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Query: UMLS:C0277787 (stigma)
 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Methadone maintenance has been evaluated since its development in 1964 as a medical response to the post-World War II heroin epidemic in New York City. The findings of major early studies have been consistent. Methadone maintenance reduces and/or eliminates the use of heroin, reduces the death rates and criminality associated with heroin use, and allows patients to improve their health and social productivity. In addition, enrollment in methadone maintenance has the potential toreduce the transmission of infectious diseases associated with heroin injection, such as hepatitis and HIV. The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with heroin. A majority of patients require 80-120 mg/d of methadone, or more, to achieve these effects and require treatment for an indefinite period of time, since methadone maintenance is a corrective but not a curative treatment for heroin addiction. Lower doses may not be as effective or provide the blockade effect. Methadone maintenance has been found to be medically safe and nonsedating. It is also indicated for pregnant women addicted to heroin. Reviews issued by the Institute of Medicine and the National Institutes of Health have defined narcotic addiction as a chronic medical disorder and have claimed that methadone maintenance coupled with social services is the most effective treatment for this condition. These agencies recommend reducing governmental regulation to facilitate patients access to treatment. In addition, they recommend that the number of programs be expanded, and that new models of treatment be implemented,if the nationwide problem of addiction is to be brought under control. The National Institutes of Health also recommend that methadone maintenance be available to persons under legal supervision, such as probationers, parolees and the incarcerated. However, stigma and bias directed at the programs and the patients have hindered expansion and the effective delivery of services. Professional community leadership is necessary to educate the general public if these impediments are to be overcome.
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PMID:Methadone maintenance treatment (MMT): a review of historical and clinical issues. 1106 85

This decade will see great strides in the acceptance of methadone treatment for heroin addiction, as a result of clear scientific and clinical evidence of its efficacy, and strong methadone advocacy. The new proposal for rule making (NPRM) will help the medical profession accept methadone treatment as beneficial for opiate addiction and realize that it should be more accessible to patients from trained physicians in the community. This will be the first step in reducing the stigma and prejudice that continue to hinder the availability of this lifesaving medication to all who need it. Methadone advocacy has grown into a powerful network of groups working toward the same major goals. As the premier methadone advocacy organization and the voice for methadone patients, the National Alliance of Methadone Advocates (NAMA) will promote the view that methadone patients are to be judged by the contributions they make to their families and communities.
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PMID:Methadone advocacy: the voice of the patient. 1113 9

Most primary care physicians do not feel competent to treat alcohol- and drug-related disorders. Physicians generally do not like to work with patients with these disorders and do not find treating them rewarding. Despite large numbers of such patients, the diagnosis and treatment of alcohol- and drug-related disorders are generally considered peripheral to or outside medical matters and ultimately outside medical education. There is substantial evidence that physicians fail even to identify a large percentage of patients with these disorders. Essential role models are lacking for future physicians to develop the attitudes and training they need to adequately approach addiction as a treatable medical illness. Faculty development programs in addictive disorders are needed to overcome the stigma, poor attitudes, and deficient skills among physicians who provide education and leadership for medical students and residents. The lack of parity with other medical disorders gives reimbursement and education for addiction disorders low priority. Medical students and physicians can also be consumers and patients with addiction problems. Their attitudes and abilities to learn about alcohol- and drug-related disorders are impaired without interventions. Curricula lack sufficient instruction and experiences in addiction medicine throughout all years of medical education. Programs that have successfully changed students' attitudes and skills for treatment of addicted patients continue to be exceptional and limited in focus rather than the general practice in U.S. medical schools. The authors review the findings of the literature on these problems, discuss the barriers to educational reform, and propose recommendations for developing an effective medical school curriculum about alcohol- and drug-related disorders.
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PMID:Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders. 1134 13

Critics of the concept of attention deficit/hyperactivity disorder (ADHD) claim that it is not a clear-cut psychiatric disorder, but rather a social stigma attached to a child that is difficult to handle. The counter-argument to this view is that ADHD is a descriptive diagnosis in which indices of the severity of behaviour enable it to be distinguished from normal behaviour. Both over-diagnosis and under-diagnosis occur. Treatment with medications is criticised on the basis that it is an inadequate replacement for good parenting and education, that it medicalises a psychosocial problem but does not cure it, and that the long-term effects of this approach have not been proven. Those in favour of medical treatment claim that medication and efforts to improve parenting and education are not counter-effective, but that they complement each other. Medication is an important contributory factor in the proper care of ADHD patients. Treatment with psychostimulants is criticised on the basis that the extent of the side-effects are underestimated, and that there is a risk of addiction. However, proponents of this approach claim that, if used correctly, the unpleasant side-effects only occur in a small minority of children.
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PMID:[Discussion of attention deficit-hyperactivity disorder (ADHD): facts, opinions and emotions]. 1151 18

Medical treatment of heroin addiction with methadone and other pharmacotherapies has important benefits for individuals and society. However, regulatory policies have separated this treatment from the medical care system, limiting access to care and contributing to the social stigma of even effective addiction pharmacotherapy. Increasing problems caused by heroin addiction have added urgency to the search for policies and programs that improve the access to and quality of opiate addiction treatment. Recent initiatives aiming to reintegrate methadone maintenance and other addiction pharmacotherapies into medical practice may promote both expanded treatment capacity and increased physician expertise in addiction medicine. These initiatives include changes in federal oversight of the opiate addiction treatment system, the approval of physician office-based methadone maintenance programs for stabilized patients, and federal legislation that could enable physicians to treat opiate addiction with new medications in regular medical practice.
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PMID:Policy progress for physician treatment of opiate addiction. 1204 33

Substitution treatment for heroin addiction, defined here as maintenance prescribing of opioid agonist drugs to opioid dependent subjects, has increased in the last decade. The recent history of substitution treatment in five countries--Canada, the U.K., Australia, Israel, and France--is reviewed. In all five countries, the critical issues around substitution treatment are similar. The first key issue concerns the balance between making treatment accessible and attractive, and minimizing diversion to the black market. The second issue concerns the role of primary health care in delivering MMT. In general, there has been increasing involvement of primary health care, with training and support for practitioners. However, there remains uncertainty and official ambivalence over whether treatment should be restricted to specialist clinics and practitioners, or available through primary care. Most importantly, underlying these issues is the problem of stigma being associated with both addiction, and with substitution treatment. The underlying problem that treatment is often at odds with community values places enormous strains on substitution treatment, and makes the treatment system vulnerable to shifting community support and abrupt, politically-driven changes in policy.
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PMID:Substitution therapy for heroin addiction. 1218 May 59

The provision of care and support to persons living with human immunodeficiency virus (HIV) in Brazil who also use drugs and/or alcohol represents special challenges because of the combined effects of addiction, poverty, stigma, and discrimination. This paper presents details on a program providing both clinic- and field-based care to HIV-infected injection drug users, highlighting the use of a specialized case management approach to address the clinical and psychosocial needs of this population. This program includes both a mobile case management team that fosters group discussions and provides individual counseling, and provision of medical consultations at 2 major drug treatment centers in Rio de Janeiro. The article also describes the experience of working with injection drug users who regularly attend an outpatient clinic serving marginalized communities through the use of mutual self-help groups and specialized support groups to address to issue of adherence to antiretroviral therapies for the treatment of HIV/acquired immunodeficiency syndrome.
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PMID:Case management of human immunodeficiency virus-infected injection drug users: a case study in Rio de Janeiro, Brazil. 1464 53

People living with addiction endure many hardships, and this may be especially true for women who face distinct clinical and significant psychologic and socioeconomic repercussions of addictive disorders and their companion stresses. Clinicians who work with women with addictions are confronted by many challenges, particularly in the care of pregnant and parenting women. The dilemmas faced by patients with addictions and their providers often arise directly from tensions among core ethical principles, from inconsistencies in the way these principles are applied, and from the pervasive effects of stigma. Although difficult issues are to be expected in the arena of substance abuse treatment, consideration of principles of voluntarism, beneficence, respect for persons and justice, confidentiality and truth-telling, and informed consent are invaluable in shaping clinical ethical decision making. Furthermore, proactive steps can be taken to enhance the ethical caliber of care. These steps involve policy-level and systemic actions, such as the development and expansion of programs serving women's unique needs, empiric research into the most effective treatments for women with various disorders, and reexamination of legal and societal stances toward pregnant and parenting women who have addictions. In addition, local and individual steps are needed, including addressing gaps or inherent biases in programs, training counselors and clinicians in effective strategies or counseling styles, and developing awareness of one's own attitudes when dealing with difficult patients and challenging disorders. Such efforts will help ensure that women who have addictions will be cared for in a manner that is respectful, beneficent, compassionate, honest, and just.
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PMID:Ethical considerations in caring for women with substance use disorders. 1466 27

Since the first report of HIV infection in India in 1986, the virus has spread all over the country although there is geographic variation. There are estimated 5.1 million people infected with HIV with an overall estimated adult prevalence below 1 per cent. Surveys carried out in different sub-populations have yielded prevalence estimates, but data on HIV incidence are limited. Both HIV serotypes 1 and 2 exist in India and HIV-1 C is the commonest subtype reported. Sexual transmission of HIV is most predominant. Spread of HIV in intravenous drug use settings is localized mostly in the north eastern region and metropolitan cities and parent to child transmission is on the rise. Dual epidemics of HIV and tuberculosis, increase in the number of infected women, stigma and discrimination are the main concerns in the Indian HIV/AIDS scenario. There is an increasing political will and commitment for HIV prevention and control efforts in India. A multi-disciplinary approach combining targeted interventions like early identification and treatment of STDs, condom promotion, blood safety, drug de-addiction programs and expanding and strengthening VCTCs and long-term strategies like awareness oriented to behavioural change especially among vulnerable populations, young people and women, steps towards improvement of literacy, status of women and overall development, reduction in poverty and development of primary prevention interventions like vaccines and microbicides will have to be considered for effective prevention and control of AIDS in India.
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PMID:HIV/AIDS epidemic in India: risk factors, risk behaviour & strategies for prevention & control. 1581 49

The study aimed to synthesise qualitative studies of lay experiences of medicine taking. Most studies focused on the experience of those not taking their medicine as prescribed, with few considering those who reject their medicines or accept them uncritically. Most were concerned with medicines for chronic illnesses. The synthesis revealed widespread caution about taking medicines and highlighted the lay practice of testing medicines, mainly for adverse effects. Some concerns about medicines cannot be resolved by lay evaluation, however, including worries about dependence, tolerance and addiction, the potential harm from taking medicines on a long-term basis and the possibility of medicines masking other symptoms. Additionally, in some cases medicines had a significant impact on identity, presenting problems of disclosure and stigma. People were found to accept their medicines either passively or actively, or to reject them. Some were coerced into taking medicines. Active accepters might modify their regimens by taking medicines symptomatically or strategically, or by adjusting doses to minimise unwanted consequences, or to make the regimen more acceptable. Many modifications appeared to reflect a desire to minimise the intake of medicines and this was echoed in some peoples' use of non-pharmacological treatments to either supplant or supplement their medicines. Few discussed regimen changes with their doctors. We conclude that the main reason why people do not take their medicines as prescribed is not because of failings in patients, doctors or systems, but because of concerns about the medicines themselves. On the whole, the findings point to considerable reluctance to take medicine and a preference to take as little as possible. We argue that peoples' resistance to medicine taking needs to be recognised and that the focus should be on developing ways of making medicines safe, as well as identifying and evaluating the treatments that people often choose in preference to medicines.
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PMID:Resisting medicines: a synthesis of qualitative studies of medicine taking. 1584 68


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