Major barriers and facilitators of care for patients with infectious complications of opioid use disorder: A multi-site, qualitative analysis of expert stakeholders from the CHOICE protocol

Given the rising rates of morbidity and mortality related to Opioid Use Disorder (OUD), hospitalization may be an opportune time to engage individuals with OUD in treatment and prevention. The 'Continuum of Care in Hospitalized Patients with Opioid Use Disorder and Infectious Complications of Injection Drug Use' ('CHOICE') protocol was a multi-site study developed to understand barriers and facilitators of care for patients with infectious complications of OUD. The study conducted semi-structured interviews with twenty-four stakeholders (community providers, harm reductionists, and other professionals) from CHOICE sites involved in the continuum of OUD care: Georgia, Maryland, Alabama, and the District of Columbia. The data was coded using qualitative management software (NVivo 11). Subsequent thematic analysis involved a hybrid deductive and inductive approach. We identified seven key themes, organized through the lens of a Social-Ecologic (SE) Model, an analytical framework that groups themes by level of influence at the individual, institutional, community, and societal/national levels. Major findings from each theme included (1) stigmatization of patients with OUD, and their providers; (2) lack of standardization around evidence-based OUD practices; (3) limited patient and provider resources; (4) poor inter- and intra-institutional communication; (5) the importance of co-localized care and harm reduction; (6) impact of the institutional and pandemic environment; and (7) the restrictive nature of national policies. These common findings across geographically and policy-diverse clinical sites point to a need for targeted policy, training, and clinical interventions at each SE level, and for standards in OUD care to be developed and prioritized.