Table 4.

Patients’ and Providers’ Attitudes and Beliefs About MOUD

Title	Author	Population	Type of Data Collection	Summary
Staff and client attitudes toward methadone maintenance treatment	(Brown, Bass, Gauvey, & Kozel, 1972)	55 patients and 23 staff members from a narcotic treatment facility in the District of Columbia Narcotics Treatment Administration	Adjective Check List surveys	Patients perceive individuals receiving methadone as being responsible, conscientious, and supportive of others “Staff members---like their clients---see the addict abstinent from all drugs as a more effective and capable person than is the addict using methadone” MMT patients see themselves as being more “self-willed” but also less insightful and having less concern for others feelings and values compared to those who do not use MOUD Staff and clients felt that the addict using heroin is characterized by being more underachieving, irresponsible, dependent, antisocial than the addict using methadone or no drugs at all Staff provide guidance and direction to clients and could communicate their attitudes to clients, even if unintentionally
Tapering from methadone maintenance: attitudes of clients and staff	(Gold, Sorensen, McCanlies, Trier, & Dlugosch, 1988)	60 clients (not currently tapering) and 30 staff members in five MMT clinics across San Francisco Bay Area	Interview/Questionnaire	Patients on MMT become phobic about voluntarily tapering off methadone and feel it interferes with ability to attain abstinence Attitudes towards tapering: 35% extremely motivated to taper Motivations for tapering: a desire to be drug free, dislike of coming to the clinic, personal growth, physical side effects of MET 28% of patients were extremely opposed to tapering, stating that methadone was a stabilizing factor and a fear of return to illicit drug use Patients view tapering from methadone as difficult Patients describe the biggest obstacle of tapering is a fear of living without methadone”. This fear is psychological in nature, which could be potentially remedied with coping strategies Both client and staff had similar attitudes toward MMT 93% of staff and 60% of clients disagree that once you’re on methadone, you have to keep taking it Over half of clients view the drug environment as the reason that they would fail treatment
Methadone maintenance in the treatment of opioid dependence a current perspective	(Zweben & Payte, 1990)	Academic sources	Opinion	General negative attitude about methadone in physicians, patients, and general public Addicts enter MMT with ambivalence or an urgency to get off of it Source of negative attitudes toward MMT is the perception that methadone treatment is “substituting one drug from another”
Buprenorphine for Office-Based Practice: Consensus Conference Overview	(Kosten & Fiellin, 2004)	Academic literature, presentations	Summary of Presentations at Conference	80% of psychiatrists were not comfortable providing office-based opiate agonist treatments, which was a barrier to moving the buprenorphine treatment forward Patients exhibited satisfaction with office-based buprenorphine
Predicting treatment retention with a brief “Opinions About Methadone” scale	(Kayman, Goldstein, Deren, & Rosenblum, 2006)	338 clients in MMT in New York City	Survey	Negative attitudes towards methadone treatment at the time of admission predicted a client’s retention in the program; negative attitudes correlate with earlier termination Specific negative attitudes toward methadone included in the survey included were “methadone is substituting one drug for another” or “it is practically impossible to get off methadone.”
Client and counselor attitudes toward the use of medications for treatment of opioid dependence	(Rieckmann, Daley, Fuller, Thomas, & McCarty, 2007)	376 counselors and 1,083 clients from outpatient, methadone, and residential drug treatment programs	Medications Opinions Survey	Methadone clients and counselors held more positive views of methadone than those in residential or outpatient settings Attitudes toward buprenorphine were neutral Social norms influenced client and counselor behaving suggesting that perceptions and beliefs play an important role in MOUD treatment Clients were generally less informed about buprenorphine
Societal perception and support for methadone maintenance treatment in a Chinese province with high HIV prevalence	(Yang et al., 2008)	411 police staff, medical health professionals, community members, and drug users	Survey questionnaires and focus groups interviews	85% of all respondents supported the MMT programs Drug users when compared to all other groups were the least optimistic about MMT 87% of all respondents believed that MMT would be effective for preventing HIV transmission
Methadone Maintenance Treatment for Youth: Experiences of Clients, Staff, and Parent	(Guarino et al., 2009)	22 clients, clinical staff, and clients’ parents	Focus groups	Clients described methadone as a “safety net” that helped them lead normal lives Clients explained that because of the physical dependence associated with methadone, MMT should be offered as a “last resort” Staff expressed frustration with provider resistance to offering methadone to clients
A qualitative inquiry into methadone maintenance treatment for opioid-dependent prisoners in Tehran, Iran	(Zamani et al., 2010)	30 prisoners (3 assistants for MMT administration) in Ghezel hesar prison, 15 others: 4 physicians, 2 nurses, 3 psychologists, 2 prison managers, 4 health policymakers	Focus group and interviews	MMT is perceived as effective by both prisoners and managing staff Prisoners and practitioners reported that MMT had health benefits MMT has alleviated financial strain on drug-using prisoners and their families Other prisoners and staff stigmatize those who use MMT The MMT program in prison significantly reduced the number of prisoners injecting drugs Some prisoners report fear of side effects of MMT
In control? Ukrainian opiate substitution treatment patients strive for a voice in their treatment.	(Golovanevskaya, Vlasenko, & Saucier, 2012)	Academic literature, 8 physicians and 20 patient advocates	Systematic review and Interviews	Methadone is heavily policed in Ukraine, and patients must be diagnosed with opiate addiction and participate in a clinical trial Doctors face the risk of arrest for not complying with the complicated documentation needed for MMT in Ukraine OST is not available by prescription or for take-home allowance in Ukraine Patients face limited clinic hours, long waiting lines, and inability to receive medication outside of work hours
Methadone maintenance treatment in China: perceived challenges from the perspectives of service providers and patients	(Wu et al., 2013)	4 focus groups: 2 with providers and 2 with patients (25 drug using patients and 14 providers)	Focus groups	Providers and patients had positive experiences with MMT but there were concerns about side effects and continued heroin use Identified barriers to care were: affordability, stigma, and accessibility Patients describe a fear of becoming addicted to methadone
Opioid maintenance therapy in Switzerland: an overview of the Swiss IMPROVE study	(Besson et al., 2014)	200 physicians and 207 opioid dependent patients	Questionnaire	Buprenorphine was prescribed most frequently by psychiatrists and internists Physicians cited barriers to care: lack of training, difficult patient group, and scarcity of resources Liquid methadone was the preferred medication in all regions “45% of all physicians interviewed reported that diversion of substances was a significant or huge problem”
Discontinuation of buprenorphine maintenance therapy: perspectives and outcomes	(Bentzley, Barth, Back, & Book, 2015)	Studies that include patient and/or provider perspectives on buprenorphine	Systematic review	Fear of relapse is a major reason for patients to remain in BMT There is a disconnect between patient impression of length of BMT and actual length of BMT One study found that the majority of physicians surveyed found long-term buprenorphine treatment beneficial
The rights of drug treatment patients: experience of addiction treatment in Poland from a human rights perspective	(Klingemann, 2017)	43 staff and 73 patients from inpatient therapeutic communities, outpatient programs, and opioid substitution programs in Poland	Focus group interviews	Patients in opioid substitution treatment (OST) experience “disrespect of privacy and dignity” Patients report feeling humiliated, belittled, and a sense of hopelessness in terms of enacting change. Staff of outpatient programs note the difficulty of gaining admission information about patients while maintaining a good patient-practitioner relationship.