Attitudes Toward Medications for Opioid Use Disorder Among Peer Recovery Coaches

Background and Purpose:
Peer recovery coaches (PRCs) are substance use service providers who draw on their lived experience to assist people in or seeking recovery from opioid use disorder. Although a large body of research demonstrates the efficacy of medications for OUD (MOUD), previous studies suggest PRCs’ attitudes toward MOUD are mixed (Suzuki et al., 2023). However, few studies have quantitatively assessed factors that may influence PRCs’ attitudes. The current study identifies factors associated with attitudes toward MOUD among PRCs.

Methods:
PRCs working at publicly-funded agencies in Michigan were recruited (07-09/2021) to complete a web-based survey (N=266). Participants self-reported their age, gender identity, racial-ethnic identity, education, and years working as a PRC. Surveys assessed current 12-step program participation, attitudes toward clients (Baldwin-White, 2016), and lived experience with MOUD (none, positive experience, negative experience, or mixed experiences). Seven items assessing perceived efficacy of MOUD, comfort working with clients surrounding MOUD, and consistency of MOUD with a recovery lifestyle were used to measure toward MOUD (Cronbach’s α=.816; higher scores indicate positive attitudes). Multiple linear regression was calculated in Mplus 8.3 to identify factors associated with PRCs’ attitudes toward MOUD.

Results:
Many PRCs (62.5%) reported current 12-step involvement and 21.5% reported a history of treatment with MOUD (n=51; positive=20, negative=18, mixed=13). The multiple regression model was significant (R2=.313, p<.001). Women had more positive attitudes toward MOUD than men (b=1.189, p=.038). Black PRCs had fewer positive attitudes relative to their white counterparts (b=-2.503, p=.001). Compared to PRCs without a history of MOUD treatment, PRCs with positive (b=4.705, p<.001) and mixed (b=3.357, p=.010) experiences had more positive attitudes toward MOUD; negative lived experience was associated with less positive attitudes (b=-3.158, p=.003). Current 12-step participation (b=-1.629, p=.007) and more stigmatizing attitudes toward clients (b=-.294, p<.001) were associated with less positive attitudes toward MOUD.

Conclusions and Implications:
Negative attitudes toward MOUD among the PRC workforce may contribute to poor treatment access, uptake, and retention. This study highlights subgroups of PRCs that could benefit from additional education and stigma reduction. Training and supervision for PRCs should aim to help PRCs reconcile discrepancies between their own lived experience, chosen recovery pathway, and the scientific evidence surrounding MOUD. Training should also address the complex relationship between self-stigma, stigma toward clients, and stigma toward MOUD. Further research is needed to examine the link between racial-ethnic identity and attitudes toward MOUD, particularly as overdose fatalities increase rapidly among Black individuals. Research that develops and tests strategies to improve PRCs’ attitudes will be an important component of efforts to increase the use of MOUD.