Table 2 Barriers to substance use treatment: key themes
Themes | PWID | Providers |
|---|---|---|
Structural level | ||
Complicated entry to MAT program | All sites: limited number of treatment slots; waiting lists Vietnam and Indonesia: procedural barriers; strict admission requirements | Vietnam: low capacity of MAT sites to accept new patients Indonesia, Vietnam: strict admission requirements to start MAT |
Problematic clinic access | Majority in Vietnam, some in Indonesia: long distance to MAT clinic Ukraine, Vietnam: inflexible clinic hours; lines at MAT sites | All sites: long distance to MAT clinic; limited/inflexible clinic hours Indonesia, Ukraine: daily visits to MAT site |
Financial barriers | Costly examinations to start MAT (Indonesia, Ukraine); a need to pay for transportation and supporting services at MAT site (Vietnam) | Most providers in Indonesia and a few in Ukraine and Vietnam: costly examinations to start MAT Vietnam: a need to pay for MAT leads to patients skipping doses |
Community level | ||
Social stigma toward PWID | All sites: stigma toward PWID in the community rather than at health facilities Vietnam: social stigma toward methadone clients | Indonesia, Ukraine: social stigma toward PWID Ukraine: stigmatization of addiction treatment per se; negative image of narcology institutions |
Individual level | ||
Lack of information about substance use treatment | Indonesia, Ukraine: lack of information about available substance use treatment | All sites: PWID’ lack of information about available substance use treatment; lack of understanding of addiction and MAT in society |
Negative opinion of methadone treatment | All sites—misconceptions of methadone: it is “drug given for free” (Ukraine, Vietnam) and “worse than street drugs” (Indonesia, Vietnam) Ukraine: PWID would prefer buprenorphine | Ukraine: misconceptions and negative opinions of methadone among PWID; PWID would prefer buprenorphine Some providers see MAT as a free substitution to a street drug |
Other barriers related to drug use | Ukraine: most PWID are used to the drug user’s lifestyle Ukraine, Vietnam: using other substances when on MAT as a barrier to adherence | Ukraine: PWID do not start MAT as they prefer a “drug user’s life” and demonstrate “lack of will” (lack of internal motivation) |
Drug interactions | Ukraine, Vietnam: fear of ART and methadone interaction | |