Implementation Polices and Priorities in Research and Training for Medication for Opioid Use Disorder in Recovery Residences
Write-up by IRIS team member: Yali Deng
Recovery residences (also sometimes called recovery housing) are alcohol and illicit substance-free, safe and supportive living environments that serve as an essential component of the continuum of care for individuals’ recovering from substance use disorder (SUD). As the opioid epidemic continues to evolve, a growing number of residents entering recovery housing are prescribed medications for opioid use disorder (MOUD)—including methadone, buprenorphine, and naltrexone. Though these medications, paired with psychosocial support, are considered the gold-standard treatment for opioid use disorder, many recovery residences were not originally designed with MOUD integration and lack policies and procedures to support people taking MOUD.
​
Historically, the use of MOUD has been discouraged or even banned in many recovery residences, driven by MOUD-related stigma, concerns about misuse or diversion, and a lack of clear guidance. However, more recovery houses have begun to accept people taking MOUD, with some states having policies to incentivize MOUD acceptance, and the National Alliance for Recovery Residence publishing a guidance for helping recovery residences adapt to support people with medication-assisted recovery.
​
This research corner will summarize two articles providing insights into the practice and research around recovery housing for MOUD-prescribed residents. The first article identifies a structured yet flexible continuum of policy approaches around MOUD in recovery housing, based on 138 interviews with residents and staff across Texas Level II and III recovery homes. The second article provides a roadmap of research and training priorities in recovery housing for individuals benefitting from MOUD. Our partners can use these articles to identify key areas for research, practice, training, and policies specific to recovery residences.
Article 1
"Development and Implementation of Recovery Housing Policies and Practices to Support People Taking Medications for Opioid Use Disorder"
Gallardo, K. R., Stewart, H. L. N., Pullin, J., Wilkerson, J. M., Neubauer, M. G., Kirzner, S. J., Thomas, I., Zoschke, I. N., Rodriguez, S. A., & McCurdy, S. A. (2026). Development and implementation of recovery housing policies and practices to support people taking medications for opioid use disorder. Journal of Substance Use and Addiction Treatment, 180, 209817. https://www.sciencedirect.com/science/article/pii/S2949875925001961
This recent study examined how stakeholders in Level II and III MOUD-accepting recovery homes across Texas developed and implemented policies to support residents prescribed MOUD. Based on 138 interviews with residents and staff within the Project HOMES (Housing for Opioid Medication Assisted Recovery Expanded Services) network, the findings revealed that MOUD policies fall along a continuum related to three domains (see figure 1).
1. Screening and Intake: Policies determined criteria for move-in, sometimes requiring potential residents to be "stable" on their MOUD or taking it for a minimum duration (e.g., 30 days). Some residences also required a release of information (ROI) allowing staff to communicate with healthcare providers.
​
2. Medication Storage and Access: Recognizing the potential for misuse or diversion, policies were carefully crafted to mitigate risk. In almost all participating organizations, residents were required to store medications in lockboxes. Some residences implemented a "two-key" policy where both the staff and resident needed to be present to open the lockbox, helping to ensure accountability for the use of MOUD as prescribed.
​
3. Medication Oversight: Residences varied in oversight, including setting scheduled medication times, and implementing medication count and documentation policies (ranging from daily to bi-monthly) to curtail misuse and diversion.
​
Residents who participated in this study reported that medication policies promoted accountability and feelings of safety. Recovery housing staff also expressed that these medication policies equipped them with the necessary tools to reduce risks of diversion and medication misuse. They also noted the importance of flexibility in policies to provide individualized support for residents and the evolution of policy through trial and error in response to issues.
​
The study concludes that recovery residences can effectively integrate MOUD by implementing tailored, flexible policies regarding medication management and storage while actively cultivating a MOUD-supportive culture to combat persistent stigma.
Article 2
"A Roadmap for Maximizing the Use and Effectiveness of Recovery Housing for Individuals Prescribed Medications for Opiate Use Disorders"
Mericle, A. A., Masson, C. L., Zemore, S. E., Subbaraman, M. S., Khebzou, D., Schmidt, D., Kapiteni, K., & Jason, L. A. (2025). A roadmap for maximizing the use and effectiveness of recovery housing for individuals prescribed medications for opiate use disorders. Frontiers in Public Health, 13, 1533082. https://doi.org/10.3389/fpubh.2025.1533082
This article presents a roadmap focusing on prioritizing research and training needed to enhance recovery housing effectiveness for individuals prescribed MOUD. The roadmap was established through an informal survey (n=15) and discussion with a diverse group of 18 Advisory Board members through the Infrastructure for Studying Treatment and Addiction Recovery Residences (I-STARR) project, including researchers, providers, and advocates.
The top three highly ranked research topics by the advisory board were: (1) Assessment of outcomes of people living in recovery housing who receive MOUD and factors that may influence these outcomes, (2) Examination of factors associated with MOUD adherence among recovery housing residents, (3) Strategies to increase linkages between MOUD prescribers/treatment providers and recovery residence operators. Additional descriptive research was also deemed necessary, focusing on the prevalence of accessing MOUD-accepting housing, gaps in utilization, and examining barriers and facilitators to accessing recovery housing for people prescribed MOUD, including potential disparities among different population groups.
​
Training priorities were established separately for researchers and recovery housing operators. For researchers, the highest-rated training topic was understanding the challenges faced by recovery housing operators/providers. This priority underscored the importance of researchers’ understanding operational realities before investigating or questioning existing practices. For operators/providers, the highest-ranked topic was overcoming potential tensions between prescribers and residence managers/operators. Other high priorities included policies regarding admission, discharge, and screening applicants prescribed MOUD. Operators also noted the importance of training to help them better leverage data collected during service delivery for outcome evaluation.
Conclusion
These two studies provide tangible examples of MOUD policies in recovery housing and a roadmap of crucial research and training needs required to increase the number of MOUD-accepting residences, and to strengthen their effectiveness in utilizing this vital treatment. Recovery housing can successfully support residents taking MOUD with strong policies, trained staff, and collaborative community partnerships. Our partners, especially recovery housing residence operators, can find additional resources to support their policy-making at National Alliance for Recovery Residences. For recovery residences looking into adding an evaluation component to their services, this additional article can be a good resource to guide the data collection and measurement selection. In addition, some members of the IRIS Leadership Committee have formed a new group called PARTNER (Peer Action Research – Transformative Networks Enhancing Recovery) which has been meeting to develop and secure funding for research and training projects. Our goal is to address the needs of recovery housing peer support workers and residences through community-engaged research which enhances practice, training, policy, and scientific inquiry. We welcome partnerships from recovery residences and others wishing to better understand and further uplift this important contributor to our continuum of care.