How Health Care Stigma Affects Treatment Engagement and Retention

Pharmacy Times interviews Allison Burns, PharmD, RPh, the CEO of End Mass Overdose (EMO) Health to discuss how stigma from health care providers or frontline staff impacts patient willingness to seek or continue treatment.

Burns discussed how stigma from health care providers, frontline staff, and health care systems can create barriers to treatment access and continuity for patients receiving mental health and substance use disorder medications in congregate care settings. According to Burns, these challenges are often compounded by the frequent transitions of care that occur as patients move from detoxification programs to stabilization units and ultimately to residential treatment facilities.

During these transitions, medication regimens can be disrupted, prescribers may change, and medication records may not be transferred completely. Burns noted that patients may not always know the names of their medications, making it difficult to advocate for continued treatment when medications are omitted from a medication list or overlooked during handoffs between facilities. Stigma surrounding mental health treatment can further discourage patients from discussing their medications or seeking clarification when issues arise.

Burns also highlighted the persistent stigma surrounding medications for opioid use disorder, particularly buprenorphine-containing products. In some cases, patients requesting refills a few days early may face skepticism from pharmacy or health care staff, who may question whether the medication is being misused. However, Burns emphasized the importance of considering the broader context of a patient's life, including work schedules, family responsibilities, travel plans, and pharmacy operating hours. These practical factors may explain why a patient seeks medication before the scheduled refill date.

While acknowledging the need for appropriate safeguards and monitoring of controlled substances, Burns stressed that clinicians must balance those responsibilities against the potential consequences of interrupted treatment. Missing doses of medications such as buprenorphine can increase the risk of relapse, which may expose patients to significant dangers, including overdose. Ultimately, Burns emphasized the importance of individualized decision-making, encouraging health care professionals to evaluate each situation on a case-by-case basis rather than relying on rigid assumptions or one-size-fits-all approaches.