PROJECT SUMMARY
In 2020 there was an estimated 20% increase in opioid overdose deaths from the previous year, and
Black/African American communities are experiencing drastic increases in opioid-related fatalities. Medication
for opioid use disorder, including methadone maintenance treatment (MMT), has a long history of efficacy for
treating opioid use disorder (OUD), but retention is a persistent challenge. Racial/ethnic minority individuals
with OUD disproportionately evidence poor outcomes, including worse MMT retention. There is an urgent need
to better understand barriers to MMT retention in order to inform targeted and efficient interventions, especially
among Black/African American individuals with OUD. Stigma at multiple levels, surrounding both substance
use disorder (SUD) and MMT, is a key driver of poor MMT outcomes, social devaluation, and inequality. Within
the level of “self,” stigma can be further categorized based on how individuals respond to and process stigma.
Internalized stigma refers to stigma directed at the self from the self. Anticipated stigma (expectation to be the
target of discrimination) and enacted stigma (past lived experience of discrimination) reflect stigma directed at
the self from others (family, employer, health care provider, etc). Further, racial minority individuals with OUD
also routinely experience race/ethnicity-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 quantitatively evaluating the intersection of racial discrimination, SUD and
MMT stigma is surprising sparse, and rarely tested in relation to MMT outcomes. The proposed study builds on
our team’s formative qualitative work, led by this proposal’s PI (Kleinman), which describes the pervasive
experience of SUD and MMT stigma and racial discrimination among people in MMT at a community-based
program in Baltimore City, which has one of the highest overdose-fatality rates in the country and greatest
burdens of OUD among low-income, racial/ethnic minority individuals. In the proposed study, we will evaluate
the experience of racial discrimination as well as internalized, anticipated, and enacted SUD and MMT stigma
in a population of patients starting MMT who identify as Black/African American (N=180). We will then
prospectively examine the effects of stigma and racial discrimination on subsequent MMT retention at 90 days
after treatment initiation. Finally, we will utilize moderation models to evaluate interactive effects between racial
discrimination and stigma measures on MMT retention. Results of this study have the potential to inform theory
and data driven interventions to improve MMT adherence and retention, particularly for this underserved and
disproportionately affected population. This study will serve as an important bridge for the PI (Kleinman) from
her graduate training to her promising early career as a clinical researcher working towards reducing health
disparities among people who use drugs.
