Stigma? Or, something else?

I saw some comments about this study as evidence of stigma among physicians.

Every time I see a discussion about physician reluctance to treat addiction, I wonder if there’s an alternative explanation.

Here’s what paper reported:

  • 67.1% believe treatment of opioid use disorder (OUD) is more effective with medication than without
  • 77.5% believe buprenorphine is an effective treatment
  • 51.4% believe injectable, extended-release naltrexone is an effective treatment
  • 20.2% are interested in treating patients with OUD
  • 81.8% support requiring insurers to cover medication treatment of OUD
  • 76.4% support increasing government spending on medication treatment of OUD
  • 47.7% support allowing clinicians to prescribe methadone to treat OUD in primary care settings
  • 38% support eliminating the requirement to complete an additional 8 hour training and register with the federal government to prescribe buprenorphine

The response that’s gotten the most attention is the 20.2% expressing interested in treating OUD. This has been characterized as discrimination and problematic.

Is it possible that these responses (or, at least a significant portion of them) do not represent stigma?

This is anecdotal, but I’ve had conversations with physicians who were considering providing treatment for OUD but do not take the leap. Their reasons are not the required training, registration, or patient limits.

Their reasons relate to their belief that effective treatment requires more than medication and their awareness that they are not capable of providing more than medication.

Their reluctance (or lack of interest) to provide addiction treatment and their acceptance of the waiver system may stem from the belief that addiction treatment is a legitimate specialty that requires training, commitment, and practice to deliver effectively. Further, they believed that these patients would require an interdisciplinary team and parallel community-based support.

While some characterize the paper’s survey responses as manifestations of stigma, other physicians believe they’d be guilty of hubris if they jumped into office-based treatment of OUD.

As with most things, I’m sure there’s a lot of nuance and variation within answers. So, why the rush to the assumption that the responses of these doctors represent stigma?