30 January 2023

Should I stay or should I go?, a new paper exploring stigma and other factors influencing opioid agonist treatment journeys, has been published in the International Journal of Environmental Research and Public Health. Opioid agonist treatment (OAT) includes taking methadone or similar medication, along with additional support such as motivational interviewing.

The study, part of Dr Vicky Carlisle’s PhD, was supported by the National Institute for Health and Care Research (NIHR).
The study involved interviews with 12 people using OAT, and 13 service providers. Key findings include:

  • The OAT journeys were influenced by a broad range of individual, social and structural factors, with stigma a particularly important barrier to staying in treatment and recovery
  • Pharmacies were a particularly strong source of stigma, both actual and perceived
  • Recovery from opioid dependency is about more than simply abstinence: it is a complex, self-defined and circuitous process

The researchers identified three themes from the interviews:

  • The system is broken
  • Power struggles
  • Filling the void

The team concluded prioritising long-term treatment – rather than focusing on the single goal of recovery – was important to make the most of OAT’s harm reduction benefits. Stigma was a systemic issue, which stopped people using OAT from leading fulfilling lives. The researchers identified an urgent need to develop targeted interventions to address stigma towards people using OAT.

Dr Vicky Carlisle, Senior Research Associate at the University of Bristol, said:

“We know that opioid agonist treatment is a successful way of managing and eventually overcoming opioid dependency. But the treatment journey for many people is fraught with difficulty. Research has shown that about 57% of people are still using OAT after a year, and just 38% after three years.”
“These statistics are heavily influenced by the stigma that people using OAT experience. Our study has shown that people often feel that the system is stacked against them, and that health services and wider society are judging them.”

Dr Jo Kesten, Research Fellow at NIHR Applied Research Collaboration West and NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, was one of Vicky’s PhD supervisors. She said:

“Stigma has a powerful role in shaping opioid agonist treatment journeys and whether people can remain in treatment or not. This study has shed light on where and how stigma, alongside other factors, affects these journeys.”

Should I stay or should I go? A qualitative exploration of stigma and other factors influencing opioid agonist treatment journeys
Vicky Carlisle, Olivia Maynard, Darren Bagnall, Matthew Hickman, Jon Shorrock, Kyla Thomas, Jo Kesten

Further information 

About the NIHR Health Protection Research Unit [HPRU] in Behavioural Science and Evaluation at the University of Bristol

The NIHR HPRU in Behavioural Science and Evaluation at University of Bristol is one of 14 HPRUs across England, part of a £58.7 million investment by the NIHR to protect the health of the nation.

The NIHR HPRU in Behavioural Science and Evaluation is a partnership between the UK Health Security Agency (UKHSA) and University of Bristol, in collaboration with MRC Biostatistics Research Unit at the University of Cambridge and University of the West of England.

Each NIHR HPRU undertakes high quality research that is used by UKHSA to keep the public safe from current and emerging public health threats.

About the NIHR

The National Institute for Health and Care Research (NIHR) is the nation’s largest funder of health and care research. The NIHR:

  • funds, supports and delivers high quality research that benefits the NHS, public health and social care
  • engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
  • attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
  • invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
  • partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.