A qualitative examination of substance use disorder treatment-seeking among women with opioid use disorders: The role of syndemics and structural violence

Women with opioid use disorders (WWOUD) experience disparities in access to substance use disorder (SUD) treatment, yet the reasons for these differences are unclear. Co-occurring social and structural factors may work synergistically to impede women's treatment-seeking efforts. The current study explored the socio-structural context of SUD treatment-seeking among WWOUD. We used in-depth, semi-structured interviews with 56 women who had misused any opioid in the past year to address the study's aims. Constructivist grounded theory principles were used to identify the socio-structural barriers to SUD treatment entry through the lens of syndemics and structural violence. Study results illustrate how WWOUD can encounter a host of mutually reinforcing negative conditions that are situated within the broader socio-structural context of social stigma, poverty, limited availability of SUD treatment options, and a punitive societal approach to drug use. Findings indicate a need to implement and expand structural interventions that address economic and housing insecurity and childcare needs. Strategies that move systems away from a punitive approach to drug use are also encouraged, in favor of supportive and cross-system collaborative approaches that can facilitate women's access to SUD treatment services.