal outcomes in women on methadone treatment during pregnancy are similar to women and infants not exposed to methadone. 177 More recent research suggests that buprenorphine treatment has similar, or superior, benefits in this population. 178 The safety of extended-release naltrexone has not yet been established for pregnant women, and naltrexone is currently not recommended for the treatment of OUD in pregnant women. 147 Despite this solid evidence base, most pregnant women with OUD do not receive any treatment with medications. 179 Among women who do receive treatment during pregnancy, many fall out of treatment during the post-partum period due to gaps in insurance coverage and other systemic barriers. An integrated approach with close collaboration between OUD treatment providers and prenatal providers has been described as the “gold standard” for care, and further research is needed to investigate interventions that could help to increase treatment retention. 147
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Book Code: MDAZ1124
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