U.S. military Veteran perspectives on barriers and facilitators to medication treatment for opioid use disorder

Abstract:Background: Opioid Use Disorder (OUD) is a significant public health concern for approximately 60,000 Unites States (U.S.) military veterans and retention is challenging within Medication treatment for OUD (MOUD) regimens. There is little research exploring veterans’ perspectives on the barriers/facilitators to their MOUD care, particularly within addiction-focused clinics. This qualitative study investigated perceived barriers/facilitators to MOUD within this population. Methods: Using rapid qualitative methods, we conducted individual semi-structured interviews grounded in the Social-Ecological Framework (SEF) of the opioid crisis. Interviews were independently coded by two interviewers who then convened to refine code definitions, develop transcript summary templates, organize codes into hierarchical structures, and organize categories into domains through consensus. Results: Veterans (N=21, M[SD]age =59.95[10.50], 80.95% White, 85.71% Non-Hispanic/Latino, 90.48% male sex-assigned-at-birth) who were prescribed methadone (47.62%) or buprenorphine (52.38%) participated. Barriers/facilitators to MOUD were most prominent at the Individual (e.g., Motivational Impediments vs. Motivational Enhancers, Daily Stressors vs. Value Pursuit & Goal Setting) and Clinical/Community levels (e.g., Lack of Resource Connection vs. Treatment Accessibility), but were also identified at the Interpersonal (e.g., Risky Social Access vs. Social Support) and Societal levels (e.g., Societal Stigma vs. Cultural Reductions in Prejudice). Descriptions of stigma appeared across all social-ecological levels. Conclusions: Extending prior research, results underscore the multi-faceted nature of MOUD barriers, which remain even within integrated, addiction-focused clinics, and the need for interventions coordinated across social-ecological levels. Future intervention efforts and research should target patient autonomy and collaborative decision-making, simplification of administrative procedures, care accessibility/convenience, and active anti-stigma practices.