Patient-Reported Barriers to Ongoing Engagement in Office-Based Buprenorphine Treatment in a Semi-rural Missouri Clinic: A Cross-Sectional Survey

Access to evidence-based treatment for opioid use disorder (OUD) remains limited, and barriers to sustained engagement in office-based opioid treatment (OBOT) may vary across communities.This study aimed to characterize patient-reported barriers to accessing and remaining in OBOT in a semi-rural Missouri community.A single-center, cross-sectional descriptive survey at the Ozark Center clinic in Joplin, Missouri, was conducted among patients receiving OBOT for OUD.Approximately 170 patients were enrolled in the OBOT program during the study period, although not all patients were offered the survey due to scheduling and clinic workflow variability.The anonymous, paper-based 11-item survey was completed by 49 patients, with participation optional for each item and therefore variable responses across questions.Among respondents, 44/49 (89.8%) reported needing treatment, 44/49 (89.8%) reported feeling comfortable discussing substance use with healthcare professionals, and 47/49 (95.9%) reported encouragement from family, friends, or community members.Eight of 49 (16.3%) reported having difficulty finding a treatment clinic.Reported barriers to accessing treatment included cost (n=14), insurance issues (n=13), and transportation availability (n=13).The most frequently reported barriers to maintaining treatment were work or other obligations (n=30), clinic hours (n=20), feeling judged or looked down on (n=18), clinic location (n=16), and travel distance (n=15).Additionally, 21 participants reported experiencing stigma related to medications for OUD.These exploratory findings are limited by the small, nonuniform survey distribution, self-reported data, and inclusion of patients already engaged in treatment, and therefore may not reflect barriers experienced by individuals who have not initiated or discontinued OBOT.Larger, multisite studies including patients outside active treatment are needed to further characterize barriers to OUD treatment initiation and retention.