Barriers to Participation in Methadone Treatment Among Adults from Small Urban and Rural Communities

Background and Purpose: Though effective medications for opioid use disorder exist, a range of barriers prevent individuals from accessing and maintaining these treatments. Treatment barriers are prevalent in small urban communities and rural areas, where availability, accessibility, and acceptability of medication treatment are limited (Lister et al., 2019). However, little research exists on barriers to methadone treatment in these communities. The purpose of this study is to (1) examine barriers to participation in treatment among clients receiving methadone treatment and (2) identify factors associated with greater endorsement of barriers. Understanding and addressing these barriers for clients in small urban communities and rural areas may help to reduce the impact of the opioid epidemic in these communities.

Methods: Clients receiving methadone treatment (N = 236) were recruited to complete a computer-based survey at their outpatient clinic (December 2019). Assistance was provided to clients who requested help (e.g., due to difficulty seeing, reading, or using technology). Surveys assessed socio-demographics (age, gender, race, education), substance use, depression and anxiety symptoms (PHQ4), trauma history and symptoms (PC-PTSD), recovery support (Social Support for Recovery Scale) and barriers to treatment (e.g. childcare responsibilities, work schedule, housing insecurity, transportation, legal obligations, mental health barriers). Descriptive statistics were used to examine endorsement of individual barriers and a multivariate linear regression was calculated to assess predictors of greater cumulative treatment barriers.

Results: Geographic and logistical issues were the most commonly endorsed barriers, with over one-third of participants reporting challenges related to their work schedule (35.6%), distance from home to treatment (33.6%), and reliable transportation (33.6%). Past year opioid use (B = 1.69, p = .023) and more severe mental health symptomology (B = 0.22, p = .031) were associated with greater numbers of barriers. Higher levels of recovery support were associated with fewer reported barriers (B = -0.20, p = .005). No associations were found for age, gender, race/ethnicity, or education.

Conclusions and Implications: This study adds to the limited research on barriers to treatment for clients in methadone treatment and brings attention to treatment retention barriers for clients in small urban and rural communities. Individuals with more recent opioid use reported a greater number of barriers to treatment, suggesting that barriers may be more substantial at the beginning of treatment. Results also suggest clients experiencing more depression and anxiety symptoms may be more vulnerable to treatment dropout, as evidenced by greater endorsement of barriers to treatment. As social support emerged as a potential protective factor against cumulative barriers to treatment, efforts to develop and enhance family and peer support should be explored as adjunctive services provided along with medication treatment for opioid use disorders. Targeted interventions to support these high risk, high need populations may improve treatment retention and substance use outcomes.