TDNet Discover

Background: Opioid use disorder (OUD) and the complications associated with opioid use is a growing concern across the globe. Increased deaths, morbidity, and crimes associated with opioid misuse are increasing in the United States. Groups such as Narcotics Anonymous (NA) advocate for an abstinence-based approach and have been known to deny memberships to patients solely based on their use of medication-assisted treatment (MAT). Despite evidence indicating better efficacy in treating OUD with MAT therapy, treatments that involve methadone, buprenorphine, and naltrexone are widely underutilized when compared to abstinence-based treatment. Objective: This systematic review aims to assess how MAT therapy is more efficacious than abstinence-based therapy along with the factors that contribute to limited MAT use, specifically focusing on the stigma and accessibility of MAT. Methods: A systematic literature review study design was completed by searching the databases JSTOR, PubMed, Cochrane Library, and Google Scholar. Search phrases included “psychosocial AND opioid”, “abstinence only opioid treatment”, “medication based opioid treatment AND abstinence” and “medication assisted treatment AND opioid use disorder AND abstinence”. Search results were reviewed against all inclusion and exclusion criteria. Each publication selected and approved for this SR was assessed for quality using the National Heart, Lung, and Blood Institute quality assessment tools including the Quality Assessment of Systematic Reviews and Meta-Analyses, along with the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Important data points including participant demographics, type of interventions used, results, quality, and conclusions were identified using an existing data v extraction tool. Analysis consensus between the three researchers resulted in nine peer-reviewed articles. Results: Nine total studies including systematic reviews, cross-sectional surveys, and qualitative research using questionnaires and interviews were included in this study. Key results indicated that MAT therapy is more effective than abstinence-based therapy in long-term treatment retention rates, decreasing illicit opioid use, relapse rates, and morbidity and mortality rates. This systematic review also found that MAT is underutilized due to strict government policies, difficult medication dosing schedule, lack of qualified healthcare providers, and negative perceptions and little knowledge of MAT therapy. Conclusion: Persistent stigma and poor education of MAT, in addition to its limited access, leads to an underutilization of an effective treatment modality for OUD. Increased education on MAT to community members and healthcare providers can be helpful in reducing MAT and OUD stigma and thereby increasing the use of MAT. Improvements in the regulation of MAT and increasing availability of additional resources would also help improve the accessibility of MAT, especially in rural communities.