Does perceived stigma impact opioid use disorder treatment uptake? A cross-sectional secondary analysis of buprenorphine engagement among syringe service program participants.

INTRODUCTION: Buprenorphine is an effective medication for opioid use disorder (OUD) treatment; however, stigma surrounding substance use may deter individuals from seeking treatment and contribute to lower engagement once treatment is initiated. This study examined relationships between substance use stigma and buprenorphine treatment engagement among syringe service program (SSP) participants. METHODS: This cross-sectional secondary analysis used data from a randomized control trial of buprenorphine treatment initiation at three SSPs. Participants met DSM-5 criteria for OUD and expressed interest in buprenorphine. Participants completed the Ahern substance use stigma scale at baseline. The primary outcome was buprenorphine engagement, defined as having an active prescription 30 days post-enrollment. Multivariable logistic regression examined associations between participants’ perceived stigma and buprenorphine engagement. RESULTS: Ninety-seven participants with a mean age of 42 years reported high levels of substance use stigma across multiple domains (discrimination, alienation, perceived devaluation); however, there were no significant differences in stigma scores between those who were and were not engaged in buprenorphine at 30 days. Participants who reported being denied medical care previously due to their substance use were significantly more likely to engage in buprenorphine (adjusted Odds Ratio = 2.64, 95% CI = 1.04–6.66). DISCUSSION: Stigma scores did not predict buprenorphine engagement, but unexpectedly, participants who had experienced discrimination in medical care were more likely to engage. While stigma was not associated with buprenorphine uptake, most participants reported high levels of stigma, highlighting the need for patient-centered models of care that mitigate stigma.