Table 3 Summary of quotes and themes

Biopsychosocial perspective

When patients come to enroll for treatment, [we] interview them first and do a full bio, social, psycho[logical], spiritual assessment. The report is then given to the doctor, who decides if the patient is a good candidate to be enrolled in the program. Once enrolled, we start moving them through the stages of recovery (Methadone Case Coordinator)

Comprehensive assessment of patients during intake allows for a deeper understanding of the patients physical, mental and social needs

Since the clinic provides specialist care, patients have to seek care for the identified needs elsewhere

Patient as person

You give them their drink, and you might have a little bit of a conversation. They [the patients] might be, you know, like one gal said, 'Oh I walked over here today and, you know, I'm trying to get back into- I used to run and,' so you learn a little bit about their lives and, you know, as you interact with them, one guy that is a drywaller so I was asking him is it busy right now?' He said, 'Yeah I got lots of drywall jobs,' so you learn a bit personal about them (Pharmacist)

HCP interest in understanding a patients’ lived experience motivates HCPs to be advocates and allied in care

There are limits to what HCPs can do for these patients who are dictated by treatment guidelines that governed the clinic operationalization

Sharing power and responsibility

I was taking Suboxone at the time, and then, I started getting depressed, really depressed inside. I would take Suboxone, and I'd pretty much sleep for three days or four days. So, I went back, and I talked to her [the methadone case coordinator] about it, I said, "This is not working." She was wondering because I quit taking Suboxone. I told her, "Well, do you think we can try methadone?" And she's like, "Okay." That was my first round with methadone (Female patient, 38 years old)

When patients are able to contribute to their treatment plan, they may be more successful in treatment adherence and recovery

A significant power imbalance between HCPs and patients exists, which had a significant bearing on patients' ability to discuss their treatment goals

Therapeutic alliance

If we need any help in basically anything like we need somebody to talk to or job, resume hunting or something… 'Cause I needed a little bit of money last week for my daughter's graduation gift so they hired me to do some cooking. I went in there and cooked them a quick couple meals and boom, gave me some money. So if I need some stuff like that, they help out…they help out a lot. These two ladies are very well, they do a good job (Male patient, 38 years old)

Patients benefited from positive and mutually respectful encounters with HCPs as it makes patients feel valued

A lot of time is needed to develop therapeutic alliance between the patient and the HCPs. Noncompliance with the treatment plan is a significant threat to the therapeutic alliance

Doctor as a person

I've never taken things personally [with patients on methadone treatment]. It's gotta be professional. And with my prior careers too and stuff, I've always been able to deal with situations well. It's never affected me mentally or emotionally. And that's the type of person I am. How I've seen it affect people—death has affected people. I've seen that. I've seen death numerous times, and never affected me. So, in a case where these people are, it's professional, right? One patient got emotional yesterday, and I feel for her, but it just doesn't affect me (Methadone Case Coordinator)

Because of complexities involved in the caring of patients with OUD, objectivity in care can be protective to both the patient and the provider

Some patients may feel the boundaries set by HCPs and the treatment contract acted as barriers to achieving full recovery, ultimately hindering the ability to form a therapeutic alliance