Barriers to Medications for Opioid Use Disorder Among Veterans Involved in the Legal System: a Qualitative Study

Opioid Use Disorder Treatment Initiation and Continuation: a Qualitative Study of Patients Who Received Addiction Consultation and Hospital-Based Providers

“…The interview guide was informed by the authors’ experience in clinical practice (SLC and CC) and by a literature review of patients’ perspectives regarding addiction treatment ( Appendix A ). 6 , 17 , 27 , 28 Interviews were conducted by two physicians (SLC and CC), both of whom work on their institution’s ACS. SLC and CC previously provided medical treatment to some study participants, but not during the study period.…”

“…We employed both a deductive and inductive approach, based on a directed content analysis, to analyze our data. 29 – 31 A deductive approach was used to transcript text to predefined codes and categories informed by the literature, 28 , 32 , 33 prior knowledge, our interview guides, and explanatory frameworks. Explanatory frameworks used to inform a priori code development included the Health Belief Model, 20 a model developed to explain and predict health-related behaviors, used with the patient transcripts, and the Knowledge, Attitudes, and Practices Framework 22 and the Donabedian Framework 23 used with the hospital-based provider transcripts.…”

Individual, interpersonal, and neighborhood measures associated with opioid use stigma: Evidence from a nationally representative survey

“…Importantly, research suggests that underlying the lack of access to MOUD is stigma towards both the disease of substance use disorder and the use of medications to treat substance use disorder ( Calver and Saitz, 2017 ; Finlay et al, 2020 ; Hadland et al, 2018 ; Olsen and Sharfstein, 2014 ; Tsai et al, 2019 ; Wakeman and Rich, 2018 ). Despite the fact that drug dependency has been long acknowledged as a disease, the general public may still view drug use and substance use disorder as a moral failure linked to criminal offense and thus, resist public health or medical interventions.…”

“…Even among people who acknowledge the need of interventions, stigma towards medical medications is still widely spread and deeply rooted, in spite of considerable evidence regarding the effectiveness of MOUDs in reducing opioid-related mortality ( Kelty and Hulse, 2017 ; Larochelle et al, 2018 ; Lee et al, 2016 ; Mattick et al, 2004 , 2009 ). Many patients, families, and even treatment providers perceive those medications should only be used as a last resort and would prefer counseling along with or instead of medications ( Finlay et al, 2020 ; Hadland et al, 2018 ). Some post-acute care facilities are unwilling to accept patients using MOUD ( Wakeman and Rich, 2017 ), and some psychosocial programs and mutual help organizations may reject people on methadone or buprenorphine ( Wakeman, 2016 ; White, 2011 ).…”

Capsule Commentary on Finlay et al., Barriers to Medications for Opioid Use Disorder Among Veterans Involved in the Legal System: a Qualitative Study

“…3 It is this gap that Finlay et al's insightful qualitative study published in this issue of JGIM addresses. 4 The VA is well situated to address the prescribing gap. There is broad access to MOUD, services for veterans involved in the criminal-legal system, and a system-wide focus on addressing opioid overdoses.…”