Bridging the Gap: Understanding Clinician Stigma in Buprenorphine Prescribing and Its Influence on Treatment Decisions and Patient Perspectives in the Veterans Health Administration

Project Summary/Abstract Amid a national overdose epidemic, treatment rates for opioid use disorder (OUD) remain concerningly low, indicating significant barriers to care. Veterans experience distinct health disparities, heightening their vulnerability to opioid use, including their risk for OUD and opioid overdose, yet nearly 60% of Veterans with OUD do not receive OUD treatment. While medications to treat OUD (MOUD) (e.g., buprenorphine) are highly effective, use of MOUDs among Veterans is low. Stigma has been identified as a barrier to MOUD treatment, impacting both treatment decisions and patient experiences. Research on stigma related to MOUD (i.e., intervention stigma) has primarily focused on the general population, used qualitative methods, and surveyed clinicians who don't prescribe MOUD. Additionally, we have a limited understanding of how comorbid substance use may compound stigma and influence clinicians' beliefs about MOUD and treatment decisions, a crucial question given the increasing rates of overdoses involving multiple substances. Consistent with NIDA priorities on stigma reduction, there is a need to further understand stigma factors affecting MOUD treatment access and utilization among Veterans. This study addresses a critical gap in the literature by conducting mixed-methods analyses with secondary data using quantitative data from a sample of VHA buprenorphine prescribers that examined clinician characteristics, attitudes, and prescribing practices and semi-structured interviews from a sample of Veterans with OUD that explored barriers and facilitators to MOUD. This project is significant in its goal to identify potential targets for interventions that reduce stigma and increase access to MOUD treatment for Veterans. This project is innovative in its use of an expansive mixed-methods approach that captures both clinician and patient perspectives to understand how stigma factors impact OUD treatment. The proposed study will utilize a patient-centered mixed-method approach to develop profiles of buprenorphine prescribers based on MOUD intervention stigma factors and explore demographic predictors of profiles and the association of profiles with specific MOUD treatment decisions across vignettes of different patient profiles of varying complexity and comorbid conditions (e.g., SUDs) (Aim 1) and qualitatively explore Veteran's perceptions experiences with intervention stigma and OUD treatment (Aim 2). Proposed work, contextualized by patient perceptions, will specifically: a) link clinician stigma factors related to MOUD to treatment approaches and, 2) provide valuable guidance for who stigma reduction interventions may be most needed and factors to address including both at the individual level and community level. The goal of this proposal is to provide the Applicant with training experiences that will improve her content area knowledge, analytic skills, and scientific communication, which are vital to flourishing as an independent researcher. The environment at the University of Rhode Island, including data analysis software, grant support, and an excellent mentorship team with content expertise, provide the ideal setting for the successful completion of the proposed project.