Introduction
deaths, addiction, OUD
SEPARATION, SECONDARY
Nearly three-quarters of the more than 91,000 drug overdose deaths in the United States in 2020 involved an opioid, representing a 37% increase in opioid-related deaths from 2019 [One barrier to scaling up MOUD treatment in primary care is stigma toward people with OUD. Health-related stigmas are social processes by which people are labeled, stereotyped, devalued, and rejected because they have a health condition [Stigma is considered a “major driver” behind the lack of access to MOUDs, because of the misconception that addiction is a volitional choice, the separation of addiction treatment from the rest of the medical system, and the language used for addiction (e.g., calling urine drug screens “clean” or “dirty” or patients “addicts” or “junkies”) [There are few evidence-based interventions for reducing OUD stigma. Common approaches to reducing health-related stigma in the general public are to provide education, facilitate contact between persons affected by the condition and members of the general public, and target popular opinion leaders or change agents [This study examined whether an intervention designed to reduce PCC stigma of persons with OUD, compared to an attention-control training, was related to stigma, intentions to get waivered to prescribe buprenorphine or to prescribe buprenorphine if a waiver were no longer required, and use of a clinical decision support (CDS) tool embedded in the electronic health record (EHR) designed to help PCCs screen, diagnose, and treat people with OUD. We also examined secondary outcome measures, including reported willingness to work with people with OUD, perceived treatment effectiveness, and perceived likelihood that patients would adhere to OUD treatment. We hypothesized that the intervention incorporating patient narratives would reduce stigma, increase intentions to get waivered to or prescribe buprenorphine, and increase CDS tool use. In secondary hypotheses, we hypothesized that the stigma reduction intervention would be associated with increased willingness to work with people with OUD, increased perceptions that the treatments were effective, and greater perceptions that people with OUD would adhere to the treatments. As a second aim, we examined whether PCC self-reported stigma was related to intention to get waivered or prescribe buprenorphine and to likelihood of using the CDS tool. We hypothesized that PCCs with lower stigma toward people with OUD would have greater intentions to get waivered or prescribe buprenorphine and would be more likely to use the CDS tool. In secondary analyses, we hypothesized that PCCs with greater stigma would also report lower willingness to work with people with OUD, that treatments would be less effective, and that people would be less likely to adhere to the treatments.