Ambivalence and stigma beliefs about medication treatment among young adults with opioid use disorder: A qualitative exploration of young adults’ perspectives
Open accessAbstract
Purpose Young adults with opioid use disorder (OUD) have low engagement in treatment with medication for opioid use disorder (MOUD). The objective of this study is to explore the beliefs and attitudes about MOUD among young adults.Methods We conducted a single-site qualitative study of 20 young adults ages 18-29 years with a diagnosis of OUD receiving care at an outpatient program and who spoke English. We used a flexible interview guide with the following domains: experience with MOUD, sources and impact of stigma, and interactions with family, healthcare professionals, and social networks. We conducted a thematic analysis based on deductive codes related to the domains and emergent codes from the interviews.Results We identified three themes. First, participants perceived being on MOUD as stigmatizing. They regarded MOUD as lifesaving but ultimately as a "crutch" hindering their full recovery. Second, young adults expressed ambivalence, distinct from stigma, about MOUD. This ambivalence was related to fear of withdrawal symptoms and concerns about their ability to live independent lives, side effects, and unknown treatment duration. Third, participants felt that MOUD was more than just a means to reduce risk of overdose, it was a means to become fully functioning in their lives.Discussion In this study of young adults in treatment for OUD, we found that stigma and ambivalence concerning MOUD could explain young adults' low engagement in care. Interventions addressing concerns about the stigmatizing effects of MOUD and the ambivalence young adults experience related to MOUD could improve engagement and retention of young adults.
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There is evidence that psychostimulant medications can reduce ADHD symptoms in adults with co-occurring ADHD.
“In addition to reduction of cocaine use, there is evidence that psychostimulant medications can reduce ADHD symptoms in adults with co-occurring ADHD.”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [142]
The Introduction discusses medications for opioid use disorder, including buprenorphine, methadone, and naltrexone; the Discussion addresses young adults’ beliefs about that treatment. Searches for psychostimulants, ADHD, and cocaine use found no passage addressing whether psychostimulants reduce ADHD symptoms in adults with co-occurring ADHD. (LLM, conf=0.76)
Experimental — accuracy not yet measuredA systematic review showed mixed results on psychostimulant effects on ADHD symptoms, possibly impacted by insufficient dosing.
“While a systematic review showed mixed results, 142 these may have been impacted by insufficient dosing”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [142]
The Discussion describes stigma and ambivalence about medications for opioid use disorder; its mention of a systematic review concerns barriers to that treatment, not ADHD. Searches for psychostimulants, ADHD symptoms, mixed results, and insufficient dosing found no passage addressing the claim. Page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredEvidence supports the use of multimodal interventions, including psychostimulant medications, to treat ADHD in individuals with co-occurring stimulant use disorder.
“Evidence supports the use of multimodal interventions, including psychostimulant medications, to treat ADHD in individuals with co-occurring StUD.142”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [142]
The Introduction discusses medications for opioid use disorder, and the Discussion addresses young adults’ ambivalence and stigma concerning that treatment; page numbers were not available in our copy. Searches for ADHD, co-occurring stimulant use disorder, psychostimulants, and multimodal treatment found no passage addressing the cited claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredSome but not all studies have demonstrated significant reduction in ADHD symptoms associated with psychostimulant prescription in individuals with stimulant use disorder without an increase in stimulant misuse.
“Some-but not all-studies have demonstrated significant reduction in ADHD symptoms associated with psychostimulant prescription in individuals with StUD without an increase in stimulant misuse.142,160”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [142]
The Introduction and Discussion (page numbers unavailable) address medications for opioid use disorder and young adults’ views of treatment, not psychostimulant prescribing for people with stimulant use disorder. Searches for ADHD symptoms, psychostimulants, and stimulant misuse found no passage in our copy addressing the claimed outcomes. (LLM, conf=0.78)
Experimental — accuracy not yet measuredEvaluations of risk mitigation strategies are found in studies of patients with ADHD, but these focus on the prevalence of practices to prevent stimulant medication diversion and misuse rather than their efficacy.
“Evaluations of risk mitigation strategies are found in studies of patients with ADHD, but these focus on the prevalence of practices to prevent stimulant medication diversion and misuse rather than their efficacy.142,162”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [142]
The Introduction and Discussion (page numbers unavailable) address young adults’ beliefs about medications for opioid use disorder, not ADHD or stimulant prescribing. Searches for ADHD, stimulant diversion, risk-mitigation practices, and their prevalence or efficacy found no passage addressing the claim. (LLM, conf=0.77)
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References 27 · Cited by 33
Research works printed but not linked: 1
- [5]National Academies of Sciences E. Medications for Opioid Use Disorder Save Lives.; 2019. doi: 10.17226/25310 30896911 · DOI
- Authors
- Bagley, S. M., Schoenberger, S. F., dellaBitta, V., Lunze, K., Barron, K., Hadland, S. E., & Park, T. W.
- Affiliations
- Boston University (US)
- London School of Hygiene & Tropical Medicine (GB)
- Rutgers New Jersey Medical School (US)
- Harvard University (US)
- University of Pittsburgh (US)
- Corresponding author
- Bagley, Sarah M.
- Venue
- Journal of Adolescent Health
- Publisher
- Elsevier BV
- Published
- 2023-01
- Volume
- 72
- Issue
- 1
- Pages
- 105-110
- ISSN
- 1054-139X (ISSN-L)
- PMC
- PMC10077517
- OpenAlex
- W4303613645
- Cited by
- 33
- References
- 27
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 13 · 2023: 2
- FWCI
- 5.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Adolescent Health (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1UL1TR001430)
- National Institute on Drug Abuse (K23DA044321, 1K23DA044324-01, K23DA045085, K99DA041245, L40DA042434)
- Boston University
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- opioid use disorder, medication-assisted treatment, stigma, ambivalence, young adults, treatment engagement, treatment retention, outpatient addiction treatment, withdrawal symptoms, patient perspectives, family and social networks
- MeSH terms
- Adolescent, Adult, Affect, Analgesics, Opioid, Emotions, Humans, Opioid-Related Disorders, Young Adult, Social Stigma, Drug Overdose
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