The Centers for Disease Control and Prevention recently released a formidable statistic - over 100,000 overdose deaths occurred in the U.S. during the 12-month period ending April 2021, representing an increase of nearly 30% compared to the previous year, and the highest number ever recorded in a 12-month period (2021). Although research demonstrates the safety and efficacy of FDA-approved medications to treat opioid use disorder (OUD), only one in three individuals with OUD receive any form of treatment, and just a fraction of those receive treatment with medication (Williams et al., 2018). What causes this gap in proven treatment options that may stem the growing tide of the OUD epidemic? According to Wayne State University School of Social Work Doctoral Student Emily Pasman, MSW, stigma plays a large role, but there is hope. Pasman explores ways to reduce stigma toward medication for OUD through social work education, research, and practice in her recent Elizabeth N. Brehler Scholars Program article.

COVID-19 has had a dramatic impact on the lives of Americans causing a spike in economic stressors, social isolation, loss of control and disrupted access to treatment. “Multiple factors play a role in the increasing overdose crisis since the beginning of the COVID-19 pandemic, but the long-standing impact stigma is having on our ability to provide life-saving treatment to those in need is often overlooked,” stated Pasman. The FDA has approved methadone, buprenorphine, and extended-release naltrexone medications to treat OUD. These medications improve treatment outcomes, reduce the risk of overdose death, and help prevent the transmission of infectious disease. However, stigma presents a major barrier to their broader use.

Pasman’s interest in this topic stems from her own experience as a social worker in long-term recovery. “I bring to my practice personal experiences, values, and beliefs about recovery. The communities I have been a part of have not always supported the use of medication. From my perspective, my MSW education was a missed opportunity to provide needed knowledge about the benefits of medication and the challenges patients face. I only became educated about pharmacology during my doctoral studies, when I assisted my advisor on a study of the experiences of methadone patients,” noted Pasman. Pasman’s work on this study involved three weeks of on-site data collection at an opioid treatment program, where she witnessed firsthand the impact of stigma on patients’ daily lives. “This was a transformative experience for me that corrected so many of my own misperceptions and shaped my scholarly interests.”

Armed with this new knowledge, Pasman undertook writing her article “Reducing stigma toward medication for opioid use disorder through social work education, research, and practice”, which reviews the impact of stigma toward medications for OUD and suggests areas for future research and social change.

As one of the primary service providers for people with opioid use disorder, social workers should be at the forefront of efforts to destigmatize medication treatments. This article is a call to action for social workers to address stigma toward medications for opioid use disorder through research, education, practice, and systems change. – Emily Pasman, 2021 Brehler Scholarship Recipient

After careful consideration by the review committee, Pasman was selected as the recipient of the 2021 Elizabeth N. Brehler Scholars Program Scholarship based on her article submission. Established in 1991 by Richard Brehler in memory of his wife, the Brehler Program began as an annual manuscript competition that allowed undergraduate and graduate students to produce a scholarly work. In 2020, the Program was reimagined to support the dissemination of social work research and the publication of scholarly works by Wayne State School of Social Work Ph.D. students. In the spirit of Elizabeth N. Brehler, competition submissions focus on one of three social work themes 1) the urban mission, ethics, values and understanding of personal bias, 2) social justice and transformation of bias in teaching, and 3) the utilization of community-engaged research methods that reflect self-awareness, personal reflection, and cultural humility.

For the Brehler Review Committee, Pasman’s submission incorporated a social justice and self-reflective lens when analyzing bias and misinformation pertaining to the OUD crisis. “Emily’s article addresses important issues about the ways that stigma and deeply held beliefs about recovery can obstruct implementation of and access to medication for treatment of opioid use disorders,” stated Social Work Program Director and Brehler Program Chair Poco Kernsmith, PhD. “This self-reflection on the biases and misinformation within the field, and discussion of the ways social work education and agency policy can address it, is critical to effectively address the opioid overdose epidemic.”

Pasman’s article supports the School’s aim to advance social justice in urban communities through the recognition that stigma towards OUD medication is not merely a health crisis, but is also a pressing social justice issue. In recent years, opioid overdose deaths have risen fastest among Blacks living in large urban areas (Lippold et al., 2019). However, these same populations have limited access to low-threshold treatments (e.g., office-based buprenorphine), and are more likely to be treated with methadone in highly regulated opioid treatment programs (Andraka-Christou, 2021; Goedel et al., 2020). Federal regulations, which require daily visits, supervised medication consumption, and frequent urinalysis for methadone patients, can evoke self-stigma and intrude on daily life.

Reducing stigma toward medications for opioids use disorder at the micro, meso, and systems level will help to improve treatment access and outcomes, and thereby reduce social inequities for urban communities. - Emily Pasman, 2021 Brehler Scholarship Recipient

The Brehler’s generous gift will continue to inspire students to take a critical look at bias, social justice and ways in which we can empower social change in our Detroit home.

Pasman’s full article can be viewed in the Journal of Social Work Practice in the Addictions.