Table 3 Key quotes demonstrating themes

OUD Treatment-Related Financial Burden

Direct

[A friend of the participant] “He was like, ‘I need to get my money right,’ is what he said to me. ‘Let me get a few things in order, and I'm going to do that so that I can afford to pay for my medication.’ He’s dead.”

“Recently, in these past couple of months, I lost my regular job. And when that happened, I kind of got screwed on the medication aspect of that, so.”

“I had insurance, but the insurance usually doesn’t cover it, my insurance at least. But yeah, I'm grateful they got the state to fund it.”

Indirect Cost

“My truck broke down, and I had to spend $400 in order to make it to my appointment. And so I had to Uber my way up there for the first two months of that happening until I got enough money to fix my truck. So if you do the math, that’s almost… That’s close to a grand.”

“I need a roommate because I can’t pay rent. I can’t pay rent because my medication is $480. That’s over half of my rent

“You'd be waiting for like three hours to get through it. And they didn’t care if you had a job or not. I had to go to work. They wouldn’t put you ahead of people that didn’t have jobs or anything like that. And I can’t tell… like I literally got fired from one of my jobs because I was late so much because I was at the clinic.”

“The places that you can go, without money, I mean they have six-month waiting lists. By the time that comes around, I'll probably be OD'd. The last six months of using, I had OD'd and ended up in the hospital four times, so the likelihood of me making it another six months is very unlikely.”

Psychosocial Effects Associated with the Cost of OUD Treatment

Coping

“I didn’t have a choice. I had to stop taking Suboxone.”

“Anything I could get my hands on, I'm going to sell it, either to get my fix, or to pay for the weeks’ worth, or to get my meds. Whatever I'm a part of at that point in time, that’s what I'm what I'm going to do.”

“Breaking the law, and like I said, one of the best ways to do it, if you can, is to maybe lie to your doctor, get some medications, get a number of medications, take the ones that you need, and have some to pay off for whatever you got on the streets.”

“If I'm not working, then I don’t get it. That’s the problem right now. If I don’t have the money, I don’t have anybody to help me. So I just don’t get the prescription, and I go without it, and I have to try to make myself really focus and go to meetings and do stuff like that during that time that I'm out of it.”

Affect

“I have a lot of anxiety over it [cost of treatment]. Like I said, it’s on a week-to-week basis. I'm trying to figure out how I'm going to pay for it. It’s like you're trying to do the right thing, and it’s so much harder than doing the wrong thing. It'd be so much easier to go back and do what you've been doing, but when you try to change, it’s a whole bunch of extra stuff comes with it, and it can be frustrating.”

“I worry about how you see like prescription drug costs and things go up. I wonder… I worry about in my lifetime that it will escalate to the point that I won’t be able to afford it. And I'm really afraid of that because, like with methadone, it’s till you're dead basically you'll be on it. And I'm like, so how am I going to afford this. Because as I get older, it’s just going to get more and more expensive. So it does make me nervous.”

Support

"No, I can’t go to treatment. I literally am holding up my entire family. If I leave my job, my everything falls apart."

“If I can’t go to work, am I going to go to that meeting? Or am I going to get kicked out of this program if I don’t go to this meeting?”

“I'm grateful for the programs, but I think there’s a lot of help out there, but people don’t know about these resources. It needs better public attention, I guess you could say that.”