Attitudes toward opioid use disorder medications: Results from a U.S. National Study of individuals who resolved a substance use problem

The attitudes of individuals who receive, provide, or influence opioid use disorder (OUD) medication services, also called stakeholders, may enhance or hinder their dissemination and adoption. Individuals who have resolved a significant alcohol or other drug (AOD) problem are a group of key stakeholders whose OUD medication attitudes are not well understood empirically. This group subsumes, but is not limited to, individuals who identify as being "in recovery." Analyses leveraged the National Recovery Study, a geo-demographically representative survey of U.S. adults who resolved a significant AOD problem (N = 1,946). We examined the prevalence of positive, neutral, and negative attitudes toward agonists, such as buprenorphine/naloxone and methadone, and antagonists, such as oral and extendedrelease depot injection naltrexone. Single-predictor logistic regression models tested for demographic, clinical, and recovery-related correlates of these attitudes and, for those significant at the.1 level, multivariable-predictor logistic regression models tested unique associations between these correlates and attitudes. Results showed that participants were equally likely to hold positive (21.4 [18.9 -24.0]%) and negative agonist (23.8 [21.2-26.7]%) attitudes but significantly more likely to hold negative (30.3 [27.4 -33.3]%) than positive antagonist attitudes (18.0 [15.9 -20.4]%). Neutral attitudes were most commonly endorsed for both agonists (54.8 [51.6 -57.9]%) and antagonists (51.7 [48.5-54.8]%). For agonists, more recent AOD problem resolution was a unique predictor of positive attitude, whereas Black and Hispanic races/ethnicities, compared with White, were unique predictors of negative attitude. For antagonists, older age group (45-59 and 60+ vs. 18-29 years), lifetime opioid antagonist medication prescription, and past 90-day non-12-step mutual-help attendance were unique predictors of positive attitude, whereas greater spirituality was a unique predictor of negative attitude. This population-level study of U.S. adults who resolved an AOD problem showed that agonist attitudes may be more positive than anecdotal evidence suggests. Certain characteristics and experiences, however, highlight a greater likelihood of negative attitudes, suggesting these factors may be potential barriers to OUD medication adoption.