Understanding the financial barriers to treatment among individuals with opioid use disorder: a focus group study

Despite the established effectiveness and relatively widespread availability of Medications for Opioid Use Disorder, individuals seeking treatment frequently encounter various structural and social barriers, including costs of treatment. This study aimed to understand the financial barriers that affect treatment continuation in individuals with opioid use disorder (OUD).

In this qualitative study, seven semi-structured in-depth focus group interviews were conducted among 28 participants in treatment for OUD. Basic demographic information were collected in a pre-focus group survey. Focus group interviews were conducted from December 2021 to February 2022. A moderator guide was used to facilitate the discussion. Transcripts were managed using ATLAS.ti© v7. Data collected from the focus groups underwent deductive thematic analysis.

Data saturation was reached in 7 focus groups with a total of 28 participants (17 [60.7%] women; 27 [96.4%] white; 24 [85.7%] non-Hispanic). All three medications for OUD were represented (18 [64.3%] buprenorphine and naloxone, 5 [17.9%] methadone, 3 [10.7%] naltrexone, and 2 [7.1%] buprenorphine) and the time in treatment ranged from 1 month to over 36 months. Nearly all participants (27 [96.4%]) indicated a financial barrier that led to delayed treatment initiation and treatment retention. Two themes were identified from the focus group interviews: (1) OUD treatment-related financial burden- the direct and indirect cost associated with the treatment, and (2) psychosocial effects associated with the cost of OUD treatment -the mental, emotional, and social effects of the disease.

Most participants described the desire and need for resources to offset the unaffordable cost that inhibits treatment initiation and retention. Further work is required to help identify individuals susceptible to financial barriers that can lead to early discontinuation in treatment.