Kleinman, Mary BuckleySuccessful engagement with medication treatment for opioid use disorder (MOUD) is an important focus in the fight against the opioid crisis. This study used qualitative methods to solicit feedback about barriers to successful outcomes in methadone maintenance treatment (MMT) and used these findings to build a conceptual framework of interaction. We recruited patients and staff from a community-based drug treatment center as well as peer recovery coaches who work in OUD recovery. Semi-structured interviews and focus groups asked about factors that influence MMT outcomes and how barriers co-occur and interact. Barriers described by participants fit into several broad themes: individual/self, social, institutional/structural, community/environmental, and stigma. Participants described co-occurrence of barriers as fueling the negative effect of one another. Understanding barriers to successful MOUD outcomes and considering their synergistic effect may assist with future identification and promotion of the types of interventions needed to effectively and efficiently mitigate their impact.enThesisClinical psychologymethadoneopioid use disordersocial determinants of healthsyndemicstreatment outcomes