Hello, my name is Derek Glimm, and I'm here to have a conversation with you about reducing Orbit Use Disorder stigma. I have no financial relationship with any commercial interests related to the content of this presentation. I will not be discussing off-label use during this presentation. Access and Training Expansion Act, which enacted June 2023, requires a one-time eight-hour training in evaluating treatment and management of substance use disorder for all new providers applying for DEA license. This content can be applied to that one-time training. The objectives. We're going to describe stigma for Orbit Use Disorder. Number two, the strategies to reduce stigma. And three, describe statistics of stigma. Now, stigma is a very complex phenomenon. It can be attributed to some constructs. Attitudes. Attitudes towards Orbit Use Disorder. Biases. Stereotypes. Prejudices. Labeling. Social identity. What are social stigmas? They are social stereotypes. For example, here's a great example. People with pink hair are mean. Prejudice. Feeling. I don't like people with pink hair. Discrimination. I am not going to let anyone with pink hair sit next to me at lunch. Understanding these constructs that make up stigma, and the phenomenon that creates barriers to people accessing the needed treatment that they need, such as medication for Orbit Use Disorder, is a huge problem. So whether it's stigma, whether it's self-stigma, meaning that you don't feel like you're good enough, feeling like I'm dirty, I'm not good enough, and this is the reason why I am abusing drugs, is a huge problem to address the increased national call for overdose, and the call for addressing this epidemic. Bias. Bias is the distinction we sometimes make in between. It's that drugs that give pleasure directly, recreational use. Drugs that give people the ability to function in society, which can directly lead to pleasure, medicine use. So that, you know, the huge bias that we have, the misconception we might have, whether hey, crack cocaine and cocaine, well cocaine is more of a socio-economical drug, and crack is more mainly for people that have low socio-economical status. So we have a bias on that. So again, we have to address, and adhere, and take a mirror and look at those biases so we have a clear understanding, so ways that we can look at it and not treat patients with stigma. Now there's two kinds of biases. There's implicit bias, which states that you have an unconscious attitude, a particular quality to a member or a certain social group. Implicit stereotypes are shaped by experience, it's based on learn, associated between particular qualities or social categories, including race or gender. So we have to really check ourselves for implicit bias. Explicit bias is the attitudes and beliefs we have about a person or group, or a conscious level. Much of the time, these biases and their expressions arise out of direct result of perceived threat. So that implicit bias is shaped by your experiences, where explicit biases is based on, hey, based on this, I have a threat of this individual, or this race, or this situation, and that's the explicit bias. Making sure that we understand what is stigma all about. It's the mistrust, it's the shame, it's the judgment, that stigmatizing that creates an issue with us receiving the adequate treatment that we need, whether it's self-stigma or whether it's stigma from other providers that are implicit bias toward the person that has the substance use disorder that prevent a barrier to them getting access to treatment. And addiction misunderstanding. Addiction is something that is personal, it's something that you did it on purpose. And oftentimes, these people that have addiction, it's genetically linked, or it's environmental. So we need to understand that it's multifactorial that might cause one to be addicted. We can't misjudge, we can't judge people because it could easily be our family member, it could easily be us. Access to treatment for drugs using disorder, or US Health, it's a national problem. It's nationally. The access, the treatment gap that exists between those that need treatment and those that are available to give the needed medication for opiate use disorder treatment is huge. So in this study, it screened about 5,000 patients, and they were diagnosed with opiate use disorder, and they also had other polysubstances such as cannabis and cocaine, and results that discussed drug use. They wanted or needed treatment, received treatment in the past. People that wanted treatment were 35.7. People that received treatment in the past year were only 28.3. Now 63% got treated outside of the HRSA-funded health center, and the reason for not receiving treatment when wanting treatment were 69% stated stigma was the biggest reason for them not getting, receiving treatment. 14% said skepticism, 12% was logistical or actually being able to get to the location. Others were financial barriers. Stigma was the major cause for one that was not able to seek treatment and get the needed help they wanted because they felt like, hey, they were going to be judged, that they felt like there was going to be a mistrust, they felt like they were addicts that didn't deserve the treatment. So that stigmatization creates a huge barrier to access to quality of care. The impact of stigma prevents individual substance abuse from getting the help they need. It prevents caregivers and others from providing the needed services that they need. It results in desperate treatment to those with substance abuse by health care providers. Leads to poor outcomes. You can see when you have non-stigmatizing conditions, it's a low perceived fault, low perceived control. So somebody that might have high blood pressure, somebody that might have diabetes, you know, that non-stigmatizing condition and one that has high perceived fault or high perceived control such as, say, you're obese, you put yourself in this situation, you ate too much. So that's a stigmatizing situation I just brought up. But somebody that might have a substance use or you're a junkie, you did this to yourself, you don't deserve treatment. In other words, we all have an implicit bias with this individual because of the state that they're in. So we have to understand it and identify our implicit biases. But also understand what's the impact on stigma and it leads to poor outcomes of patients. Stigmatizing effect, high health and quality of life. When you're stigmatized, health and quality of life decrease. Your self-esteem, I'm not worthy. You know, your self-esteem, your self-stigmatizing, I'm a junkie, my family says I'm no good, I never amount to nothing. They have that conception that their self-esteem is very low. Self-efficacy, how can I be effective? You know, I have this problem with drugs. Social interaction, oftentimes these patients or people, they don't have a lot of social interaction. Or the social interaction people that they hang out with, they have the same problems they have. They have drug addiction, they have drug addicts, or they have drug problems. And so when you socialize with the same people that are exhibiting those behaviors, it's very hard to change your behavior. So people that have opiate use disorder need to have people that are in their circle that are encouraging, that are not using or abusing substances. It's a cycle. You have public stigma. You have discrimination and prejudice and fear. So again, they have that explicit bias that somebody that is on opioids or abusing, they're bad people. It damages self-esteem and hope. That stigma causes their self-esteem to really spiral. Your self-stigma, you internalize saying that you are not worthy, you're a bad person. There's shame and doubt. Of course, that leads to when you're getting those treatments, such as medication for opiate use disorder, such as methadone, such as buprenorphine, there's going to be a huge drop-off rate because you have self-doubt whether you can even make it. However, when we have reinforcing positive self-esteem, it's going to reduce the rate of a drop-out. You want to use substance to avoid a suppressed negative effect. So again, that stigmatizing, low self-esteem is going to make me in turn want to use and abuse the substance because I don't want to feel that hurt. I don't want to feel that way because I'm being that negative stigma. Language matters. Words are powerful, especially when talking about addiction. Stigmatizing language perceptions, negative perceptions. Person first. Language focus on the person, not the disorder. Again, person first. Focus on the person, not the disorder. In other words, you are, you have, I have an addiction. I have opiate use disorder. That is not who I am. It's something that I'm going through, but that's not me. For example, say this, person with a substance use disorder, say person with a substance use disorder, person living in recovery, person living with an addiction, person arrested for drug violation, choose not, choose to be, choose to, at this point, medication is a treatment tool, have a setback, I'm in a road to recovery, I had a positive drug test. Do not say that, I'm an addict, I'm a junkie, I'm a druggy, I'm an ex-addict, I'm battling, I'm suffering from an addiction, I'm a drug offender, I'm non-compliant, I bobbed out, medication is a crutch, I've relapsed, stayed clean, I had a dirty drug screen. So we want to stay away from this language, this negative connotation language. In addition, furthermore, we have other languages, medication for opiate use disorder, medication for alcohol use disorder, recommended language, stigmatizing language is opiate replacement, substitute, maintenance therapy, medication assisted treatment. What's the rationale? Treatment for other diseases are not labeled medication assisted treatment. So substance use disorder should not be treated differently. Medicine suggested that patients are treated one substance use disorder for another. In other words, I'm replacing opioids with buprenorphine or methadone. Opiate epidemic is often recommended replacing methadone clinics with opioid treatment programs. Assume or express reoccurrence of substance use or substance use disorder symptoms. Stigma language, I relapse. I slip. Neutral, non-judgmental language. Recovery managed, stigmatizing language, relapse, prevention. Neutral, non-judgmental language. Well healthy and recovering. Sober is sick and start aging. Stay neutral. In other words, hey, I'm on the road to recovery. Maintain recovery, stay clean. Neutral, non-judgmental. See, you know, understand that, hey, it is, you know, it's a, it's not me. I'm in a process of recovery. I'm in a recovering process. Person is using substance X. Neutral, non-judgmental language. Several studies compare abusers and abuse to a person with substance use disorder and confirmed that person's first language is less stigmatizing. Level of conscience around activity using is unclean though is often used in public health. So again, we want to take away that stigmatizing language so the patient can not have that negative self image about their recovery. Language matters to reduce stigma. Instead of opiate substance replacement therapy again, or medication assisted treatment, we want to use opiates against therapy, pharmacotherapy, addiction medication, medication for substance use disorder, medication for opiate disorder. You know, those medicines that include methadone, buprenorphine, naltrexone. The term MAT implies that a medication should have supplemented or temporary role in treatment. It's not a temporary, opiate use disorder is a chronic health condition. Using modern lines with the way other psychiatric medications are understood, antidepressants, antipsychotics, as critical tools as central to a patient's treatment plan. Medication is a tool for their treatment and we have to understand that. We must stop stigma. Stigma is a barrier to access for recovery. It's a barrier for getting the medications that is needed to continue on a continuous process of a chronic condition such as opiate use disorder. And we as healthcare providers, as people that might be in recovery, must stop stigmatizing language. What are some interventions that we can do to reduce stigma? We can contact, we can educate, and we can protest. We're going to discuss these three interventions in detail. Contact, we mean by positive interprofessional contact with stigmatized groups. You know, we have to understand peer groups, alcoholic anonymous, narcotic anonymous. These groups are groups of individuals that have similar problems but they come together for self-support. Self-support to aid them in their recovery, road to recovery. So actually understanding that these groups shouldn't be stigmatized but these are groups that aid in the recovery process. Contesting negative attitudes by direct interaction. You know, oftentimes we might have a negative explicit bias about the individual because we really don't know the person. But when we sit down and have conversations, we sit down and break bread with these individuals, we realize we're a lot more similar than we are different. We want to reduce desire for social distance. Again, keeping in contact, understand that this person does not have a disease, they don't have something that is contagious, but we have to treat them as a person that is just like if they had high blood pressure. We're not going to say, oh I can't sit with you because you have high blood pressure, I'm going to get it because that's a stigmatizing on that patient. But we want to be deliberate and understand that hey, we're strong together and this is a road to recovery that we're in. The interpersonal skills for your career. Understanding when we say I want to be contact, I want to be active listener, I want to interact, I want to be caring in my approach, leadership, I want to be motivational interviews or motivational interaction. In other words, encouraging them that hey, I might not have had this addiction, but I had this. I might not have had this problem, but I had this. So and being responsible and understanding that when we collaborate, when we work together as a team, there's nothing we can't accomplish. So as a family unit or it's a peer group that has a common goal, you can accomplish great things. Education. Understanding that different cultures might look at and perceive opiate use disorder differently. Again, some cultures might perceive it as being weak or somebody that has, they don't have enough self-esteem to fight it. But understand this is a process that it is something that we can work with the person in their recovery. Again, it's a continuum. You know, it's a chronic condition that but understanding that by getting educated with culture training and communicating implicit bias is a healing step to preventing stigmatizing language. Educate. You know, we have to start at the grassroots level with health care providers. Demystifying social sharing information. Understand that we must spread this information. We must share it with our colleagues. We must share it with our family members. We must let them know that hey, this person is a road to recovery. And so we have to be recovering. And so if we understand that this individual can socially, we can share this information, you know, illegal supply and supply control, home reduction strategies, first responders, how we can educate, you know, substance disorder treatment. We must put this education in the curriculum of health care providers. We must provide them with the resources such as SAMHSA and other resources that will allow them to have access to this medication and the people that can treat them for that. We must protest aims at reduction stigma by adopting legal measures. Right now, currently, the Justice Department have prosecuted several companies based on the American with Disabilities Act because opiate use disorder is considered a disability. So, you know, when they have stigmatizing language in their policies, the Justice Department is coming down on people because, again, it's a recovery process. They're not abusers or addicts, but they're going through a period of recovery. And with anything you have recovered, you have areas sometimes that you have positive impact and sometimes that you struggle with. But being honest and open and being transparent to yourself and to others will help aid in your recovery. Stigma and discrimination. No other conditions are more stigmatizing than addiction. Stigma is an attitude. It's a behavior, a condition that is socially discriminating. Stigma is influenced by two main factors. It's not their fault, cause. Stigma is diminished. Controllability, they can't help it. Stigma is diminished. Many people perceive addiction as a choice and that addicts, individuals really can't control it. So understanding what drives somebody's bias. Understanding that, hey, even though they have this condition, we should not stigmatize. We shouldn't judge them. That's going to impede their recovery process. It's going to impede the access they have to life-saving medication. And describe, we describe the bias one has, providers have to prescribing buprenorphine. One of the huge biases they have is lack of psychosocial support. There's a time constraint. Oftentimes when one starts one on buprenorphine, it's over, it's, they have to do it over a period of days. Lack of confidence. There's restrictions to practice patterns, lack of institution support. There's concern about when you primary care, what's, how am I going to get reimbursed? Lack of patient needs. Patients, they don't need that. That's a crutch. So understand that bias because buprenorphine is a life-saving medication. It has a ceiling effect. So there's a decrease, overdose, and it's a, it's a gold standard, a treatment for people that have opioid use disorder. Racial disparities in buprenorphine. As you can see, buprenorphine is, methadone is more used toward people that have lower socio-economical status, where buprenorphine, as you can see in this graph, is a huge racial and ethnic disparity in buprenorphine treatment. We can see that the aggregate whites receive treatment much more than black and racial ethnic minority groups. So understand that every single person that's on buprenorphine treatment, everyone should have access to this life-saving treatment. Again, buprenorphine has, many literatures have showed that it's more of the gold standard for people to have mods. So everyone, despite their socio-economical status, besides their racial makeup, should have access to this life-saving medication. There's misconceptions about addiction and recovery. Addiction is a choice. Addiction is a sign of poor character. The professional treatment won't help. Replacement is a sign of failure. Again, often these drugs, fentanyl is 10 times, 50 times, 100 times more potent. More potent. People are vulnerable based on their genetic factors. Their recovery increases as life expectancy. Oftentimes, they're relapsed the first three years. Understanding that it's a chronic illness, just like high blood pressure, just like type one diabetes. Addiction is a chronic condition. Next to cost and disbelief, stigma is the third largest reason why individuals choose not for treatment. They don't want other people to characterize or judge them. And that's a huge barrier to getting access to treatment. Check your attitude and ego at the door. Check your attitude and ego at the door. In this slide, it shows, assesses one's bias. In other words, their bias and how they see themselves. Their bias and how they see themselves. And that this tool is aided to assist the recovery process in those that might have substance use disorder. These are resources that are invaluable. SAMHSA, Center for Substance Abuse and Treatment, Center for Substance Use and Addiction, Stop Talking Dirty, Clinical Language and Quality of Care for Leading Calls and Prevention of Death in the United States Toward Addiction. So these are resources that are available to one to help and increase the recovery process. We must stop stigma. We must respect. We must give supportive. We must listen. Understand that oftentimes stigma is associated with mental health and low self-esteem. We must be inclusive. Understand that these are people that we have to go and meet them where they're at. This is a recovery process. And that with any recovery, you're going to have times where you have compliance and non-compliance. And just like with any chronic health conditions, there's going to be areas where we need help with. So we must stop stigma in order to combat the opioid epidemic and to reduce opioid overdoses and to recover and get access to life-saving medication for opioid use disorder.

opioid use disorder

stigma

treatment access

self-stigma

healthcare providers

interventions

racial disparities