“Don’t Judge a Book Its Cover”: A Qualitative Study of Methadone Patients’ Experiences of Stigma

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Abstract

INTRODUCTION

Despite its efficacy and widespread use, methadone maintenance treatment (MMT) continues to be widely stigmatized. Reducing the stigma surrounding MMT will help improve the accessibility, retention, and treatment outcomes in MMT.

METHODS

Semi-structured interviews were conducted with 18 adults undergoing MMT. Thematic content analysis was used to identify overarching themes.

RESULTS

In total, 78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies.

DISCUSSION AND CONCLUSION

Stigma is a widespread and serious issue that adversely affects MMT patients’ quality of life and treatment. More efforts are needed to combat MMT-related stigma.

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Most cited references 41

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Understanding Labeling Effects in the Area of Mental Disorders: An Assessment of the Effects of Expectations of Rejection

Bruce G. Link (1987)

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Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence.

Richard P. Mattick, Courtney Breen, Jo Kimber … (2009)

Methadone maintenance was the first widely used opioid replacement therapy to treat heroin dependence, and it remains the best-researched treatment for this problem. Despite the widespread use of methadone in maintenance treatment for opioid dependence in many countries, it is a controversial treatment whose effectiveness has been disputed. To evaluate the effects of methadone maintenance treatment (MMT) compared with treatments that did not involve opioid replacement therapy (i.e., detoxification, offer of drug-free rehabilitation, placebo medication, wait-list controls) for opioid dependence. We searched the following databases up to Dec 2008: the Cochrane Controlled Trials Register, EMBASE, PubMED, CINAHL, Current Contents, Psychlit, CORK [www. state.vt.su/adap/cork], Alcohol and Drug Council of Australia (ADCA) [www.adca.org.au], Australian Drug Foundation (ADF-VIC) [www.adf.org.au], Centre for Education and Information on Drugs and Alcohol (CEIDA) [www.ceida.net.au], Australian Bibliographic Network (ABN), and Library of Congress databases, available NIDA monographs and the College on Problems of Drug Dependence Inc. proceedings, the reference lists of all identified studies and published reviews; authors of identified RCTs were asked about other published or unpublished relevant RCTs. All randomised controlled clinical trials of methadone maintenance therapy compared with either placebo maintenance or other non-pharmacological therapy for the treatment of opioid dependence. Reviewers evaluated the papers separately and independently, rating methodological quality of sequence generation, concealment of allocation and bias. Data were extracted independently for meta-analysis and double-entered. Eleven studies met the criteria for inclusion in this review, all were randomised clinical trials, two were double-blind. There were a total number of 1969 participants. The sequence generation was inadequate in one study, adequate in five studies and unclear in the remaining studies. The allocation of concealment was adequate in three studies and unclear in the remaining studies. Methadone appeared statistically significantly more effective than non-pharmacological approaches in retaining patients in treatment and in the suppression of heroin use as measured by self report and urine/hair analysis (6 RCTs, RR = 0.66 95% CI 0.56-0.78), but not statistically different in criminal activity (3 RCTs, RR=0.39; 95%CI: 0.12-1.25) or mortality (4 RCTs, RR=0.48; 95%CI: 0.10-2.39). Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy. It does not show a statistically significant superior effect on criminal activity or mortality.

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Societal costs of prescription opioid abuse, dependence, and misuse in the United States.

Howard Birnbaum, Alan G White, Matt Schiller … (2011)

The objective of this study was to estimate the societal costs of prescription opioid abuse, dependence, and misuse in the United States. Costs were grouped into three categories: health care, workplace, and criminal justice. Costs were estimated by 1) quantity method, which multiplies the number of opioid abuse patients by cost per opioid abuse patient; and 2) apportionment method, which begins with overall costs of drug abuse per component and apportions the share associated with prescription opioid abuse based on relative prevalence of prescription opioid to overall drug abuse. Excess health care costs per patient were based on claims data analysis of privately insured and Medicaid beneficiaries. Other data/information were derived from publicly available survey and other secondary sources. Total US societal costs of prescription opioid abuse were estimated at $55.7 billion in 2007 (USD in 2009). Workplace costs accounted for $25.6 billion (46%), health care costs accounted for $25.0 billion (45%), and criminal justice costs accounted for $5.1 billion (9%). Workplace costs were driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion). Health care costs consisted primarily of excess medical and prescription costs ($23.7 billion). Criminal justice costs were largely comprised of correctional facility ($2.3 billion) and police costs ($1.5 billion). The costs of prescription opioid abuse represent a substantial and growing economic burden for the society. The increasing prevalence of abuse suggests an even greater societal burden in the future. Wiley Periodicals, Inc.

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Author and article information

Journal

Journal ID (nlm-ta): Subst Abuse

Journal ID (iso-abbrev): Subst Abuse

Journal ID (publisher-id): Substance Abuse: Research and Treatment

Title: Substance Abuse: Research and Treatment

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Electronic): 1178-2218

Publication date Collection: 2017

Publication date (Electronic): 23 March 2017

Volume: 11

Electronic Location Identifier: 1178221816685087

Affiliations

[1 ]Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

[2 ]Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.

[3 ]Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.

[4 ]Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada.

[5 ]MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.

[6 ]Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada

Author notes

CORRESPONDING AUTHOR: Zainab Samaan, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. Email: samaanz@ 123456mcmaster.ca

[*]

J.W. and A.B. are co-first authors.

Article

Publisher ID: 10.1177_1178221816685087

DOI: 10.1177/1178221816685087

PMC ID: 5398333

PubMed ID: 28469424

SO-VID: 18e68afb-55fb-44a4-8b4b-84a0df952748

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

“Don’t Judge a Book Its Cover”: A Qualitative Study of Methadone Patients’ Experiences of Stigma

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Abstract

INTRODUCTION

METHODS

RESULTS

DISCUSSION AND CONCLUSION

Related collections

International Journal of Applied Technology in Medical Sciences

Most cited references 41

Understanding Labeling Effects in the Area of Mental Disorders: An Assessment of the Effects of Expectations of Rejection

Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence.

Societal costs of prescription opioid abuse, dependence, and misuse in the United States.

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Affiliations

Author notes

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