Skid Row, located in downtown Los Angeles contains the largest concentration of individuals experiencing homelessness in the United States. A recent homeless count identified that 29% of unsheltered and 6% of sheltered individuals reported chronic substance use. In the service planning area where Skid Row is located drug overdose was the second leading cause of premature death. Despite the public health issues related to opiate use in this region, opiate research, specifically research on treatment, is especially lacking. This qualitative study was conducted to explore perceptions on opiate addiction treatment among a diverse group of opiate users receiving services from a harm reduction center in Skid Row. Methods: A total of 50 adults reporting past year prescription opiate use participated in the six focus group sessions. Using an inductive thematic approach the transcripts were coded into general and specific themes. Findings: The mean age of participants was 43.5 years and the majority of participants identified as male and Hispanic. Most respondents were unemployed and experiencing residential instability. Themes of treatment entry and retention emerged. For treatment entry participants identified waiting lists and limited program space. Treatment retention barriers included experiences of stigma from treatment providers, family related concerns and obligations, motivation to change, and program requirements. Recommendations for improving access to treatment included inpatient treatment options, assistance in transportation, and access to housing. Treatment retention recommendations included expansion of services such as specialized case management, integrated care, and mental health care. Conclusion: While much of the current opiate epidemic has focused on primarily white, middle-class and rural populations, it is important to understand the perspectives of urban historically marginalized individuals. Understanding perceived barriers and recommendations for improving access to and retention in treatment from the perspective of patients/clients can translate into more effective patient-centered care.