This article presents a sub-analysis of specific themes emerging from a larger qualitative study investigating patient and provider experiences in a perinatal substance use treatment program in Southern Appalachia [42]; a program housed within a high-risk obstetrics and gynecology practice serving a large, mostly rural region. The perinatal substance use treatment program serves pregnant and postpartum patients from a large region; it is one of the only programs of its kind in this part of the country. It also serves patients with many kinds of substance use disorders, not only OUD. Those patients diagnosed with OUD report using a range of opioids, including diverted prescription pills, injected heroin (with and without fentanyl), smoked heroin (with and without fentanyl), other synthetic opioids, and buprenorphine and methadone obtained illicitly. Not all patients with OUD are prescribed buprenorphine products within the program; some obtain methadone through providers at other substance use programs, and attend the program where the research occurred primarily for perinatal care. However, for the larger study from which a sub-analysis is herein presented and based on input from program providers who specifically desired to learn about access barriers affecting OUD patients receiving buprenorphine at that time, inclusion criteria for the larger study included that participants be prescribed buprenorphine products by program providers.