Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 E. 17th Ave, Aurora, CO, 80045, USA.
J Gen Intern Med. 2023 May;38(7):1638-1646. doi: 10.1007/s11606-022-07865-y. Epub 2022 Nov 17.
The chronic disease model of opioid use disorder (OUD) is promoted by many public health authorities, yet high levels of stigma persist along with low support for policies that would benefit people with OUD.
Determine if a survivorship model of OUD, which does not imply a chronic, relapsing disease state, compared to a chronic disease model improves public stigma and support for opioid-related policies. Explore if race or gender moderates any effect.
Online, vignette-based randomized study.
US adults recruited through a market research firm.
Participants viewed one of 8 vignettes depicting a person with OUD in sustained remission. Vignettes varied in terms of the OUD model (survivorship, chronic disease) and vignette individual's race (Black, White) and gender (man, woman).
(1) Public stigma measured by desire for social distance, perceptions of dangerousness, and overall feelings toward the vignette individual. (2) Support for 7 opioid-related policies. Overall feelings were measured on a feelings thermometer (0/cold-100/warm). Stigma and policy support responses were measured on Likert scales dichotomized to indicate a positive (4, 5) or negative/indifferent (1-3) response.
Of 1440 potential participants, 1172 (81%) were included in the analysis. Exposure to the survivorship model resulted in warmer feelings (mean 72, SD 23) compared to the chronic disease (mean 67, SD 23; difference 4, 95%CI 1-6). There was no effect modification from the vignette individual's race or gender. There was no significant difference between OUD models on other measures of public stigma or support for policies.
The survivorship model of OUD improved overall feelings compared to the chronic disease model, but we did not detect an effect of this model on other domains of public stigma or support for policies. Further refinement and testing of this novel, survivorship model of OUD could improve public opinions.
许多公共卫生当局都推崇慢性疾病模式来治疗阿片类药物使用障碍（OUD），然而，污名化程度仍然很高，同时也缺乏支持那些有利于 OUD 患者的政策。
与慢性疾病模式相比，OUD 的生存模式（不暗示慢性、复发性疾病状态）是否会改善公众对 OUD 的污名化和对阿片类相关政策的支持。探讨种族或性别是否会调节任何效果。
在线、基于情景的随机研究。
通过市场研究公司招募的美国成年人。
参与者观看了 8 个情景中的一个，描绘了一个处于持续缓解状态的 OUD 患者。情景在 OUD 模式（生存模式、慢性疾病模式）和情景个体的种族（黑种人、白种人）和性别（男性、女性）方面有所不同。
（1）通过对社交距离的渴望、对危险的认知以及对情景个体的整体感觉来衡量公众污名化。（2）对 7 项阿片类相关政策的支持。整体感觉通过情感温度计（0/冷-100/暖）进行测量。污名化和政策支持的反应通过利克特量表进行测量，分为积极（4、5）或消极/中立（1-3）。
在 1440 名潜在参与者中，有 1172 名（81%）被纳入分析。与慢性疾病模型（均值 67，标准差 23）相比，生存模型导致了更温暖的感觉（均值 72，标准差 23；差异 4，95%置信区间 1-6）。情景个体的种族或性别没有产生影响。在其他公众污名化或对政策的支持的测量方面，OUD 模型之间没有显著差异。
与慢性疾病模型相比，OUD 的生存模型改善了整体感觉，但我们没有发现这种模型对其他公众污名化或对政策的支持领域产生影响。进一步完善和测试这种新颖的、生存模式的 OUD 可以改善公众意见。
