Patients with opioid use disorder preferred clinicians to use terms like "dependence," which they viewed as less stigmatizing, while participants in recovery often embraced "addiction" as an accurate descriptor despite its potential stigma, according to a recent study published in BMJ Open.

Researchers from multiple U.S. health systems conducted a qualitative study to examine patient perspectives on primary care clinician communication regarding opioids and opioid use disorder (OUD). Building on an existing four-archetype framework, the study identified two additional archetypes for tailoring communication strategies. These findings highlight the framework’s applicability not only for enhancing clinician-patient communication but also for integration into clinical decision support systems (CDS) to improve care quality.

The study involved semistructured phone interviews with 40 participants from primary care clinics in Pennsylvania, Minnesota, Wisconsin, and North Dakota. Participants were adults aged 18 to 75 years with an OUD diagnosis, receiving medication for OUD (MOUD), or prescribed opioids at least three times in the prior year. Of the participants, 68% were female, 97% were white, and the mean age was 51 years. Interviews lasted an average of 51 minutes and were analyzed using the Rigorous and Accelerated Data Reduction technique.

The six archetypes included:

1. Patients using opioids for chronic pain (27.5%), who viewed opioids as essential for daily functioning and downplayed risks.

2. Patients using opioids for acute pain (52.5%), who recognized risks but often avoided chronic use.

3. Patients with problematic opioid use not open to treatment (22.5%).

4. Patients with problematic opioid use open to treatment (35.0%).

5. Patients in treatment/recovery without MOUD (20.0%).

6. Patients in treatment/recovery with MOUD (17.5%).

Participants’ preferences for terminology varied across archetypes. Those managing pain preferred "dependence" for its empathetic tone, while patients in recovery found "addiction" empowering and accurate, despite its potential for stigma. These nuanced preferences underscore the importance of patient-centered language to foster trust and improve care.

The researchers noted that the updated six-archetype framework aligns conceptually with the Transtheoretical Model (TTM) of behavior change, offering clinicians a structured approach to guide conversations about opioid risks and treatment options. However, the study’s generalizability is limited due to its predominantly white and rural sample.

Further research is needed to validate the framework in diverse populations and explore its integration into CDS systems to support decision-making and improve health outcomes for individuals with OUD.

Full disclosures can be found in the published study.