Multi-stakeholder perspectives on acceptability and delivery of buprenorphine for women who use drugs

Abstract

Women who use drugs (WWUD) face substantial barriers to accessing medications for opioid use disorder (MOUD), including buprenorphine. As part of a formative evaluation to co-design a community-based intervention for MOUD delivery, we explored multi-stakeholder perspectives on the acceptability and delivery of buprenorphine for WWUD. We conducted qualitative interviews with 16 WWUD (who reported lifetime history of injection drug use) and 5 healthcare and harm reduction professionals (HHRP) who work closely with WWUD. Interviews asked open-ended questions about attitudes and beliefs towards buprenorphine, experience receiving (WWUD) or facilitating receipt (HHRP) of buprenorphine, and barriers to using buprenorphine in the future. Interviews were audio-recorded, professionally-transcribed, and coded using Rapid Assessment Process. Two coders generated templated coding summaries of each transcript, which were placed into a matrix and iteratively reviewed to identify cross-cutting themes. Qualitative learnings were finalized with the investigative team and confirmed with community advisors. Among 16 WWUD participants, 12 (75%) identified as White and 11 (69%) were unstably housed. All participants had a lifetime history of injection drug use and 10 (63%) had ever tried buprenorphine. Most WWUD did not perceive buprenorphine to be the right choice for them, in part due to beliefs about its limited effectiveness and concerns about their personal safety and stigmatizing beliefs. Fear of physical discomfort from buprenorphine inductions further discouraged willingness, especially for those using fentanyl. Participants described the ways in which housing instability and limited social supports compounded barriers to starting and staying on buprenorphine, but that harm reduction approaches might help. WWUD face multilevel barriers to buprenorphine use and both WWUD and HHRP are working to respond to the ways in which fentanyl further heightens those barriers. Future efforts to expand buprenorphine use among WWUD should consider supports that improve the ease and acceptability of buprenorphine delivery.