Experiences of Opioid Use and Perceptions of Medication-Assisted Treatment (MAT) in Oakland's Safety Net Clinics Amid the COVID-19 Pandemic

Introduction: Opioid-related overdose is a leading cause of death worldwide. Overdose deaths are rising in the United States, with California attributing almost half of opioid-related deaths in 2018. Amid this worsening epidemic, the COVID-19 pandemic accelerated these trends, predominantly among Black Americans. Medication-assisted treatment (MAT) can reduce the risk of death among those with opioid use disorder (OUD), however its implementation in primary care has faced challenges, particularly during COVID-19. To better understand a MAT community program implementation in a predominantly Black community in Oakland, California, we sought to describe patients’ experiences with OUD and their perceptions of the program, which was implemented during the COVID-19 pandemic at a multi-site community health center.Methods: In this mixed methods study, conducted between May and September 2020, we invited a purposive sample of 185 eligible individuals to complete a 38-item phone survey. Individuals were recruited through street outreach at homeless encampments and needle exchanges or identified from a patient registry as having an OUD diagnosis. Semi-structured phone interviews were subsequently conducted with a subset of surveyed individuals.Results: A total of 47 patients (25%) completed the survey, of whom 8 participated in the qualitative interviews. Most surveyed individuals were Black (n=35; 74%) and unemployed (n=46; 98%), and about half were unsheltered (n=23; 49%). Thirty-one (66%) survey participants reported using opioids at the time of the survey, often for chronic pain relief. Although interviewees carried an OUD diagnosis, many did not consider themselves addicted to opioids and sought to distance themselves from this portrayal of addiction. Despite a consistent desire to change their relationship with opioids, interviewees faced significant barriers to treatment including stigma, lack of access to resources, and unmet social and physical needs. Although interviewees were generally satisfied with MAT, some expressed hesitancy, and experienced exacerbated barriers during the COVID-19 pandemic.Conclusions: More work is needed to raise knowledge and awareness on opioids and OUD. In additions, efforts are needed to improve adoption of the MAT program locally, particularly in higher-risk populations, by destigmatizing OUD, acknowledging chronic pain, and expanding treatment options to include counseling, group visits, and peer support groups.