Table 1.
Excerpts and Examples from Codebook used for Thematic Analysis.
| Code | Code Description | Inductive/ deductive | Example Quote |
|---|---|---|---|
| Accessing telehealth services | Discussing switch to telehealth platforms to receive opioid treatment medications or other services related to COVID-19 closures | Deductive | “I was on a waiting list before their COVID-19 stuff had started. I was going to be on buprenorphine sometime around now had things not shut down. My counseller isn't able to take phone calls, my social worker is shut down too, and I'm facing things that take my breathe away” |
| COVID-related closure changes | Discussing issues related to closure/changes in service availability due to COVID-19 | Deductive | “Feeling horrible for all the recovering addicts who have been making progress with their medication assisted treatment who are going to suddenly go into withdrawals and may ruin their clean time by choosing to go back to the black market for their opiates to stave off withdrawals” |
| Triggers for use/cravings | Discussing experiences of cravings or triggers for use tied to COVID-19-related circumstances | Inductive | “This whole lockdown with the coronavirus is also not making it any easier. Keeping busy is tough as my outlets have always been the gym playing basketball, socializing, or work. There are also no in-person meetings to attend at the moment. I've considered telling my parents and checking-back into rehab, but I'm not even sure if that's running right now.” |
| Increased interest in treatment | Discussing new or increased interest in treatment as a result of COVID-19 circumstances | Inductive | “Because of covid-19 I am out of a job. I'm trying to look at it as a blessing because now I have the time off from work to be able to do this and to be serious about it!!” |
| Changes in access to MOUD | Discussing issues related to accessing opioid treatment medications (methadone, buprenorphine (suboxone) or naltrexone (vivitrol) during COVID-19- | Deductive | “Yeah with the stay-at-home order and the streets like a ghost town, I figured it's time to quit my street dope habit. Fortunately or unfortunately I have methadone to fall back on. But never having passed a test I don't get take-homes, so every day I mask and glove up and go run that germ gauntlet for my dose” |
| Stocking supply of medication | Discussing stocking or assuring full supply of medication treatments (methadone, buprenrorphine, naltrexone) as to not run out during COVID-19 | Deductive | “Typically, take home privileges for even 1 night have to be earned through good behavior over the 1st couple of months of treatment. However, given the covid-19 situation the clinics have had to take precautionary measures, and have made the difficult decision to grant take home privileges to every patient, in the hopes that they will be able to self-regulate and only take their allotted dosage each day. This is a tremendous responsibility for anyone who enjoys opioids, let alone someone who's just beginning their recovery. Being given a big bottle of an opioid agonist and told to only take “X amount per day” is a difficult task even for someone who's been on methadone for a while.” |
| Relapse/return to use | Discussing experience of relapse tied to COVID-19-related circumstances | Deductive | “I'm on Vivitrol and had been for three and a half years. I screwed up after 3 weeks off the shot because the doctor's office was closed due to the pandemic.” |
| Increased fear or anxiety | Discussing increased feelings of fear or anxiety tied to opioid use under COVID-19 circumstances | Inductive | “I'm worried that if we go on a two week shutdown how will I get my next weeks script? Will I have no choice but to withdrawal? Is the government even considering this? I feel worse for the daily methadone patients-how will they survive? With most at my clinic being homeless and on methadone. This seems like a serious issue that needs to be addressed or maybe it has and I was not aware of it.” |
| Offering advice/support | Offering advice/support/information related to issues or questions that arise during COVID19 | Deductive | “Recently, I have been in a weird place since we went on lockdown. I haven't been doing as much for my recovery and it has taken a toll on my spiritual condition. But have to remember, when I was getting high I was in a bad place. Maybe not at first but definitely at the end, and I don't want to go back there.” |
| Asking for advice/support | Asking other users for advice/support/information related to issues or questions that arise during COVID19 | Deductive | “My clinic is insanely disrespectful to me even though I am drug-free, and now have a job, go to school, have a steady place to live, am engaged to a great person and have a healthy relationship with family and friends. one of that matters because i forgot to call in once and they now want me to lose all my take-homes and start coming in every day of the week (traveling total of four hours each day) in the middle of a pandemic. i want to be done with this shit, how can i successfully taper down with these?” |
| Stream of consciousness/venting | Writing about personal experiences or thoughts without a specific purpose of asking for or offering advice | inductive | My General Practitioner (I'm in the UK) has been giving me monthly take homes of 112 x dihydrocodeine 120 mg and 112x diazepam five mg since the start of this pandemic. 480 mg of dihydrocodeine and 20 mg of diazepam daily. Truth is I would be screwed if he hadn't of done this. About time this was the norm instead of just offering methadone or suboxone, both of which never worked for me for over 13 years. Now i'm stable and have zero desire to use H [heroin] because all the right feelings are hitting the right receptors.” |
| Reducing overdose risk | Discussing experiences related to reducing overdose risk, such as not using opioids alone or stocking naloxone despite COVID-19 changes | “Vancouver is now giving hydromorphone and morphine to its opiate addicts to help with social distancing and reducing COVID-19 exposures. Thoughts: Canada has just rolled out a program to distribute opiate drugs to the homeless […], drugs like morphine and hydromorphone at that, not your usual buprenorphine or methadone which understandably are not all that interesting if you're in a hardcore addiction. It's seems like a dicey position at first but what are your guys thoughts on doing this in other countries? I think this would be a fantastic idea in areas like LA or Chicago” | |
| Coping strategies for sobriety | Discussing strategies being used to address cravings and maintain sobriety from opioid use under COVID-19 circumstances | Inductive | “Like myself and I'm sure hundreds of new people fresh out of treatment or detoxed on their bathroom floor out of losing their job and income do to the virus are isolated from circumstances out of our control with social distancing. The good news is there's an application called Zoom that you can attend hundreds of meetings online.” |
| COVID-related job/income loss | Discussing issues related to job loss due to COVID-19 related closures/changes | Deductive | “I'm also worried that even though I didn't get the [vivitrol] shot today it may count as one of my three free internal medicine visits, after which are used up I am liable for 2800 out of pocket for the vivitrol injection. Currently out of work for eight weeks because coronavirus situation.” |
Note: This table includes codes that were applied in the thematic analysis for this study and is not a comprehensive list of codes that were originally proposed/assessed. Quotes were slightly revised to preserve anonymity of post.