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Overcoming Stigmas of Medication-Assisted Treatment (MAT)

May 4, 2022

Table of Contents

Stigma against Medication-Assisted Treatment (MAT), or Medication for Addiction Treatment, is unfortunately still common, and represents an ongoing barrier for people who need help overcoming addiction..[1]

MAT is a lifesaving intervention that works. The medical community continues to work to decrease stigma as a barrier to treating patients with MAT. 

Stigmas Surrounding Medication-Assisted Treatment

There are a number of reasons why some people feel uncomfortable with Medication-Assisted Treatment or are outright against it, but these are the most common issues cited: 

Stigma among providers

In order to access Suboxone, patients must connect with a provider who is certified to prescribe the medication. Unfortunately, many providers choose to remain uncertified. Some don’t want to take on the training required, while others have concerns that treating people who struggle with addiction will introduce a negative element to their waiting rooms and scare off other patients.[2] This kind of prejudice limits the ability of enough providers to provide this life saving medication.

Stigma among 12-step programs

Many people who seek sobriety through the support of 12-step groups like Narcotics Anonymous hold a prejudice toward Suboxone use. This is because they see Suboxone as an addictive substance in its own right, therefore making anyone who takes it “not truly sober.” 

This simply isn’t true, but the stigma remains. Members may block MAT patients from speaking at meetings or allowing them to connect with a sponsor.[3]

Stigma related to Suboxone

Some people are concerned that buprenorphine, one of the active ingredients in Suboxone, will be diverted rather than used for treatment.[4] 

There is also concern that Suboxone and buprenorphine are addictive drugs themselves, and patients who take them are only perpetuating their addiction and potentially increasing their risk of relapse and overdose.[5] This isn’t true - the studies consistently confirm that MAT helps people with OUD to avoid relapse and sustain sobriety

Evidence for MAT in Opioid Use Disorder Treatment

While stigma is a common obstacle for people who need Medication-Assisted Treatment, almost all of the reasoning behind the stigma is baseless. 

Here are just a few of the myths debunked: 

  • Buprenorphine and Suboxone are sought-after street drugs for the purposes of getting high. Buprenorphine does not cause a euphoric high like heroin or other opioids, and Suboxone triggers immediate withdrawal due to its naloxone content if injected illegally. While these medications can be diverted, the majority of patients prescribed Suboxone take their prescription legally and appropriately. Even when these medications are purchased on the street, it is often those who want to use it to get sober and cannot otherwise access treatment.[7] This argues that instead of restricting this medication, we should be expanding its use to all peoples who seek to avoid illicit opioid use. 
  • People struggling with OUD who seek help through Medication-Assisted Treatment are trying to get free opioids This is rarely true - people who pursue MAT are almost always doing so with good intentions and the desire to avoid illicit use of opioids. When someone living with addiction asks for help, they should be celebrated for their efforts and not judged or scrutinized. .[8]

Stigma & the 12 Step Programs

Support groups can be a great help in recovery from addiction, but one of the most popular and easily accessible styles of support, the 12-step model, has historically been opposed to members using MAT. 

The one requirement for taking part in NA or AA, the two most popular forms of 12 steps, is that you have an honest desire to get sober and stop using all addictive substances.[9]

Unfortunately, many people in AA and NA categorize buprenorphine and Suboxone as drugs of addiction or a replacement for illicit drugs. They then characterize people who follow this path as “not truly being sober”. 

Because group support and being part of a sober community are important pieces of recovery, people in Medication-Assisted Treatment are encouraged to:

  • Avoid 12-step meetings in which their use of MAT  is attacked and questioned. 
  • Connect with support groups that are independent of the 12 steps and support Medication-Assisted Treatment. 
  • Work with a therapist regularly to stay grounded and address feelings that surface if they are exposed to 12-step members who attack their choice of treatment. 

Tips to Reduce Stigma Around MAT

If you or your loved one are struggling with stigma around Medication-Assisted Treatment, you can: 

  • Know that you have made the right choice in getting help. 
  • Know that no two people are alike, and no one can tell you what’s best for your life.
  • Know that the vast majority of medical professionals support patients in their use of MAT.  
  • Use different language when discussing MAT. Instead of saying you are clean right now, say you are sober or abstinent.[10] Ask patients and family members what language they prefer to use when describing their condition. 
  • Keep the information to yourself, if you prefer. It is no one’s business what medications you take, and you don’t have to tell people you are in MAT if you don’t want to.
  • Surround yourself with like-minded people who are in the MAT community, and join support groups that are just that - “supportive”!
  • Acknowledge how far you have come because of MAT. Consider how your life was before and what you have accomplished since you started MAT.

Substance use disorder (SUD) is not a matter of willpower. SUD a disease that must be treated as such.[11] 

There is no shame in getting help, and the more education is available on this process, the less stigma be a barrier to this lifesaving treatment[12,13]

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Intervention Stigma: How Medication-Assisted Treatment Marginalizes Patients and Providers. Social Science and Medicine. https://pubmed.ncbi.nlm.nih.gov/31125801/. July 2019. Accessed March 2022. 
  2. Medication-Assisted Treatment: Tool Tackling Opioid Crisis Faces Stigma, Other Barriers. Social Work Today. https://www.socialworktoday.com/archive/JA18p10.shtml. Accessed March 2022. 
  3. Stigmatization of Medications for Opioid Use Disorder in 12-Step Support Groups and Participant Responses. Substance Abuse. https://pubmed.ncbi.nlm.nih.gov/34214400/. 2022. Accessed March 2022. 
  4. Demystifying Buprenorphine Misuse: Has Fear of Diversion Gotten in the Way of Addressing the Opioid Crisis? Substance Abuse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800751/. April 2019. Accessed March 2022. 
  5. Challenging the Myths About Medication Assisted Treatment for Opioid Use Disorder. The National Council for Mental Wellbeing. https://www.opioidlibrary.org/wp-content/uploads/2019/06/NCBH_MAT_MythsVFacts.pdf. Accessed March 2022. 
  6. Opioid Agonist Treatments and Heroin Overdose Deaths in Baltimore, Maryland, 1995–2009. American Journal of Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670653/. May 2013. Accessed March 2022. 
  7. MAT for Opioid Use Disorder: Overcoming Objections. California Health Care Foundation. https://www.opioidlibrary.org/wp-content/uploads/2019/08/CHCF_MATOpioidUseDisorderOvercomingObjections.pdf. July 2019. Accessed March 2022. 
  8. Critical Support Where High-Risk Pregnancy Meets Addiction. Health Affairs. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.01449 January 2021. Accessed March 2022. 
  9. 12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview. Social Work in Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753023/. August 2013. Accessed March 2022. 
  10. Reducing Stigma Toward Medication-Assisted Treatment. Utah State University. https://extension.usu.edu/heart/research/reducingstigma. Accessed March 2022.
  11. Science Says, Addiction Is a Chronic Disease, Not a Moral Failing. University of Michigan. https://healthblog.uofmhealth.org/brain-health/science-says-addiction-a-chronic-disease-not-a-moral-failing. May 2017. Accessed March 2022.
  12. Addressing the Stigma That Surrounds Addiction. National Institute on Drug Abuse. https://nida.nih.gov/about-nida/noras-blog/2020/04/addressing-stigma-surrounds-addiction. April 2020. Accessed March 2022.
  13. As a Physician and a Patient, I’ve Seen the Damage Caused by the Stigma of Addiction. It Must End. STAT. https://www.statnews.com/2020/12/08/stigma-weaponized-helps-fuel-addiction-crisis/. December 2020. Accessed March 2022.

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