Physical Accessibility Barriers to Medications for Opioid Use Disorder Treatment: A Qualitative Study of Perspectives from Women with Opioid Use Disorder and Health and Criminal Legal Professionals

Abstract

Introduction: The opioid overdose crisis necessitates the development of effective treatment and harm reduction practices. Recent increases in opioid use disorder (OUD) and overdose rates among women in tandem with lower medications for opioid use disorder (MOUD) treatment utilization rates make a case for investigating the barriers faced by women with OUD in accessing MOUD treatment. To inform future interventions, this study examines factors that impede access to MOUD treatment and explores evidence-based solutions through triangulating the perspectives of affected women as well as criminal legal and health professionals who work with women with OUD. Methods: Semi-structured interviews (N = 42) were conducted from May to June 2022 to assess participants’ lived experiences with MOUD treatment. Participants included criminal-legal involved women with a lifetime history of OUD and MOUD use (N = 20), criminal legal professionals (N = 10), and substance use disorder (SUD) treatment professionals (N = 12) who work with women with OUD. We used a thematic qualitative data analysis process to identify common barriers to accessing MOUD treatment. Results: The thematic analysis identified three categories of factors impeding MOUD treatment accessibility: (1) financial barriers (including program difficulties procuring grant funding and individuals’ concerns regarding insurance coverage), (2) travel hardships (including inadequate public transportation infrastructure and lack of access to personal vehicles), and (3) insufficient provider availability (including demand that exceeds the supply of open spots in MOUD treatment programs and a limited number of treatment facilities). Conclusion: There was substantial consensus among the three groups, and participants identified financial barriers, travel hardships, and insufficient provider availability as barriers to accessing MOUD treatment. Our study's results make a strong case for addressing travel-related hardships. To best serve affected women, solutions such as allocated transportation, gas mileage reimbursement, bus passes, flexible take-home treatment options, and alternative medication dispensing settings should be implemented to mitigate transportation-related barriers to accessibility.