The Role of Trust in the Opioid Epidemic
Martin P. Repetto
In recent times, the United States has witnessed an epidemic of drug overdoses in rural counties across the nation, closely followed by new spikes in HIV (Human Immunodeficiency Virus) and Hepatitis C infections. Policymakers are thus confronted with the need to act to prevent both overdoses and infections and to do so, they need to understand how to encourage individuals to trust their providers and seek treatment and prevention services.
Even though people who inject opioids frequently go to their providers for medical care regarding injection-related injuries, they do not always trust their healthcare providers enough to speak to them about their condition. They are often afraid of scorn or rejection from the providers who are supposed to help them, leading them to staying silent, sharing needles, and overdosing.
Researchers at the University of Illinois, West Virginia University, and the University of Pennsylvania wanted to understand the basis for trust in healthcare providers in rural Appalachian and Midwestern areas similarly affected by the opioid epidemic.
Preparation
Before the researchers could start gathering data, they first needed to set out a hypothesis that would either be proven or disproven by their work. The hypothesis essentially functions as a compass that guides research work in the correct direction, allowing the team to focus only on the data to illuminate sources of trust in healthcare providers. In this case, the hypothesis was that the more people perceived that their providers believed in the effectiveness of Syringe Service Programs (SSP), the stronger their trust in them. Likewise, the more people perceive that their providers believe in the efficacy of medication-assisted treatment, the greater their faith in them.
With their hypothesis set out, the researchers began their work by sampling target counties and states with online surveys. They selected fourteen Appalachian and midwestern states wherein the counties comprised a large proportion of the top 5% of counties most vulnerable to an infectious disease outbreak due to injected drug use, as outlined by the Centers for Disease Control.
The survey used in this study included questions meant to judge how they viewed their communities, how they viewed harm reduction programs, how much they trusted healthcare providers to care for people, how they expected interactions between patients and providers to play out, and how much money they made in a year.
Results
After examining their survey results, the researchers found their hypothesis correct: patients trusted their healthcare providers when they thought the providers supported SSP and harm-reduction programs.
Conclusion and Recommendations
The study thus concluded that the best way for healthcare providers to gain the trust of a community is to advertise themselves as sources of social support, acceptance, and healing, including harm reduction forms like SSPs. By framing themselves as friends and caretakers, they silently encourage people to come to them for unbiased help, which is often what vulnerable people need the most.
Sources:
1. O’Brien, T. C., Feinberg, J., Gross, R. & Albarracín, D. Supportive environments during the substance use disorder epidemic in the rural United States: Provider support for interventions and expectations of interactions with providers. Social Science & Medicine 294, 114691 (2022).