Table 2.

Qualitative theme with additional health care perspectives and representative quotes.

Theme and subtheme	Respondent	Representative quote
Greater use of methadone and buprenorphine to manage opioid withdrawal and OUD
• Increased use of methadone and buprenorphine was perceived to have contributed to improved patient outcomes	Pharmacist	I think more people are being treated, fewer people are falling through the cracks with transitions in care, especially with things being initiated inpatient and the communication to the outpatient clinic world.
• Increased use of methadone and buprenorphine contributed to the perception of greater provider self-reliance and satisfaction	Pharmacist	I think a shift from considering as-needed medications for controlling withdrawal vs prescribing methadone or buprenorphine, that’s where there has been a decent switch with the new protocols and the expansion of addiction medicine.
	Social worker	It’s pretty significant for me from a social work standpoint. It has significantly reduced the amount of planning and coordination that I have to do because we have people who are experts in doing that and coordinating methadone and Suboxone starts. We really have an exceptional team too that goes above and beyond. They really know the system.
Inconsistent care provided to patients with OUD
• OUD treatment was thought to be varied by the admitting team and physician’s level of training	Social worker	Our doctors are not coming at situations motivationally interviewed or trauma-informed when they’re having these conversations. I do not know that everybody’s skill set includes that or has given them the opportunity to really practice and home in on it. … Creating a safe space to be able to tell your provider what you’re really going through without worrying about the consequences. I think that’s a huge barrier.
•Accessible protocols could potentially resolve discrepancies in OUD care	Pharmacist	I know sometimes somebody’s admitted overnight. We have limited knowledge of what they have been using. The overnight resident isn’t familiar with our protocols so they’re deferring to the day team. I’ve seen several patients we could have intervened on earlier. They start to have withdrawal symptoms. Then it’s not until the next morning after the physician has seen them that we get them squared away with more robust treatment
Challenges with pain management in patients with OUD persist
• Increased communication between nurses and physician may reduce challenges with pain management in patients with OUD	Nurse	A times, patients will say, “I’m in pain,” and your observation is they look completely comfortable, and they’re on their phone. It’s usually oxycodone that I’m administering or hydromorphone. I thought in the past, “Well, I’m not a provider. I don’t prescribe,” but with the fact that state is looking at nursing and our nursing assessments regarding pain, that’s—that’s frustrating to me that I’m not the one who prescribes these, I’m not the one who makes those decisions.
• Perceived confusion regarding buprenorphine dosing in setting of acute pain and OUD	Pharmacist	Buprenorphine tends to be the trickier one because there are different preferences for whether a patient stops, but again, mine is usually for pain, so it’s not really for opioid use disorder. That’s tricky. For pain, it’s different, whether they stop or start it.

Note. OUD = opioid use disorder.