A qualitative investigation of Veterans' perceived barriers to medication treatment for opioid use disorder

Abstract: Aim: Opioid Use Disorder (OUD) is a significant public health concern for ~70,000 United States veterans. While Medication treatment for Opioid Use Disorder (MOUD; e.g., buprenorphine, methadone) is a first-line intervention, dropout is common and associated with dramatic increases in morbidity and mortality. Understanding patient perspectives on MOUD care barriers is vital, but research has primarily examined civilian populations. Guided by a social-ecological framework of the opioid crisis, we qualitatively examined perceived barriers to MOUD among veteran patients. Methods: We conducted individual semi-structured interviews with veterans receiving opioid agonist treatment and utilized rapid qualitative analytic methods. A team-based approach was used to develop a start-list of semi-structured interview questions. Individual semi-structured interviews were subsequently conducted. Interview templates were independently coded by each interviewer, who then convened to discuss and refine code definitions, develop transcript summary templates, organize codes into hierarchical structures, and refine categories into domains through consensus. Results: A total of 15 veterans (M[SD]age = 60.05[10.77], 86.67% White, Non-Hispanic/Latino, 93.33% male sex assigned at birth, 40% prescribed methadone, 60% prescribed buprenorphine) participated. The social-ecological levels with the most prominent identified barriers were Individual (Co-Occurring Symptoms, Daily Stressors, Motivational Impairments, Self-Stigma, and Negative Reactions to MOUD Medications) and Community (Rigid Treatment Structure, Provider Rapport and Communication, Administrative and Logistical Challenges, Holistic Recovery Needs, and Treatment-based Stigma); however, Interpersonal (Risky Socialization, Social Stigma) and Societal barriers (Societal Stigma) were also identified. Conclusions: Veteran emphasis on individual and community-based barriers suggests a need for greater adjunctive support to facilitate improved quality of life, increase treatment plan transparency, and foster patient-provider communication throughout MOUD (induction, maintenance, and, if desired, tapering). Additionally, stigma-related barriers reported across ecological domains indicate the need for continued patient support and multi-faceted interventions.

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