BACKGROUND: Stigma surrounding opioid use disorder (OUD) and medications for opioid use disorder (MOUD), such as methadone, remains a significant barrier to care, despite the effectiveness of MOUD. Intersectional stigma tied to addiction, methadone treatment, structural racism, and classism disproportionately affects minoritized people with OUD, with direct consequences for health and wellbeing. Less is known about how Black and Latine people in methadone treatment think about and experience various dimensions of stigma related to addiction and the social determinants of health. METHODS: Semi-structured interviews were conducted with Black and Latine patients from two Newark, NJ, United States, methadone clinics (n = 37). Participant experiences and perceptions around SUD, MOUD, and stigma were explored. Participant transcripts were thematically coded to identify recurring themes and perspectives. RESULTS: Three major themes emerged: First, participants rejected views of addiction as a choice or moral failing, instead framing addiction as a chronic disease shaped by environment, trauma, and social pressure. Second, participants framed methadone as a legitimate, recovery-facilitating medical treatment, directly challenging the stigma that reduces it to a mere substitute. Third, participants emphasized that intersectional stigma related to substance use, structural racism, and classism significantly harmed their care, particularly noting resource deficits that disproportionately neglect Black and Latine communities. CONCLUSIONS: Reducing structural stigma is critical to improving access to MOUD for populations affected by structural inequity. Institutional efforts to reduce stigma and expand low-threshold programs are critical to expanding MOUD access and uptake. Intentional efforts to build trust with minoritized populations are essential to advance equity and can be achieved by acknowledging and addressing the structural drivers that shape people's daily lived experiences.
Ward et al. (Fri,) studied this question.