Addictions, Drug & Alcohol Institute

Introduction   [back to top]

Background

Services for opioid use disorder (OUD) vary widely and may include harm reduction strategies, medications, and access to substance use disorder counseling through inpatient or outpatient settings, such as specialized clinics.¹

Harm reduction typically includes services and supplies to support the health of people who use drugs using a person-centered and trauma-informed approach. These services are often delivered by syringe services programs (SSPs), community-based programs that provide health education and other supports to reduce disease transmission and other health risks of drug use. SSPs often provide sterile syringes and/or smoking equipment, naloxone, wound care, and other supplies.

Opioid use disorder is a treatable long-term condition that can cause serious psychosocial and health problems and death.² Medications for OUD (MOUD) are the most effective treatment and include buprenorphine and methadone which reduce the risk of death by over 50%.³ However, many people are not able to start or stay on these medications, and only about one in five people with OUD is on them.⁴ Long-acting naltrexone (aka Vivitrol) is also FDA-approved for MOUD but has limited effectiveness for OUD.⁵

Objective

This report documents the range of experiences SSP participants had with MOUD, primarily buprenorphine and methadone. These interviews were conducted as part of a larger project⁶ focused on understanding SSP participant perspectives about their use of both harm reduction services and other substance use disorder (SUD) services, including evidence-based counseling, inpatient and outpatient treatment models, and MOUD.

Among participants in the larger study, 67% (n=18) shared their experiences with MOUD. In this report, we’ll share some of these insights and explore both facilitators and barriers to MOUD. We’ll also address some misconceptions about MOUD that may arise from outdated information, word of mouth, or the complexity and variability of MOUD treatment.

Study design

This descriptive study used qualitative interviews to understand experiences and perspectives of participants accessing both harm reduction services (at SSPs) and SUD treatment. Approval for this study was obtained from the University of Washington Human Subjects Division. Project partners included three SSPs in Washington State that were selected for geographic variability (Table 1).

Interviews were conducted during regular SSP hours in fall 2024. SSP participants were eligible if they:

• had accessed SUD treatment in the last two years
• had used non-prescribed opioids or stimulants in the past week
• were at least 18 years old
• spoke English

Semi-structured interviews were completed after verbal informed consent was obtained. Interviews were recorded and transcribed by a HIPAA-compliant transcription service. Rapid qualitative analysis was conducted using transcript summaries and team-based thematic analysis.^7,8 MaxQDA software⁹ supported the initial summary process. This analysis is limited to those who used some form of MOUD in the past two years, including methadone and/or buprenorphine.

Results   [back to top]

Demographics   [back to top]

This analysis includes 18 participants, 12 from Grays Harbor County, four from Clark County, and two from Mason County. Slightly over half of participants were men, over two-thirds were white, about half were unhoused, and the mean age was 42, with a range of 20-64.

Table 1: Participant demographics (n=18)

Table 1: Participant demographics (n=18)

Gender				Race/ethnicity
Man	10	56%		White	12	70%
Woman	8	44%		Native American	2	11%
Age				White & Native American	1	6%
Mean	43			White + Latino	1	6%
Range	20–64			Hispanic	1	6%
Housing Status				White + Pacific Islander	1	6%
Unhoused	8	44%
Housed	6	33%
Temporary	4	22%

Participants described their experiences and perspectives on MOUD in a wide-ranging way, including a variety of positive and negative experiences. Themes are presented in two main groups related to facilitators and barriers to accessing and maintaining engagement in MOUD care.

Benefits and facilitators to MOUD access and engagement   [back to top]

Participants reflected on their experiences and perspectives on MOUD; a summary of the benefits of and facilitators to successful access and retention in MOUD treatment are listed in Table 2.

Table 2: Benefits of and facilitators to MOUD interest, access, or retention

Table 2: Benefits of and facilitators to MOUD interest, access, or retention

Benefits of engagement in MOUD	Decreased need for and use of fentanyl
	Medications decrease cravings and withdrawal
	Increased life stability and improved relationships
Facilitators to engagement in MOUD	Individual medication preferences
	Non-stigmatizing care from MOUD providers and staff
	Social support, such as groups within an MOUD treatment program and/or having a supportive group of people (family or friends)
	Convenience: Telehealth and other flexibilities increased ability to stay engaged in treatment. Similarly, long-acting formulations (naltrexone and buprenorphine) can be more convenient

Benefits of MOUD

Participants described a variety of factors that drew them to and helped them stay engaged in MOUD. Positive MOUD benefits included: decreased reliance on fentanyl, better withdrawal symptom management, increased life stability, and improving relationships.

Decreased need for and use of fentanyl

Respondents were often motivated to try MOUD because they no longer wanted to use opioids, expressing that they were “tired of doing it.”

Participants shared that they benefitted from methadone and buprenorphine because they freed them from the need to continue to use illicit opioids, which decreased the chaos of drug seeking, or “running around and trying to find fentanyl” and also provided them more free time and stability.

Decreased cravings and withdrawal

Relatedly, many people shared that a substantial benefit of MOUD is that it eliminated opioid cravings and withdrawals.

Several participants mentioned appreciating the near immediate impact of MOUD to manage withdrawal symptoms and contribute to feeling better physically.

Increased life stability and improved relationships

Respondents also noted the cumulative impact of MOUD on decreasing “life chaos.” Not having to constantly manage withdrawal symptoms helped them to reconnect with family or regain custody of their children.

When asked what the best part of being on MOUD was, another participant said, “getting my kids back.”

Facilitators to MOUD access

When discussing what facilitated their access to and retention in MOUD treatment, several themes emerged, including individual medication preferences, non-stigmatizing care, need for support, access to long-acting formulations, and the convenience of telehealth.

Individual medication preferences

Many interview participants expressed a preference for or interest in one form of MOUD over another. For example, several preferred methadone over buprenorphine because they believed it was easier to initiate, less likely to cause withdrawal, and could be started without a break from using fentanyl. A few also preferred methadone over buprenorphine because of how it made them feel.

Conversely, some participants described positive experiences with buprenorphine.

Medication preferences were diverse and often quite nuanced, with some people preferring one specific formulation of medication. One person said they preferred buprenorphine mono-product (without naloxone) while another shared that they felt that Suboxone (buprenorphine combined with naloxone) felt more effective for them because it contained naloxone.

A few people expressed that they did not like the taste of buprenorphine and that this was a barrier to taking it.

These experiences reflect that medication decisions should be individualized, and that patients may have strong preferences for different medications or formulations.

Non-stigmatizing care

Participants described how important it was to be treated with respect and compassion and explained that being treated warmly made all the difference for their desire to stay engaged in treatment.

Support

Several people we spoke with expressed that support from family was both a motivator for engaging in treatment and an outcome of successful treatment. One participant explained that support was important to access and remain engaged in MOUD.

Convenience/telehealth

Some participants preferred buprenorphine because it was available by prescription and did not necessitate counseling and the near-daily dosing often required for methadone. One participant said buprenorphine worked well for them because the majority of follow-up care was available over the phone or via telehealth.

One person expressed a preference for Vivitrol (injectable naltrexone) because it is long-acting, rather than a daily pill.  However, awareness of injectable buprenorphine products was low among those we interviewed, so it is impossible to know if these products would be preferable compared to naltrexone.

Concerns and barriers   [back to top]

Participants described many concerns and barriers that prevented them from starting or continuing MOUD; these were sometimes personal and sometimes related to experiences with the medications themselves. A list of the concerns about and barriers to MOUD access and retention from participant interviews can be found in Table 3.

Table 3: Concerns about & barriers to MOUD

Concerns and Barriers to MOUD

Concerns about MOUD	Medication induction hurdles
	Trading “one addiction for another” & long-term medication dependence
Barriers to MOUD	Program requirements, e.g. daily dosing, group meetings or counseling
	Transportation to clinic
	Other challenges in life, e.g. mental health challenges, like depression or anxiety, economic and housing insecurity, trauma

Concerns

Medication induction

Several people expressed concerns about initiating buprenorphine due to perceived risks of it causing withdrawal or the perception that one may need to be in withdrawal to start the medication. Some participants’ concerns were from hearsay and some were based on personal experience.

Many participants expressed concerns about insufficient dosing when they first started methadone. Several people felt their methadone dose was insufficient to reduce withdrawal, and they continued to use fentanyl until their dose was sufficient to address this.

Trading “one addiction for another” and long-term medication dependence

There was a frequently echoed perception that methadone or buprenorphine were not substantially different from illicit opioids like heroin or fentanyl, and that using MOUD was “trading one addiction for another.”

Some people expressed concerns about having to take buprenorphine or methadone for a lifetime, and that this made them not want to start the medication. One person noted that a family member had been on methadone for 20 years, and they did not want to repeat that and stay on medication forever.

Barriers

Program requirements, e.g. daily dosing, group meetings or counseling

Several participants reported benefitting from methadone but said they found the program requirements difficult to meet when they sought care.  For example, participants mentioned  required near-daily dosing and mandatory individual and group counseling made staying on the medication challenging.

One person spoke about the benefits they had experienced from methadone, such as increased stability, but how frequent clinic-observed dosing limited their ability to travel or leave the area.

Transportation

Access issues due to transportation and program requirements came up frequently as barriers to starting or continuing MOUD.

Other life challenges

Some individuals shared that they discontinued their medications and returned to fentanyl use due to stressful or tragic circumstances in their lives, rather than from challenges with the medications. One participant explained discontinuing buprenorphine treatment after the stress and trauma of a car accident:

Others identified that MOUD may have helped with stability, cravings, and withdrawal but they still had important other issues to work on that contributed to their drug use, such as depression, homelessness, etc.

Overall, participant barriers to MOUD are complex and varied and include both medication-specific concerns and worries about long-term dependence, along with barriers like limited transportation, program requirements, unstable housing, and mental health challenges.

Clarifying common misperceptions and misunderstandings about MOUD   [back to top]

Participant perspectives about MOUD contained some misconceptions either about the medications themselves or about the variety of treatment choices available for MOUD care. These are very understandable given the changing nature of the opioid supply (e.g., variable fentanyl potency and contents), as well as new types of MOUD and evolving ways of using these medications. A list of important clarifications about MOUD can be found in Table 4.

Table 4: Clarifying common misunderstandings

1	Daily and clinician-observed methadone dosing regulations have changed so that near-daily observed dosing is not always required, longer take-home doses are an option, and counseling is no longer required.10 These changes are still at the discretion of the opioid treatment program and can vary by clinic.
2	There are a variety of medication options or formulations that might offer more flexibility if daily or weekly appointments do not work. In particular, long-acting injectable buprenorphine was not well known among participants.10 These newer medications can last 7-28 days.
3	Methadone induction, increasing to an effective dose, is a careful and individual process, and ideally clinicians will work with patients to get to an effective dose as quickly and safely as possible.11 Additional communication about why getting to an effective dose can be a slow process could make this less confusing to patients.
4	MOUD is the gold standard of care for OUD and can provide relief from withdrawal and cravings, reduce risk of overdose, and increase stability.3 People stable on MOUD are in remission from OUD; they can be out of the “disorder,” and in recovery.

Recommendations for providers   [back to top]

Listen, learn, and address concerns. Ask patients or clients about past experiences with MOUD.

Start a conversation to learn more about the person’s past experiences and knowledge, help fill in any information gaps, and address any concerns or misperceptions they have about the medications. Many people with OUD have already tried MOUD or know someone who has. They may have preexisting knowledge and preferences that inform what options they feel are most likely to be effective. These may be accurate, but they may be based on their experiences with dependence on a different opioid, or a different form, dose, or approach to starting MOUD.

Patients may not be aware of newer options for MOUD, including new program types or medication formulations. Regulations on MOUD continue to evolve, as do programs, and someone’s past experiences with a program may not reflect how it currently operates.

For example, long-acting injectable buprenorphine may be effective for patients, easier to maintain, and eliminate the taste issue associated with oral buprenorphine.

For methadone, federal regulations no longer require counseling, and regulations have also loosened to allow for more take-home doses. However, individual clinics decide if and how these changes are implemented in their programs.

For patients concerned about withdrawal, providers can talk to them about what they can expect, options to minimize/manage symptoms, and how they can be supported as they reach a stable dose of their medication.

Patient education is essential to support client investment in care decisions. The Washington State Health Care Authority has endorsed this MOUD shared decision-making tool as a certified patient decision aid, and this online guide can help orient the health care team to using the aid.

Respect autonomy.

Treatment works best when someone is engaged and invested in their own care and can consider their options in dialog with a knowledgeable and supportive provider and care team. Educating patients or clients about the range of options available is important, but it’s up to the patient or client to decide if they want to take a recommended medication.

Make MOUD the easy choice. Support low-barrier programs where possible.

People may have had positive experiences with MOUD but faced challenges in accessing or staying on their medication. Being more accessible in terms of location, hours, and program requirements may help patients start or stay in treatment.  Responsive and transparent dosing strategies to quickly and safely get patients to a therapeutic dose, adjunctive medications to mitigate withdrawal as clinically relevant, and fostering a welcoming environment can all help decrease medication barriers. Flexibility with take-home doses or prescriptions can also be helpful. These options can help patients address their other life goals at the same time they treat their OUD.

Help the whole person.

Medications are the gold standard to help reduce overdose risk and withdrawal and treat OUD. However, these medications cannot address every concern someone with OUD might have about their physical health, mental health, or life circumstances. When possible, offer care or provide referrals to help address these issues, regardless of whether someone is ready to start MOUD.

Resources   [back to top]

• Medications for Opioid Use Disorder Brochure, UW ADAI
• Information on Health Engagement Programs (UW ADAI) and Health Engagement Hubs (WA HCA), a model for low-barrier holistic care for people with OUD.
• LearnAboutTreatment.org, Resources for individuals, friends, and family of people with opioid use disorder
• Long-acting injectable buprenorphine resources, handouts and videos from the Clinical Trials Network at UW ADAI
• ScalaNW, technical assistance for healthcare providers in emergency departments
• Surveys and Interviews with People Who Use Drugs in Washington State, UW ADAI

References   [back to top]

1. Nelson, J., Bundoc-Baronia, R., Comiskey, G., & McGovern, T.F. (2017). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health: A commentary. Alcoholism Treatment Quarterly, 35(4), 445-454. doi:10.1080/07347324.2017.1361763
2. Taylor, J.L. & Samet, J.H. (2022). Opioid use disorder. Annals of Internal Medicine, 175(1), ITC1-ITC16. doi: 10.7326/AITC202201180
3. Sordo, L., Barrio, G., Bravo, M.J., Indave, B.I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ, 357, j1550. doi:10.1136/bmj.j1550
4. Mauro, P.M., Gutkind, S., Annunziato, E.M., & Samples, H. (2022). Use of medication for opioid use disorder among US adolescents and adults with need for opioid treatment, 2019. JAMA Network Open, 5(3), e223821. doi:10.1001/jamanetworkopen.2022.3821
5. Harris, M.T.H., Weinstein, Z.M., & Walley, A.Y. (2026). Medications for opioid use disorder, opioid withdrawal, and opioid overdose: A review. JAMA, 335(11), 986-998. doi:10.1001/jama.2025.26348
6. Newman, A., Winstead, T., & Layman, L. (2025). “I think one enhances the other”: Use of harm reduction and drug treatment among participants of syringe services programs. Seattle, WA: Addictions, Drug & Alcohol Institute, Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington.
7. Hamilton, A. (2013). Qualitative methods in rapid turn-around health services research [presentation]. Veterans Affairs Health Services Research & Development CyberSeminar.
8. Hamilton, A. B., & Finley, E. P. (2019). Qualitative methods in implementation research: An introduction. Psychiatry Research, 280, 112516. doi:10.1016/j.psychres.2019.112516
9. VERBI Software. MAXQDA 2024 [computer program]. Version 2024. Berlin, Germany.
10. 42 CFR Part 8 Final Rule. January 31, 2024. Accessed March 26, 2026.
11. American Society of Addiction Medicine. (2020). The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update. Rockville, MD: American Society of Addiction Medicine.