Table 1 Participant quotes supporting variability in OUD management of OUD

1. Variable management of opioid withdrawal

 i. “I think it’s a much more nuanced decision-making process to deal with withdrawal than with a patient who is acutely intoxicated and not breathing, someone you can use naloxone with as an intervention.” (Physician 12)

 ii. “I have a lot less experience treating people with opioid withdrawal than with an overdose and that I find can be extremely frustrating.” (Physician 19)

 iii. “There are some physicians who just simply take more time in terms of providing patient education and some who do less of that because of time restraints. There’s also variability in terms of physician interest in the subject matter. There’s variability in terms of what physicians feel should be done about these issues and what they feel their role is in the whole realm of addictions.” (Physician 4)

 iv. “I think more and more in terms of habits, people are comfortable using [buprenorphine].” (Physician 12)

 v. “There are a variety of different medications that you can use to deal with these people when they’re leaving. There’s low doses of clonidine, NSAIDs and laxatives. Before you discharge them, you want to sure that people are comfortable enough to leave. It depends on what kind of symptoms they’re having, whether or how quickly you’re able to discharge them.” (Physician 13)

 vi. “Clonidine is something that people have been using for a long time and using acetaminophen and naproxen to treat other symptoms of withdrawal. I think those things people are comfortable with and have been using for quite a while. I suspect there’s probably some people that give opiates and some people that give a lot of benzodiazepines, but I don’t. Some people, they give nothing and say no one dies of opiate withdrawal. I think it probably varies a lot.” (Physician 19)

 vii. “As a group we’ve decided we would not like to prescribe narcotics. I think there’s still a large number of other individuals that take other stances. Oh well, it’s Friday. Oh well, this person’s a nuisance. I’m just going to write whatever it is and give it to them and get them out of the department. I think that still goes on.” (Physician 8)

 viii. “Opioid withdrawal is not terribly successful. We don’t have the same medications as we do for alcohol withdrawal and I don’t think they’re effective.” (Physician 15)

 ix. “We never would have given them naloxone kits. We never would have given the buprenorphine. So all that is pretty new.” (Physician 13)