The Intersecting Effect of Substance Use Stigma, Methadone Treatment Stigma, and Racial Discrimination on Methadone Treatment Outcomes in Baltimore, MD

Opioid overdose deaths continue to rise precipitously, and Black/African American communities are experiencing drastic increases in opioid-related fatalities. Methadone treatment has a long history of efficacy for treating OUD, but adequate engagement in treatment is a persistent challenge. Racially minoritized individuals with OUD disproportionately evidence poor treatment outcomes. There is an urgent need to better understand barriers to treatment engagement in order to inform targeted and efficient interventions, especially among Black/African American individuals with OUD. Stigma surrounding both substance use disorder and methadone treatment, is a key driver of poor treatment outcomes and inequality. Further, racially minoritized individuals with OUD also routinely experience race-related stigma and discrimination in everyday social situations, which has been found to be broadly associated with poor mental and physical health outcomes, and may further worsen OUD outcomes. Research evaluating the intersection of racial discrimination, substance use and methadone treatment stigma is sparse, and rarely tested in relation to methadone treatment outcomes.

In this study, we evaluate the experience of racial stigma as well as substance use and methadone treatment stigma in a population of patients receiving methadone treatment who identify as Black/African American. We prospectively examine the effects of substance use, methadone treatment, and racial stigmas on subsequent methadone treatment engagement. Finally, we will utilize exploratory moderation models to evaluate interactive effects of racial stigma on substance use and methadone treatment stigma predicting methadone treatment outcomes. Results of this study have the potential to inform theory and data driven interventions to improve methadone treatment outcomes.

Location: Baltimore, MD; Funding: NIDA (R36DA056761; 2022-2024; PI: Kleinman)