Background/Objectives: Though effective medications for opioid use disorder exist, treatment barriers are prevalent in rural and small metropolitan communities (Lister et al., 2019). The purpose of this study is to (1) examine barriers to participation in methadone treatment in a small Midwest community and (2) identify factors associated with greater endorsement of barriers.
Methods: Clients receiving methadone treatment (N = 267) were recruited to complete a computer-based survey (December 2019). Surveys assessed socio-demographics (age, gender, race, education, community), substance use, depression and anxiety symptoms, trauma history and symptoms, recovery support, and barriers to treatment (e.g., childcare, work, housing, transportation, legal obligations, mental health). Descriptive statistics were used to examine individual barriers and a multivariate linear regression was calculated to assess predictors of greater cumulative barriers.
Results: Geographic and logistical issues were the most commonly endorsed barriers, with over one-third reporting challenges related to their work schedule (35%), distance from home to treatment (34%), and transportation (34%). Past year opioid use (B = 1.73, p = .017) and more severe mental health symptomology (B = 0.23, p = .017) were associated with greater numbers of barriers. Greater levels of recovery support were associated with fewer barriers (B = -0.23, p = .001). No associations were found for demographic variables.
Conclusion: This study adds to the limited research on barriers to methadone treatment for clients in rural and small metropolitan communities. Individuals with more recent opioid use reported a greater number of barriers, suggesting barriers may be more substantial early on. Clients experiencing more depression and anxiety symptoms may be more vulnerable to treatment dropout, as evidenced by greater endorsement of barriers. As social support emerged as a potential protective factor against cumulative barriers to treatment, efforts to enhance family and peer support should be explored as adjunctive services to medication treatment.
