Background: The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been\nparticularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals\nwith opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to\ndecreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment postrelease\nfrom prison because treatment can be particularly difficult to access in resource-limited rural Appalachia.\nMethods: A social ecological framework was utilized to examine barriers to community-based substance use treatment\namong individuals with OUD in Appalachian Kentucky following release from prison. Semi-structured qualitative\ninterviews with 15 social service clinicians (SSCs) employed by the Department of Corrections were conducted to\nidentify barriers at the individual, interpersonal, organizational/institutional level, community, and systems levels. Two\nindependent coders conducted line-by-line coding to identify key themes.\nResults: Treatment barriers were identified across the social ecological spectrum. At the individual-level, SSCs\nhighlighted high-risk drug use and a lack of motivation. At the interpersonal level, homogenous social networks (i.e.,\nhomophilious drug-using networks) and networks with limited treatment knowledge inhibited treatment. SSCâ??s high\ncase load and probation/parole officerâ??s limited understanding of treatment were organizational/institutional barriers.\nEasy access to opioids, few treatment resources, and a lack of community support for treatment were barriers at the\ncommunity level. SSCâ??s noted system-level barriers such as lack of transportation options, cost, and uncertainty about\nthe implementation of the Affordable Care Act.\nConclusions: More rural infrastructure resources as well as additional education for family networks, corrections staff,\nand the community at large in Appalachia are needed to address barriers to OUD treatment. Future research should\nexamine barriers from the perspective of other key stakeholders (e.g., clients, families of clients) and test interventions\nto increase access to OUD treatment.
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