Fostering Compassion in Opioid Treatment

Date: December 26, 2024 Reference: Steinhauser S et al. Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. AEM December 2024 Guest Skeptic: Dr. Suchismita Datta. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. Case: You and your resident physician have been working hard all day taking care of patients, saving lives, and making a difference. You hear your resident groan. You ask her what’s the matter, and she says: “I just picked up a patient with the chief complaint ‘abdominal pain,’ thinking it would be a simple, bread-and-butter workup, but the patient is on methadone. I don’t feel like dealing with this at the end of my shift.” Your resident looks up at you intently, looking for answers and hoping for wisdom. You wonder what you can say to help motivate your resident the right way and bring your patient back to the center of the encounter. Background: Opioid Use Disorder (OUD) represents a profound public health challenge, impacting millions of individuals worldwide. Defined as a chronic, relapsing condition characterized by a compulsive urge to use opioids despite harmful consequences, OUD transcends demographic boundaries, affecting individuals across all socioeconomic strata and geographies. In the United States alone, the burden is staggering: over six million individuals were estimated to have OUD in 2022. Emergency departments (EDs) are often the first point of contact for patients experiencing opioid-related crises, ranging from overdose to withdrawal. This positions EDs as critical spaces for intervention, offering a chance to initiate treatment, provide education, and connect patients with long-term resources. Despite this, patients with OUD frequently encounter stigma in healthcare settings, including the ED. Stigma in this context refers to the devaluation and discriminatory attitudes directed at individuals due to their condition. Such attitudes can manifest in subtle ways—disparaging comments, undertreatment of pain, or reluctance to initiate evidence-based treatments like medication-assisted therapy (MAT). This stigma not only undermines the patient-provider relationship but also discourages individuals from seeking care, perpetuating cycles of harm and disengagement. The stigma associated with OUD in emergency settings is multifaceted, rooted in misconceptions about addiction as a moral failing rather than a medical condition. Education and empathy-focused interventions have shown promise in mitigating these biases. By fostering an environment of compassion and understanding, healthcare professionals can significantly enhance the quality of care for these patients and potentially reduce the fear of stigma, as suggested by emerging research. Clinical Question: What is the prevalence of the fear of enacted stigma among patients who present to the ED with OUD, and is experiencing greater compassion from the ED staff associated with lowering this fear? Reference: Steinhauser S et al. Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. AEM December 2024 Population: Adult patients with diagnosed OUD presenting to an academic ED between February and August 2023. Exclusions: Patients unable to consent, non-English speakers, prisoners, acutely psychotic patients, critically ill patients, those suffering from dementia and those without a definitive diagnosis of OUD. Intervention: NA Comparison: NA Primary Outcome: The level of fear of enacted stigma, measured via the 9-item subscale of the Substance Abuse Self-Stigma Scale. The subscale consists of items rated on a 5-point Likert scale. Scores range from 9 to 45, with higher scores indicating greater fear of enacted stigma. Type of Study: Survey-based,