Abstract
Purpose: This paper reviews and integrates the literature on
the stigma associated with opioid use disorder (OUD) and how this acts
as a barrier for patients seeking Medication Assisted Treatment (MAT).
Implications for patients in rural areas who face stigma for opioid use
disorder are reviewed. Methods: We examine the extant
literature since 2007, reviewing studies focused on the stigma against
patients suffering from OUD and MAT. Findings: The review
identifies five categories of sources of stigma that research has
addressed: Stigma against the patient; stigma by nurses; stigma by
primary care physicians; stigma from counselors; stigma by pharmacy and
dispensary staff; stigma against MAT by drug courts, stigma by family
members, coworkers, and employers. Conclusions: Stigma exists
as prejudice, negative stereotypes and associations, and labels. Despite
widespread evidence supporting Methadone Maintenance Therapy (MMT) and
Buprenorphine Maintenance Therapy (BMT) effectiveness, stigma abounds
within the medical community and society at large. Discriminatory
practices, poor relationships with dispensing staff, pharmacists,
counselors, and doctors, and a feeling of being separate or “alien”
from others are cited as barriers to involvement and participation in
MAT. This has created disparities in health care outcomes as well as the
access and availability of MAT services. Rural patients experience these
sources of stigma and face a heightened barrier to access for MAT
services. However, the primary care setting along with delivery of care
through primary care physicians, physician assistants, and nurse
practitioners offers a means to increase care in rural areas.