1
|
Satcher MF, Belenko S, Coetzer-Liversage A, Wilson KJ, McCart MR, Drazdowski TK, Fallin-Bennett A, Zaller N, Schultheis AM, Hogue A, Vest N, Sheidow AJ, Del Pozo B, Watson DP, Hibbard PF, Stevens R, Stein LAR. Linkage facilitation for opioid use disorder in criminal legal system contexts: a primer for researchers, clinicians, and legal practitioners. HEALTH & JUSTICE 2024; 12:36. [PMID: 39207608 PMCID: PMC11363440 DOI: 10.1186/s40352-024-00291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.
Collapse
Affiliation(s)
- Milan F Satcher
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- Department of Community & Family Medicine, Dartmouth Health, Lebanon, NH, USA.
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Steven Belenko
- Department of Criminal Justice, Temple University, Philadelphia, PA, 19122, USA
| | | | | | | | | | - Amanda Fallin-Bennett
- University of Kentucky College of Nursing, Lexington, KY, USA
- Voices of Hope, Lexington, KY, USA
| | - Nickolas Zaller
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alysse M Schultheis
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Aaron Hogue
- Partnership to End Addiction, New York, NY, USA
| | - Noel Vest
- Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Ashli J Sheidow
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, USA
| | - Brandon Del Pozo
- Division of General Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Dennis P Watson
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, USA
| | | | - Randy Stevens
- Hope for New Hampshire Recovery, Manchester, NH, USA
| | - L A R Stein
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
- Department of Behavioral & Social Sciences, Brown University, Providence, RI, USA
- Department of Behavioral Healthcare, Developmental Disabilities & Hospitals, Cranston, RI, USA
| |
Collapse
|
2
|
Couch JV, Whitcomb M, Buchheit BM, Dorr DA, Malinoski DJ, Korthuis PT, Ono SS, Levander XA. Patient perceptions of and experiences with stigma using telehealth for opioid use disorder treatment: a qualitative analysis. Harm Reduct J 2024; 21:125. [PMID: 38937779 PMCID: PMC11210005 DOI: 10.1186/s12954-024-01043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Patients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access and engage with healthcare, particularly with medications for OUD treatment. Telehealth is a relatively new form of care delivery for OUD treatment. As reducing stigma surrounding OUD treatment is critical to address ongoing gaps in care, the aim of this study was to explore how telehealth impacts patient experiences of stigma. METHODS In this qualitative study, we interviewed patients with OUD at a single urban academic medical center consisting of multiple primary care and addiction clinics in Oregon, USA. Participants were eligible if they had (1) at least one virtual visit for OUD between March 2020 and December 2021, and (2) a prescription for buprenorphine not exclusively used for chronic pain. We conducted phone interviews between October and December 2022, then recorded, transcribed, dual-coded, and analyzed using reflexive thematic analysis. RESULTS The mean age of participants (n = 30) was 40.5 years (range 20-63); 14 were women, 15 were men, and two were transgender, non-binary, or gender-diverse. Participants were 77% white, and 33% had experienced homelessness in the prior six months. We identified four themes regarding how telehealth for OUD treatment shaped patient perceptions of and experiences with stigma at the individual (1), public (2-3), and structural levels (4): (1) Telehealth offers wanted space and improved control over treatment setting; (2) Public stigma and privacy concerns can impact both telehealth and in-person encounters, depending on clinical and personal circumstances; (3) The social distance of telehealth could mitigate or exacerbate perceptions of clinician stigma, depending on both patient and clinician expectations; (4) The increased flexibility of telehealth translated to perceptions of increased clinician trust and respect. CONCLUSIONS The forms of stigma experienced by individuals with OUD are complex and multifaceted, as are the ways in which those experiences interact with telehealth-based care. The mixed results of this study support policies allowing for a more individualized, patient-centered approach to care delivery that allows patients a choice over how they receive OUD treatment services.
Collapse
Affiliation(s)
- Jessica V Couch
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Mackenzie Whitcomb
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Bradley M Buchheit
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David A Dorr
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Darren J Malinoski
- Office of Digital Health, Oregon Health & Science University, Portland, OR, USA
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - P Todd Korthuis
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Ximena A Levander
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA.
| |
Collapse
|
3
|
Patel K, Pokorski E, Norkoli D, Dunkel E, Wang X, Yang LH. Persistence of stigma and the cessation of substance use: comparing stigma domains between those who currently use and those who no longer use substances. Front Psychiatry 2024; 14:1308616. [PMID: 38260794 PMCID: PMC10800797 DOI: 10.3389/fpsyt.2023.1308616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Cessation of substance use, a facet of recovery, as well as mitigating stigma experienced by individuals with substance use disorder (SUD), are important to supporting health and well-being of those who use substances. But there is limited and mixed evidence on whether cessation of substance use has a positive impact on individuals' stigma experiences. This study examined whether there were differences in stigma perceptions between those who self-report using substances and those who self-report not currently using substances associated with their SUD. Materials and methods A survey was conducted among individuals in 10 counties of Michigan with self-identified history with SUD. The survey aimed to understand five dimensions of stigma perceptions: enacted stigma, anticipated stigma, internalized stigma, social withdrawal, and treatment stigma. Survey items for each measure were adapted from prior literature. The mean was calculated for each stigma measure for analyses. Data analyses tested whether there were significant differences in each of the five stigma domains between the two groups using either regression or t-test, depending on the necessity to include covariates. Results Findings suggested that among the five stigma domains, only internalized stigma showed statistically significant differences between the two groups (b = 0.19, se = 0.08, p < 0.05) after adjusting for covariates (as needed). Those who were no longer using substances had lower internalized stigma compared to those who were currently using substances associated with their SUD. Analyses suggested that the other four stigma domains, enacted stigma, anticipated stigma, social withdrawal, and treatment stigma, did not show statistically significant differences between the two groups. Discussion While self-stigmatization (i.e., internalized stigma) was lower among those who report no longer using, our patterns suggest a persistence of stigma regardless of cessation of substances associated with SUD, particularly among stigma domains that are based on perceptions of how others may still perceive individuals who have used substances. Though more research is needed, results suggest that public health programmatic, policy, and campaign efforts that aim to eliminate stigma should account for and tailor to both people who report using and those who report no longer using substances to capture the breadth of needs in communities.
Collapse
Affiliation(s)
- Krishna Patel
- National Association of County and City Health Officials, Washington, DC, United States
| | - Emily Pokorski
- District Health Department #10, Cadillac, MI, United States
| | - Donna Norkoli
- District Health Department #10, Cadillac, MI, United States
| | - Emily Dunkel
- School of Global Public Health, New York University, New York, NY, United States
| | - Xinyue Wang
- Teachers College, Columbia University, New York, NY, United States
| | - Lawrence H. Yang
- School of Global Public Health, New York University, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| |
Collapse
|