{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T17:22:06Z","timestamp":1779297726299,"version":"3.51.4"},"reference-count":94,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,14]],"date-time":"2023-01-14T00:00:00Z","timestamp":1673654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Elizabeth Blackwell Institute, University of Bristol","award":["204813\/Z\/16\/Z"],"award-info":[{"award-number":["204813\/Z\/16\/Z"]}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["204813\/Z\/16\/Z"],"award-info":[{"award-number":["204813\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute for Health and Social Care Research, School for Public Health Research","award":["204813\/Z\/16\/Z"],"award-info":[{"award-number":["204813\/Z\/16\/Z"]}]},{"name":"National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West)","award":["204813\/Z\/16\/Z"],"award-info":[{"award-number":["204813\/Z\/16\/Z"]}]},{"name":"NIHR Health Protection Research Unit in Behavioural Science and Evaluation","award":["204813\/Z\/16\/Z"],"award-info":[{"award-number":["204813\/Z\/16\/Z"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) The harm-reduction benefits of opioid agonist treatment (OAT) are well-established; however, the UK government\u2019s emphasis on \u201crecovery\u201d may be contributing to a high proportion of people leaving treatment and low retention rates. We wanted to develop a rich and nuanced understanding of the factors that might influence the treatment journeys of people who use OAT. (2) We explored factors at each level of the socioecological system and considered the ways these interact to influence treatment journeys in OAT. We carried out semi-structured interviews with people who use OAT (n = 12) and service providers (n = 13) and analysed data using reflexive thematic analysis. (3) We developed three themes representing participant perceptions of treatment journeys in OAT. These were: (1) The System is Broken; (2) Power Struggles; and (3) Filling the Void. (4) Conclusions: The data suggest that prioritisation of treatment retention is important to preserve the harm-reduction benefits of OAT. Stigma is a systemic issue which presents multiple barriers to people who use OAT living fulfilling lives. There is an urgent need to develop targeted interventions to address stigma towards people who use OAT.<\/jats:p>","DOI":"10.3390\/ijerph20021526","type":"journal-article","created":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T02:04:45Z","timestamp":1673834685000},"page":"1526","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0452-8729","authenticated-orcid":false,"given":"Victoria Rice","family":"Carlisle","sequence":"first","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK"},{"name":"School of Psychological Sciences, University of Bristol, Bristol BS8 1TU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia M.","family":"Maynard","sequence":"additional","affiliation":[{"name":"School of Psychological Sciences, University of Bristol, Bristol BS8 1TU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darren","family":"Bagnall","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Hickman","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Shorrock","sequence":"additional","affiliation":[{"name":"Avon & Wiltshire NHS Mental Health Trust, Specialist Drug and Alcohol Services, Colston Fort, Montague Place, Bristol BS6 5UB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyla","family":"Thomas","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Kesten","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK"},{"name":"The National Institute for Health and Care Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK"},{"name":"The National Institute for Health and Care Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol BS8 1TL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,14]]},"reference":[{"key":"ref_1","unstructured":"World Health Organisation (2002). WHO Policy Perspectives on Medicines-The Selection of Essential Medicines."},{"key":"ref_2","unstructured":"UK Department of Health (2022, November 01). Drug Misuse and Dependence: UK Guidelines on Clinical Management, Available online: www.gov.uk\/dh."},{"key":"ref_3","unstructured":"National Treatment Agency (2007). National Treatment Agency National Treatment Agency Independent Expert Working Group, Clinical Guidelines on Drug Misuse and Dependence Update: Consultation Draft June 2007."},{"key":"ref_4","first-page":"CD002209","article-title":"Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence","volume":"3","author":"Mattick","year":"2009","journal-title":"Cochrane Database Syst. Rev"},{"key":"ref_5","unstructured":"Public Health England (2022, November 01). Part 1: Introducing Opioid Substitution Treatment (OST). London, Available online: https:\/\/www.gov.uk\/government\/publications\/opioid-substitution-treatment-guide-for-keyworkers\/part-1-introducing-opioid-substitution-treatment-ost."},{"key":"ref_6","first-page":"1664","article-title":"Association between opioid agonist therapy use and HIV testing uptake among people who have recently injected drugs: A systematic review and meta-analysis","volume":"166","author":"Ferraro","year":"2020","journal-title":"Addiction"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"148","DOI":"10.2471\/BLT.12.109553","article-title":"Mitigating the risk of HIV infection with opioid substitution treatment","volume":"91","author":"Gowing","year":"2013","journal-title":"Bull. World Health Organ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e5945","DOI":"10.1136\/bmj.e5945","article-title":"Opiate substitution treatment and HIV transmission in people who inject drugs: Systematic review and meta-analysis","volume":"345","author":"MacArthur","year":"2012","journal-title":"Bmj"},{"key":"ref_9","first-page":"CD012021","article-title":"Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs","volume":"9","author":"Platt","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"j1550","DOI":"10.1136\/bmj.j1550","article-title":"Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies","volume":"357","author":"Sordo","year":"2017","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"109494","DOI":"10.1016\/j.drugalcdep.2022.109494","article-title":"The impact of opioid agonist treatment on hospitalisations for injecting-related diseases among an opioid dependent population: A retrospective data linkage study","volume":"236","author":"Jones","year":"2022","journal-title":"Drug Alcohol Depend."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"O\u2019Connor, A.M., Cousins, G., Durand, L., Barry, J., and Boland, F. (2020). Retention of patients in opioid substitution treatment: A systematic review. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0232086"},{"key":"ref_13","unstructured":"NDTMS (2022, October 11). Substance Misuse Treatment for Adults: Statistics 2020 to 2021. GOV.UK, Available online: https:\/\/www.gov.uk\/government\/statistics\/substance-misuse-treatment-for-adults-statistics-2020-to-2021."},{"key":"ref_14","unstructured":"Carlisle, V. (2022, October 10). \u201cHolding on by the Seat of Their Pants\u201d A Mixed Methods Exploration of Retention, Completion and Recovery in Opioid Substitution Treatment. University of Bristol. Available online: https:\/\/research-information.bris.ac.uk\/en\/studentTheses\/holding-on-by-the-seat-of-their-pants-a-mixed-methods-exploration."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.drugalcdep.2005.05.010","article-title":"Cycling in and out of treatment; participation in methadone treatment in NSW, 1990\u20132002","volume":"81","author":"Bell","year":"2006","journal-title":"Drug Alcohol Depend."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1001\/jamapsychiatry.2021.0976","article-title":"Association of opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence: A systematic review and meta-analysis","volume":"78","author":"Santo","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"ref_17","unstructured":"HM Government (2022, October 24). 2017 Drug Strategy, Available online: https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/628148\/Drug_strategy_2017.PDF."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"j4405","DOI":"10.1136\/bmj.j4405","article-title":"Is the UK\u2019s 2017 drug strategy fit for purpose?","volume":"358","author":"Ford","year":"2017","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.drugalcdep.2012.06.030","article-title":"Does recovery-oriented treatment prompt heroin users prematurely into detoxification and abstinence programmes?","volume":"127","author":"Neale","year":"2013","journal-title":"Qualitative study. Drug Alcohol Depend."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1016\/j.drugpo.2014.01.015","article-title":"The role of evidence and the expert in contemporary processes of governance: The case of opioid substitution treatment policy in England","volume":"25","author":"Duke","year":"2014","journal-title":"Int. J. Drug Policy"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s10610-017-9364-z","article-title":"Treatment and intervention for opiate dependence in the United Kingdom: Lessons from triumph and failure","volume":"24","author":"Kalk","year":"2018","journal-title":"Eur. J. Crim. Policy Res."},{"key":"ref_22","unstructured":"Day, E. (2020, January 9). Recovery Orientated Systems of Care. Has Their Time Finally Come? 2020. Proceedings of the NHS APA 2020 Virtual Conference, Available online: https:\/\/www.nhsapa.org\/post\/session-1-2020conf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1111\/add.13552","article-title":"Rethinking recovery","volume":"112","author":"Lancaster","year":"2017","journal-title":"Addiction"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"310","DOI":"10.3109\/09687637.2014.918089","article-title":"How should we measure addiction recovery? Analysis of service provider perspectives using online Delphi groups","volume":"21","author":"Neale","year":"2014","journal-title":"Drugs Educ. Prev. Policy"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3109\/09687637.2014.947564","article-title":"\u201cYou\u2019re all going to hate the word \u2018recovery\u2019 by the end of this\u201d: Service users\u2019 views of measuring addiction recovery","volume":"22","author":"Neale","year":"2015","journal-title":"Drugs Educ. Prev. Policy"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1080\/10826080802483936","article-title":"Supervised methadone consumption: Client issues and stigma","volume":"44","author":"Anstice","year":"2009","journal-title":"Subst. Use Misuse"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1080\/10826080500259497","article-title":"Users\u2019 Experiences of Heroin and Methadone Treatment","volume":"40","author":"Gourlay","year":"2005","journal-title":"Subst. Use Misuse"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1177\/1049732311432718","article-title":"Methadone as social control: Institutionalized stigma and the prospect of recovery","volume":"22","author":"Harris","year":"2012","journal-title":"Qual. Health Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1108\/DAT-05-2013-0022","article-title":"Stigma and perceptions of recovery in Scotland: A qualitative study of injecting drug users attending methadone treatment","volume":"13","author":"McPhee","year":"2013","journal-title":"Drugs Alcohol Today"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"103788","DOI":"10.1016\/j.drugpo.2022.103788","article-title":"Can a new formulation of opiate agonist treatment alter stigma?: Place, time and things in the experience of extended-release buprenorphine depot","volume":"107","author":"Treloar","year":"2022","journal-title":"Int. J. Drug Policy"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"117822181668508","DOI":"10.1177\/1178221816685087","article-title":"\u201cDon\u2019t Judge a Book by Its Cover\u201d: A Qualitative Study of Methadone Patients\u2019 Experiences of Stigma","volume":"11","author":"Woo","year":"2017","journal-title":"Subst. Abuse Res. Treat."},{"key":"ref_32","unstructured":"Goffman, E. (1963). Stigma: Notes on The Management of Spoiled Identity, Simon and Shuster."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1146\/annurev.soc.27.1.363","article-title":"Conceptualizing Stigma","volume":"27","author":"Link","year":"2001","journal-title":"Annu. Rev. Sociol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1007\/s10461-009-9593-3","article-title":"From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures","volume":"13","author":"Earnshaw","year":"2009","journal-title":"AIDS Behav."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1111\/add.14799","article-title":"Factor structure, internal reliability and construct validity of the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT-SMS)","volume":"115","author":"Smith","year":"2020","journal-title":"Addiction"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1080\/14659891.2016.1223764","article-title":"Lifelong maintenance treatment or \u201cpositive\u201d dropout?","volume":"22","author":"Cordella","year":"2017","journal-title":"J. Subst. Use"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1080\/01634370802609049","article-title":"Mistrust and self-isolation: Barriers to social support for older adult methadone clients","volume":"52","author":"Smith","year":"2009","journal-title":"J. Gerontol. Soc. Work"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/109019818801500401","article-title":"An ecological perspective on health promotion programs","volume":"15","author":"McLeroy","year":"1988","journal-title":"Health Educ. Q."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Carlisle, V., Maynard, O., Padmanathan, P., Hickman, M., Thomas, K., and Kesten, J. (2020). Factors influencing recovery in opioid substitution treatment: A systematic review and thematic synthesis. arXiv.","DOI":"10.31234\/osf.io\/f6c3p"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13722-020-00210-w","article-title":"Conceptualizing the effects of the COVID-19 pandemic on people with opioid use disorder: An application of the social ecological model","volume":"16","author":"Cowan","year":"2021","journal-title":"Addict. Sci. Clin. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s12961-020-00596-8","article-title":"The opioid crisis: A contextual, social-ecological framework","volume":"18","author":"Jalali","year":"2020","journal-title":"Health Res. Policy Syst."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1108\/IJPH-04-2020-0020","article-title":"A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons","volume":"17","author":"Komalasari","year":"2021","journal-title":"Int. J. Prison. Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"899","DOI":"10.15288\/jsad.2018.79.899","article-title":"Investigating the Social Ecological Contexts of Opioid Use Disorder and Poisoning Hospitalizations in Pennsylvania","volume":"79","author":"Mair","year":"2018","journal-title":"J. Stud. Alcohol Drugs"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"100083","DOI":"10.1016\/j.ssmqr.2022.100083","article-title":"Applying the socio-ecological model to understand community reintegration experiences among individuals on opioid agonist treatment (OAT) released from federal incarceration in Ontario, Canada","volume":"2","author":"Russell","year":"2022","journal-title":"SSM-Qual. Res. Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s13722-018-0124-2","article-title":"Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: A social ecological approach","volume":"13","author":"Bunting","year":"2018","journal-title":"Addict. Sci. Clin. Pract."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1177\/10497323221104315","article-title":"Treatment Experiences Among People Who Use Opioids: A Social Ecological Approach","volume":"32","author":"Kahn","year":"2022","journal-title":"Qual. Health Res."},{"key":"ref_47","unstructured":"Black, D.C. (2020). Review of Drugs Executive Summary."},{"key":"ref_48","unstructured":"Black, D.C. (2021). Review of Drugs Part Two: Prevention, Treatment and Recovery: Annexes."},{"key":"ref_49","unstructured":"HM Government (2022, August 22). From Harm to Hope: A 10-Year Drugs Plan to Cut Crime and Save Lives, Available online: https:\/\/www.gov.uk\/government\/publications\/from-harm-to-hope-a-10-year-drugs-plan-to-cut-crime-and-save-lives."},{"key":"ref_50","unstructured":"HM Government (2022, September 26). Government Response to the Independent Review of Drugs by Dame Carol Black. GOV.UK, Available online: https:\/\/www.gov.uk\/government\/publications\/independent-review-of-drugs-by-dame-carol-black-government-response\/government-response-to-the-independent-review-of-drugs-by-dame-carol-black."},{"key":"ref_51","unstructured":"The White House (2022, September 26). FACT SHEET: Biden-Harris Administration Announces New Actions and Funding to Address the Overdose Epidemic and Support Recovery. The White House, Available online: https:\/\/www.whitehouse.gov\/briefing-room\/statements-releases\/2022\/09\/23\/fact-sheet-biden-harris-administration-announces-new-actions-and-funding-to-address-the-overdose-epidemic-and-support-recovery\/."},{"key":"ref_52","unstructured":"Hay, G., Rael dos Santos, A., Reed, H., and Hope, V. (2022, October 24). Estimates of the Prevalence of Opiate Use and\/or Crack Cocaine Use, 2016\/17: Sweep 13 Report. Available online: www.ljmu.ac.uk\/phi."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample Size in Qualitative Interview Studies: Guided by Information Power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual. Health Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","article-title":"Reflecting on reflexive thematic analysis","volume":"11","author":"Braun","year":"2019","journal-title":"Qual. Res. Sport Exerc. Health"},{"key":"ref_56","unstructured":"Bhaskar, R. (1975). A Realist Theory of Science, Leeds Books Limited."},{"key":"ref_57","first-page":"658","article-title":"What is critical realism? And why should you care?","volume":"42","author":"Gorski","year":"2013","journal-title":"ontemp. Sociol."},{"key":"ref_58","unstructured":"QSR International Pty Ltd. (2022, November 01). NVivo (Version 12). Available online: https:\/\/www.qsrinternational.com\/nvivo-qualitative-data-analysis-software\/home."},{"key":"ref_59","unstructured":"Braun, V., and Clarke, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners, SAGE."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"267","DOI":"10.3109\/16066359909004387","article-title":"Juggling multiple roles: Staff and client perceptions of keyworker roles and the constraints on delivering counselling and support services in methadone treatment","volume":"7","author":"Lilly","year":"1999","journal-title":"Addict Res. Vol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s12954-021-00535-y","article-title":"\u201cIt\u2019s like \u2018liquid handcuffs\u201d: The effects of take-home dosing policies on Methadone Maintenance Treatment (MMT) patients\u2019 lives","volume":"18","author":"Frank","year":"2021","journal-title":"Harm. Reduct. J."},{"key":"ref_62","unstructured":"Scott, J., and Carlisle, V. (2021). A Pharmacy Resolution for 2021: Let\u2019s Improve the Way Patients with Addiction are Treated. Pharm. J., Available online: https:\/\/www.pharmaceutical-journal.com\/news-and-analysis\/opinion\/comment\/a-pharmacy-resolution-for-2021-lets-improve-the-way-patients-with-addiction-are-treated\/20208688.article."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3233\/JVR-2012-0600","article-title":"Methadone maintenance and Special Community Employment schemes: A study of Irish participants\u2019 views","volume":"37","author":"Bingham","year":"2012","journal-title":"J. Vocat. Rehabil."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1080\/10826080802289762","article-title":"Conceptualizing recovery capital: Expansion of a theoretical construct","volume":"43","author":"Cloud","year":"2008","journal-title":"Subst. Use Misuse."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1080\/1556035X.2016.1153441","article-title":"An Evaluation of the Mutual Aid Facilitation Sessions Pilot Program, \u201cYou do the MAFS\u201d","volume":"11","author":"Aslan","year":"2016","journal-title":"J. Groups Addict. Recovery"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"31992","DOI":"10.3402\/qhw.v11.31992","article-title":"Stuck in limbo: Illicit drug users\u2019 experiences with opioid maintenance treatment and the relation to recovery","volume":"11","author":"Gronnestad","year":"2016","journal-title":"Int. J. Qual. Stud. Health Well-Being"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1080\/08897077.2014.941085","article-title":"Exploring the Concepts of Abstinence and Recovery Through the Experiences of Long-Term Opiate Substitution Clients","volume":"36","author":"Notley","year":"2015","journal-title":"Subst. Abuse"},{"key":"ref_68","first-page":"e12275","article-title":"Methadone maintenance treatment as social control: Analyzing patient experiences","volume":"26","year":"2018","journal-title":"Nurs Inq."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1111\/add.12392","article-title":"\u201cNot just methadone Tracy\u201d: Transformations in service-user identity following the introduction of hepatitis C treatment into Australian opiate substitution settings","volume":"109","author":"Rance","year":"2014","journal-title":"Addict Vol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1081\/JA-120002807","article-title":"Canadian Opioid Users\u2019 Views on Methadone and other Opiate Prescription Treatment: An Exploratory Qualitative Study","volume":"37","author":"Fischer","year":"2002","journal-title":"Subst Use Misuse"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"963","DOI":"10.3109\/01612840.2015.1074769","article-title":"From Resistance to Existence\u2014Experiences of Medication-Assisted Treatment as Disclosed by People with Opioid Dependence","volume":"36","author":"Lindgren","year":"2015","journal-title":"Issues Ment. Health Nurs."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.drugalcdep.2015.12.031","article-title":"Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis","volume":"160","author":"Yarborough","year":"2016","journal-title":"Drug Alcohol Depend. Vol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.socscimed.2019.05.027","article-title":"Intervention stigma: How medication-assisted treatment marginalizes patients and providers","volume":"232","author":"Madden","year":"2019","journal-title":"Soc. Sci. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1007\/s10461-013-0437-9","article-title":"HIV stigma mechanisms and well-being among PLWH: A test of the HIV stigma framework","volume":"17","author":"Earnshaw","year":"2013","journal-title":"AIDS Behav."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1093\/eurpub\/ckaa073","article-title":"Sexual health services in community pharmacy for women on opioid substitution treatment: A qualitative study","volume":"30","author":"Scott","year":"2020","journal-title":"Eur. J. Public Health"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Turan, J.M., Elafros, M.A., Logie, C.H., Banik, S., Turan, B., Crockett, K.B., Pescosolido, B., and Murray, S.M. (2019). Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med., 17.","DOI":"10.1186\/s12916-018-1246-9"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"103391","DOI":"10.1016\/j.drugpo.2021.103391","article-title":"Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs","volume":"Vol 98","author":"Kesten","year":"2021","journal-title":"Int. J. Drug Policy"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1037\/0022-3514.53.6.1024","article-title":"The Support of Autonomy and the Control of Behavior","volume":"53","author":"Deci","year":"1987","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"103323","DOI":"10.1016\/j.drugpo.2021.103323","article-title":"Positive effects of community attachment on internalised stigma and wellbeing among people who inject drugs","volume":"97","author":"Brener","year":"2021","journal-title":"Int. J. Drug Policy"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.psychres.2017.01.097","article-title":"Stigma and social support in substance abuse: Implications for mental health and well-being","volume":"252","author":"Birtel","year":"2017","journal-title":"Psychiatry Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.ijnurstu.2011.03.009","article-title":"A good quality of life under the influence of methadone: A qualitative study among opiate-dependent individuals","volume":"48","author":"Vanderplasschen","year":"2011","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Holland, A.D., Stevens, A., Harris, M., Lewer, D., Sumnall, H., Stewart, D., Gilvarry, E., Wiseman, A., Howkins, J., and McManus, J. (2022). Analysis of the UK Government\u2019s 10-Year Drugs Strategy\u2014A resource for practitioners and policymakers. J. Public Health, fdac114.","DOI":"10.1093\/pubmed\/fdac114"},{"key":"ref_83","unstructured":"NHS Addictions Provider Alliance (2022, September 23). Dame Carol Black\u2019s Independent Review of Drugs-Part Two Report is Welcomed by the NHS APA. Available online: https:\/\/www.nhsapa.org\/post\/dame-carol-black-phase-2-report."},{"key":"ref_84","unstructured":"HM Government (2022, September 23). About Project ADDER. GOV.UK, Available online: https:\/\/www.gov.uk\/government\/publications\/project-adder\/about-project-adder."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1111\/add.13644","article-title":"Psychosocial interventions in opiate substitution treatment services: Does the evidence provide a case for optimism or nihilism?","volume":"112","author":"Day","year":"2017","journal-title":"Addiction"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1080\/10826084.2017.1325376","article-title":"Primary Care Physicians\u2019 Views about Prescribing Methadone to Treat Opioid Use Disorder","volume":"53","author":"Livingston","year":"2018","journal-title":"Subst. Use Misuse"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.socscimed.2019.01.022","article-title":"A qualitative study on intersectional stigma and sexual health among women on opioid substitution treatment in England: Implications for research, policy and practice","volume":"222","author":"Scott","year":"2019","journal-title":"Soc. Sci. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/dar.12079","article-title":"Regaining control: The patient experience of supervised compared with unsupervised consumption in opiate substitution treatment","volume":"33","author":"Notley","year":"2014","journal-title":"Drug Alcohol Rev."},{"key":"ref_89","unstructured":"Centre for Social Research in Health (2021, July 21). Stigma Indicators Monitoring Project|Arts & Social Sciences-UNSW Sydney. Available online: https:\/\/www.arts.unsw.edu.au\/centre-social-research-health\/our-projects\/stigma-indicators-monitoring-project."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s10464-009-9229-9","article-title":"Theorising interventions as events in systems","volume":"43","author":"Hawe","year":"2009","journal-title":"Am. J. Community Psychol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"n2061","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1111\/dar.13382","article-title":"Opioid agonist treatment and patient outcomes during the COVID-19 pandemic in south east Sydney, Australia","volume":"41","author":"Lintzeris","year":"2022","journal-title":"Drug Alcohol Rev."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s12954-020-00394-z","article-title":"A national model of remote care for assessing and providing opioid agonist treatment during the COVID-19 pandemic: A report","volume":"17","author":"Crowley","year":"2020","journal-title":"Harm Reduct. J."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"103877","DOI":"10.1016\/j.drugpo.2022.103877","article-title":"Methadone and buprenorphine-related deaths among people prescribed and not prescribed Opioid Agonist Therapy during the COVID-19 pandemic in England","volume":"110","author":"Aldabergenov","year":"2022","journal-title":"Int. J. Drug Policy"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1526\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:05:54Z","timestamp":1760119554000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1526"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,14]]},"references-count":94,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20021526"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20021526","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,14]]}}}