Theme: Social Science & Policy Research Year: 2025
Background:
Methadone and buprenorphine are effective medications for reducing health and social harms related to heroin or other opioid use. However, people that receive these medications can be subject to discrediting attributions. This research explored the attitudes and experiences of people who dispense or receive opioid agonist treatment (OAT) within community pharmacies in two regions of New South Wales, Australia.
Methods:
Interviews were undertaken with OAT pharmacists and consumers to investigate their experiences of the treatment model (n=25). Reflective thematic analysis was applied to the qualitative data. Crosssectional survey data were collected from matched pharmacists (n=63) and consumers (n=132). Pharmacist implicit and explicit attitudes were measured, and longitudinal consumer data (n=98) were obtained six months later to analyse the influence of pharmacist attitudes on consumer outcomes over time. Additional follow up interviews were conducted which focusing on treatment disruptions that occurred in 2022 due to flooding (n=24).
Results:
Experiences of connection (such as socially inclusive and person-centred service approaches) enhanced service perceptions and engagement, whereas conditions of subjection (such as burdensome fees or rules and issues of mistrust) impeded this. OAT-related stigma was described as inhibiting treatment access and wellbeing. Structural stigma embedded with the restrictive OAT policies and practices was found to intensify risks related to privacy and medication access during flooding events. When measured in consumers’ lives and in pharmacists’ implicit attitudes, stigma was found to be associated with poorer wellbeing outcomes for OAT consumers over time.
Conclusion:
The interview and survey findings provided evidence that quantified and explained how opioid agonist treatment stigma is experienced within pharmacy dispensing encounters, and the effects that it has in consumers’ lives. Through investigating the interpersonal and structural dimensions of stigma from both consumer and pharmacy perspectives, characteristics of the service relationship that aligned with better treatment experiences were identified.
Disclosure of Interest Statement:
Theresa Caruana was supported by a UNSW Scientia PhD scholarship. The study was funded by the UNSW Faculty of Arts, Design & Architecture Higher Degree Research Essential Costs of Research Funding Support.
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