Table 1.

Example Quotes From Theme 1 (Archetypes of Patient Relationships With Opioid Use and the Health Care System)

Theme	Quote
Archetype 1: Opioids used by patients for chronic pain	“Well, it’s kind of hard to say because I really needed the pills to function. I really did. I was in so much pain.” [58-year-old female] “The abuse, I know, happens. I know there’s a lot of people who abuse it. And that’s really hard for those of us who need it and do everything we can to limit the amount that we take. It’s kind of almost a slap in the face because other people are abusing it.” [58-year-old male] “And like I say, the legitimate users are going to get caught up in the whole push to get this nation off opioids.” [63-year-old male] “It scares me because literally not having that pain medication, or something that would work as effectively, I can’t lift heavy stuff. I can’t make a decent living. So it did scare me because it’s important for me to keep work [sic] and to not feel the pain in my back and shoulders.” [47-year-old male] “I did actually need them. And when I would talk about wanting to go up, [my doctor] said something like, ‘Well, now you sound like an addict.’ And that was really offensive, but at the same time, it was true.” [42-year-old male] “I don’t want to be on any of the drugs … but there’s no alternative. You name it, we’ve tried it.” [64-year-old male]
Archetype 2: Acute use of opioids by patients	“I take them as little as possible. I do not like that feeling. But I’ve had it for a short period of time after brain aneurysm repair; I took it for maybe two days, day and night. And then just two or three nights just so I could sleep after a knee replacement, for maybe a day or two after shoulder repair, and I took it for a day or so after the broken wrist surgery. But I don’t like the feeling when I’m taking it.” [72-year-old female] “As soon as I didn’t need them, I didn’t use them … after the second operation, when they removed the osteo in my leg, I really wasn’t in any more pain … I had already stopped taking them at that point.” [67-year-old male] “Absolutely no worries have I ever had with regard to developing a risk. In fact, I had had a prescription for Tramadol in the past. I had had a prescription for 30 pills, which took me over a year to use. And I kept using this as an example for my responsibility factor in getting on board with another pain medication. And that didn’t seem to have any bearing on anything. And again, I understand there are procedures and policies, et cetera, involved with the entire group of opioid medications. But I felt like I was kind of being treated in a punitive manner in order to be able to just get access to something, in order to be able to assist me with pain that I was having with my back, which was documented.” [61-year-old male] “I didn’t have any worries because I didn’t think I was going to be on them long enough to get addicted to them.” [72-year-old female] “I would probably check out of that conversation [about opioid risks]. Because I never really saw myself that way.” [43-year-old female]
Archetype 3: Problematic opioid use leading to openness to treatment for an opioid use disorder diagnosis	“Well, eventually I needed stronger medications because they weren’t working, and then eventually, my doctor at the time, sent me to a pain clinic. And then they were being monitored, and then we thought it was time for me to go off of them, and I kept getting violently ill every time I’d go off of them. And we just were having a hard time tapering me off of them, and so I just started to do research on my own. And I would ask questions.” [40-year-old female] “I went to my doctor at [clinic name] … to find out how I can get off of opioids, and he referred me to Dr. [name] because Dr. [name] is involved in the program of administering a medication that can help me get off the pills and stop the cravings and the withdraw [sic] symptoms. And so I made my appointment with him. So he prescribed this medication. It just helped me so much immediately. And so yeah, I kind of looked to him as like a savior at this point because it really, really helped me.” [58-year-old female] “I knew I had a problem … I said [to physician], ‘Okay, I want to get off [opioids]. So, if I want to get off them and you have the support system, then I will get off them.’” [42-year-old male]
Archetype 4: Problematic opioid use not yet open to treatment for an opioid use disorder diagnosis	“… they would at least respond with a ‘I’m not ready’ or ‘Can we give it a little longer?’ And there are so many people out there who just want to stay on this stuff [opioids]. And I get that, I do, because it does give some sort of semblance of normalcy.” [39-year-old male] “Now, like I said, I’m an addict/alcoholic, and I seek opioids at certain times in my life because there are certain doctors, word is out … ‘well, go to Dr. so-and-so at such and such a clinic to get your meds.’ I don’t go to [my primary care clinician] for that reason. I go to him for medical reasons only. I’ve never asked him for opioids, and I won’t because there are certain doctors, that’s why you visit them. And then you have your other doctors for medical reasons, which he is.” [66-year-old male]