Thread by @jonathan_giftos

Stigma, revealed.

A clinician approaches me to say that he disagrees w/ our effort to offer patients w/ opioid use disorder methadone or bupe maintenance while incarcerated. Better, he says, for us to “detox” as many patients as possible so they are “normal” when they leave. 1/

I shared some data, citing increased mortality risk for patients w/ OUD during post-release period & evidence suggesting these medications associated w/ large reduction in that risk. He responds by saying, “Well, I just don’t want to pay for it ... you know, as a tax payer.” 2/

So, I then share what we know from Massachusetts Medicaid data, that patients on maintenance medications tend to cost society less per month than do patients not on medications (fewer ODs, ER visits, HIV infections, etc). He listens, then follows up with the kicker ... 3/

“Well,” says clinician, “then, I don’t EMOTIONALLY agree w/ these medications”.

While not sure what he means, I do know concerns not about efficacy (didn’t respond to data) or cost (didn’t respond to savings). Sadly, best I can say is they reflect deadly stigma against OAT. 4/

Note 1: Methadone and buprenorphine fully integrated in NYC jail-system, with over 8,000 patients (sadly, a lot of people incarcerated with OUD) served each year, and an OTP with almost 1,000 enrolled on any given day.

drive.google.com/open?id=0Byheg…

Note 2: For those interested in source of some of this data, see below presentation on evidence-based treatment for OUD. References in light gray at base of slides.

drive.google.com/open?id=1XKnyP…