Telehealth and Intervention Stigma: Patient Perspectives About Flexible Opioid Use Disorder Treatment Delivery

Background: While medications for opioid use disorder (MOUD) are widely considered the "gold standard" of opioid use disorder (OUD) care, more than 80% of people with OUD receive no treatment; of those who do receive care, less than half receive MOUD. Stigma is a major impediment to both OUD treatment in general and MOUD in particular. Recent scholarship has documented how particular medical interventions can themselves become the target of "intervention stigma" distinct from the "condition stigma" often attached to stigmatized medical conditions or patient populations. Telehealth, which has become a more viable and popular option for delivering MOUD since the onset of the COVID-19 pandemic, can potentially alleviate some of the stigma patients face when accessing in-person care, but also may itself be subject to particular forms of stigma. While telehealth offers an opportunity to provide lower-barrier, more accessible care, its uptake as a treatment modality depends on its acceptability to patients and providers. Methods: This qualitative, interview-based study of 25 patients with OUD in Philadelphia, Pennsylvania, explores patient experiences with and perceptions of OUD treatment and telehealth for MOUD, with a focus on how patients compare different treatment modalities and their beliefs about the effectiveness and appropriateness of telehealth for MOUD. Results: We explore how ideas about drug dependence and treatment inform opinions about MOUD and telehealth, generating a distinct form of "intervention stigma" around this modality of care. We show how assumptions about people who use drugs combine with the technical affordances and limitations of telehealth to compound stigma above and beyond the stigma directed at MOUD generally. Conclusion: While previous research about telehealth MOUD suggests that it is as effective as in-person care and reduces important barriers to treatment, this form of intervention stigma may negatively impact patient perceptions about its appropriateness and effectiveness.