Ambivalence and contingencies: A qualitative examination of peer recovery coaches' attitudes toward medications for opioid use disorder

Emily Pasman; Sydney O'Shay; Suzanne Brown; Erin Fanning Madden; Elizabeth Agius; Stella M Resko

doi:10.1016/j.josat.2023.209121

Ambivalence and contingencies: A qualitative examination of peer recovery coaches' attitudes toward medications for opioid use disorder

J Subst Use Addict Treat. 2023 Dec:155:209121. doi: 10.1016/j.josat.2023.209121. Epub 2023 Jul 19.

Authors

Emily Pasman¹, Sydney O'Shay², Suzanne Brown³, Erin Fanning Madden⁴, Elizabeth Agius³, Stella M Resko⁵

Affiliations

¹ School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, United States of America. Electronic address: emily.pasman@wayne.edu.
² Department of Communication Studies & Philosophy, Utah State University, 0720 Old Main Hill, Logan, UT 84322, United States of America.
³ School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, United States of America.
⁴ Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 3939 Woodward Ave, Detroit, MI 48201, United States of America.
⁵ School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, United States of America; Merrill Palmer Skillman Institute, Wayne State University, 71 E Ferry St, Detroit, MI 48202, United States of America.

PMID: 37474006
DOI: 10.1016/j.josat.2023.209121

Abstract

Introduction: Peer recovery coaches (PRCs) are an important provider group affecting medications for opioid use disorder (MOUD) uptake and retention. However, some PRCs may have experiences and beliefs that do not align with the use of MOUD. This study examines PRCs' perceptions of MOUD and how PRCs' attitudes affect their interactions with clients. The article also explores factors influencing PRCs' attitudes.

Methods: The study team conducted semi-structured interviews by phone with PRCs in Michigan (N = 34, July through September 2021). The study asked participants about their opinion of MOUD, how they help clients to make decisions about MOUD, and whether they have encountered negative attitudes toward MOUD in their work. Data analysis was guided by Tracy's (2020) iterative phronetic approach.

Results: Nearly all PRCs acknowledged the social stigma surrounding MOUD. PRCs described the stigma toward MOUD as affecting treatment access, utilization, and recovery support. While most PRCs expressed support for many recovery pathways, support for MOUD was contingent on the type of medication and the conditions under which it is used. PRCs often described MOUD as acceptable only in the short-term when paired with psychosocial interventions, after nonpharmacological treatment attempts had failed. PRCs with concerns about MOUD reported sometimes avoiding discussions about MOUD with clients, spreading misinformation about MOUD, and encouraging clients to discontinue treatment. However, many PRCs expressed a desire to support clients' self-determination despite their own biases.

Conclusions: Findings highlight a need for education and stigma reduction among PRCs and point to specific areas for intervention. PRCs described deeply engrained beliefs about MOUD rooted in their own treatment histories and recovery practices. Provision of high-quality training and supervision to shift attitudes among PRCs will be key to increasing the use of MOUD.

Keywords: Attitudes; Medications for opioid use disorder; Opioid; Peer recovery coach; Stigma; Treatment.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Affect
Biological Transport
Data Analysis
Humans
Opioid-Related Disorders*
Social Stigma*