Barriers and facilitators of opioid treatment among Indigenous Syringe Services Program clients

American Indian and Alaska Native individuals are disproportionately impacted by the opioid epidemic, partially due to structural racism. Tribal nations and communities are finding innovative ways to provide opioid use disorder (OUD) treatment, but barriers to medications for opioid use disorder (MOUD) remain. This study surveyed Indigenous clients at a Syringe Services Program about barriers and facilitators to OUD treatment.

Interviews were conducted with 27 Indigenous individuals who had used opioids in the past month and were receiving opioid harm reduction services from a tribally-run Anishinaabe Syringe Services Program (rural Minnesota). Participants were asked five questions in interview style format about their experiences with opioid use disorder care with a focus on barriers and facilitators. The coding team analyzed interviews utilizing the Collaborative Story Analysis method to highlight overall impressions of participants' narratives.

There were 27 participants: 48% male and 52% female. The main themes of barriers and facilitators were connection to others, flexibility of treatment services, and ensuring individual needs were met. Having a positive relationship with providers (e.g. non-judgmental), access to MOUD and Harm Reduction services, and minimizing assessment requirements prior to starting treatment were some of the most frequently identified facilitators to care. Lack of transportation, prioritizing care for others, and turbulent relationships with providers and certain aspects of care services were identified as barriers.

Study participants cited clear barriers and facilitators to accessing OUD treatment in a rural Anishinaabe Tribal Nation in Minnesota. The Tribal Nation has already implemented several strategies to improve access to MOUD care (e.g., hiring additional drivers to help with transportation, facilitating immediate MOUD care prior to an intake, if needed, and giving take home MOUD doses). Tailoring services to address identified barriers and leverage facilitators of connection and flexibility will enhance care.