Understanding stigma towards opioid use disorder and its role as a barrier to treatment in Sub-Saharan Africa: A scoping review.

Public Health Addictions Dissertation Prize Winner

Abstract

Background: Opioid use disorder is a global problem and an overwhelming public health concern, as opioids remain the most fatal class of drug responsible for two thirds of drug- related deaths. Opioid use disorder is the most stigmatized health condition worldwide and it serves as a huge barrier to treatment. Stigma associated with opioid use disorder does not exist in isolation but worsened by marginalization linked to race, gender, and ethnicity. Opioid trafficking routes along Sub-Saharan Africa have created local markets and increased consumption of heroin in East and Southern Africa and increased misuse of Tramadol and Codeine in West and Central Africa. Opioid use disorder has serious health repercussions that can include higher overdose risk, infectious diseases, mental health issues, as well as social and economic disturbances for affected persons and their families. Access to evidence-based treatment of opioid use disorder in Sub-Saharan Africa is often limited and stigma can act as a barrier to seeking and accessing treatment.

Methods: A scoping review was conducted to search for studies on stigma towards opioid use disorder and its role as a barrier to treatment in Sub-Saharan Africa using Arksey and O’Malley’s methodological framework for scoping review. Screening was done in two stages based on inclusion and exclusion criteria. Data was charted and relevant studies identified (n=16) and subsequent thematic analysis was performed.

Results: Sixteen studies were identified, majority from East Africa. Five themes emerged: stigma towards opioid use disorder are significant barriers to treatment, stigmatization of women who inject drugs, lack of sufficient healthcare facilities, mode of administration/enrolment as a barrier to treatment, and integration of antiretroviral therapy and medication-assisted treatment generates stigma.

Conclusion: The review highlighted diverse forms of stigma towards opioid use disorder which impacts on availability and accessibility of treatment in Sub-Saharan Africa as well as harm reduction which is slowly gaining recognition as effective strategies to address the health and social consequence of opioid use disorder. There is need for more research, advocacy, policy reforms, and collaboration towards addressing opioid use disorders and stigma.