PRP038: Barriers to MAT access and retention among people with Opioid Use Disorder (OUD)

Monika Wozniak, MA

Abstract

Context: Medication Assisted Treatment (MAT) is well-established as the gold standard for opioid use disorder (OUD) treatment. In upstate New York, the Erie County Opiate Epidemic Task Force has worked hard to increase access and retention to treatment, however barriers to effective treatment remain. Objectives: To uncover contextual factors relating to treatment seeking, access and retention, and dropping out among people with opioid use disorder (OUD). Design: Qualitative design. Semi-structured interviews were conducted with 35 adult community members who used opioids. Researchers used inductive thematic content analysis, incorporating Atlas.ti software to identify themes. Setting: The majority (20/35) of participants were recruited from a local needle exchange program. A Harm Reduction approach at the needle exchange allowed a space where many participants felt safe being interviewed. Participants: All participants had reported using opioids and had experienced at least one overdose and naloxone reversal in the preceding 12 months. Most participants were white (86%), male (66%), and the average age was 33 (SD=6.6). 24 were enrolled in medication assisted treatment at the time of the interview. Results: Three broad thematic categories were identified with multiple subthemes: (1) Reasons to seek treatment: Participants mentioned losing children, pivotal events, fatigue with the lifestyle, and court mandates; (2) Barriers accessing and retaining treatment: These included long waiting lists, requirements, and difficulty navigating the system; (3) Reasons for relapse and dropping out: Once linked to treatment, participants described “bargaining:” continuing to use drugs while engaged in MAT, traumatic events, dope sickness, influence of friends, and feeling overwhelmed by the urge to use opioids. Many participants described multiple experiences engaging in MAT and dropping out. Conclusions: That participants dropped in and out of treatment multiple times underscores the chronic relapsing, remitting characteristic of opioid use disorder – similar to other chronic diseases. They should anticipate this behavior pattern when prescribing MAT to their patients. They need to consider assessing patients’ social supports and life events, and focus on keeping patients engaged in treatment rather than strictly adhering to their treatment.

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