Exploring opioid use disorder, its impact, and treatment among individuals experiencing homelessness as part of a family

Background: Opioid Use Disorder (OUD) causes significant morbidity and mortality among people experiencing homelessness. We aimed to explore the unique way in which OUD impacts individuals experiencing homelessness as part of a family. Methods: We conducted semi-structured interviews with adults experiencing OUD staying in Boston-area family shelters along with dependent children. We used Borkan's Immersion-Crystallization method to uncover themes from interview transcripts. Results: We conducted 14 interviews. Eleven participants identified as female and three as male. Mean age was 35 (range 24-51) and median number of children was 2.5 (range 1-5). Emergent themes fell in three categories: 1) Initiation of OUD: Many patients were introduced to opioids through physician prescriptions, with recreational use coming first for some. Parents and partners also contributed to opioid use. 2) Impact of OUD: Overdose, homelessness, and unemployment were common impacts of OUD. Many patients described co-morbid chronic pain and mental illness. Psychosocial trauma, prominently due to loss of child custody, was common. 3) Treatment for OUD: Childcare, transportation to treatment at distant sites, and requirements that interfered with life responsibilities were barriers to treatment that shelter-based opioid treatment (SBOT) allowed patients to overcome. Family unity was universally seen as motivation for treatment. Conclusions: According to a sample of adults experiencing OUD in the context of family homelessness, an ideal OUD treatment program would overcome logistical barriers, provide comprehensive treatment for comorbidities, support employment and housing needs, and focus care on the family. Future work should explore the generalizability and financial feasibility of this model.