# Creating a multi-level intervention to reduce stigma for buprenorphine use for individuals with End Stage Kidney Disease (ESKD) and Chronic Pain

> **NIH NIH U01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2020 · $250,945

## Abstract

Project Summary / Abstract
Individuals with end stage kidney disease (ESKD) have high prevalence of painful conditions. Common
pain medications have poor efficacy and safety profiles due to either the ESKD itself or dialysis
treatment. Buprenorphine, a partial opioid agonist has theoretical advantages as a pain medication as
its metabolism is in the liver and it is not dialyzed. Although it is approved for pain treatment, it is
overwhelmingly prescribed as a treatment for opioid use disorder. Stigma toward opioids and especially
medications for substance use disorder may contribute to its being rarely prescribed for pain. Offering
to switch from full agonist opioids to buprenorphine is one of the active intervention arms in a HEAL-
funded NIDDK-sponsored randomized controlled trial in patients with ESKD and chronic pain,
Hemodialysis Opioid Prescription Effort (HOPE). This proposed supplement will augment the main study
by examining multilevel barriers, focusing on stigma related to initiation and use of buprenorphine for
pain and physical dependence due to prescribed long-term opioid therapy in individuals with ESKD on
dialysis. Aim 1 of the study will inform development of a multi-level stigma intervention to facilitate use
of buprenorphine pain medication, when indicated, in patients with ESKD on dialysis through
stakeholder interviews with patients, nephrologists, dialysis nurses, primary care physicians,
buprenorphine prescribers, dialysis organizations and insurance company executives. We will conduct
qualitative interviews with 30 HOPE Trial subjects and their family members (15 who accepted
buprenorphine and 15 who did not), and 30 stakeholders including dialysis and primary care clinicians,
buprenorphine prescribers, pharmacists, dialysis organization representatives and insurance company
executives. A study team including 2 patient-partners will analyze the data using the constant
comparative method to inform an intervention targeted at personal, organizational and structural levels.
Aim 2 of the proposal will employ a user design sprint methodology to create a blueprint for a multi-
level stigma intervention that would address patients (internalized stigma), clinicians (interpersonal
stigma), dialysis organizations (organizational) and insurers (structural) to address barriers to pain
treatment with buprenorphine in individuals with ESKD, chronic pain who are physiologically depending
on opioids. An exploratory aim of the trial will include a validated measure of stigma for patients
enrolled in the parent HOPE trial to be completed beyond the time of the supplement. At study
completion, the research team will seek funding to test and disseminate the resulting proposed
intervention.

## Key facts

- **NIH application ID:** 10175416
- **Project number:** 3U01DK123812-01S1
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Manisha Jhamb
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $250,945
- **Award type:** 3
- **Project period:** 2019-09-24 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10175416

## Citation

> US National Institutes of Health, RePORTER application 10175416, Creating a multi-level intervention to reduce stigma for buprenorphine use for individuals with End Stage Kidney Disease (ESKD) and Chronic Pain (3U01DK123812-01S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10175416. Licensed CC0.

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