Attitudes Towards Medication for Opioid Use Disorder Among Substance Use Treatment and Prevention Providers

Background: Improving access to medications for opioid use disorder (MOUD) can help reduce drug overdoses and improve treatment outcomes. Unfortunately, stigma and misinformation about MOUD are common and create barriers to treatment. Provider-based stigma can negatively affect MOUD uptake, retention, and quality of care. The purpose of this study was to examine attitudes towards MOUD among substance use treatment and prevention providers and to identify personal and professional characteristics associated with more positive attitudes.

Methods: Treatment and prevention staff working for publicly-funded substance use agencies (e.g., licensed social workers, counselors, psychologists, certified addiction specialists, peer recovery coaches, clinical supervisors) in Michigan (N=433) were recruited by email to complete a web-based survey (November 2020 through January 2021). Surveys assessed demographics (gender, race/ethnicity, education, rural/urban community), work experiences (years working in the SUD field, frequency of supervision, populations served), personal experience with substance use (recovery identity), and attitudes towards MOUD (seven items using a five-point Likert scale). Multiple regression was used to identify personal and professional characteristics associated with attitudes toward MOUD.

Results: Race, education, recovery identity, and work experiences were significantly associated with attitudes toward MOUD. Participants who identified as Black (B = -2.62, p = .019) and as being in recovery (B = -1.46, p = .027) had less positive attitudes towards MOUD. Individuals with a bachelor’s degree had less positive attitudes than those with lower levels of education (B = -2.75, p = .017). More years working in the SUD field (B = .08, p = .009) and work with pregnant women and women with children (B = 1.81, p = .003) were associated with more positive attitudes. Work with justice-involved individuals was associated with less positive attitudes (B = -1.24, p < .001).

Implications: Results highlight how some substance use treatment and prevention providers have negative attitudes toward MOUD. As social workers are among the primary service providers for people with SUD, findings have clear relevance to social work education and practice. More time spent working in the field and work with pregnant women, who are often prescribed MOUD to prevent dangerous withdrawal symptoms, were associated with more positive attitudes, suggesting exposure to MOUD may improve attitudes among service providers. Greater exposure to MOUD in bachelor’s level programs in social work and related fields may be beneficial. Findings suggest attitudes towards MOUD vary by racial and recovery identity. Given racial/ethnic disparities in access to MOUD and SUD treatment outcomes, these findings have important implications for work with people of color. Culturally appropriate MOUD training and education programs are needed to address the role of personal identity and substance use history. Less positive attitudes among those working with justice-involved populations also indicate a need for targeted training. Future research should examine other factors associated with attitudes toward MOUD and how training and education can improve attitudes. Efforts to improve attitudes towards MOUD among social workers and other substance use treatment and prevention providers have potential to increase referrals to care and client receptivity to MOUD, ultimately improving treatment outcomes.