Subtheme 3a: Confronting poor relations with external healthcare providers
prejudice, pain
Participants revealed that one of the advantages of facilitated telemedicine situated in the OTP is that it permits them to circumvent the obstacles they face in traditional healthcare settings where they are ‘labelled as a drug user’. One participant related a similar sentiment when seeking healthcare in a conventional healthcare settingWhen they found out that I was an IV drug user, the whole atmosphere changes… And that's one of the reasons I never sought treatment for [HCV].Another participant cited a story about seeking care for injury‐associated pain in the hospital where they perceived hospital workers' prejudice when checking the opioid registry.[I was] red flagged every single time. When you try to get pain pills, [they think] you fake it because you can't afford the drugs on the streets. You have to go by the [healthcare] system [rules].Another participant shared his/her experience with a provider that demonstrated a misunderstanding of methadone's role to alleviate withdrawal symptoms:[The dentist] actually refused to give me Novocain because I was on methadone… Obviously I switched dentists… A lot of it is knowledge‐related and [lack of] education.The shame and stigma of substance use led participants to delay or entirely avoid seeking healthcare in conventional settings. As the participants learned of the negative consequences of disclosing their methadone status to providers, they also realized that practicing nondisclosure was a strategy to avoid the shunning when seeking healthcare in conventional settings:I don't usually bring it up, unless I absolutely have to… If I'm in a medical setting, obviously I want them to know what medications I'm on, but in my normal discourse with people, I don't bring up that I'm on methadone.