"Supporting Individuals Using Medications for Opioid Use Disorder in Recovery Residences: Challenges and Opportunities for Addressing the Opioid Epidemic"

This article addresses barriers and facilitators in the utilization of medications for opioid use disorder (MOUDs) within recovery residences (RRs). Despite the evidence base for both recovery pathways, numerous obstacles stand in the way of combining these recovery pathways to their full extent. 

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As a key recovery support, RRs help individuals with OUD build recovery capital to maintain long-term recovery. Reduced substance use and increased employment are two important benefits found by prior research. At RRs individuals receive psychosocial support from resident peers, and at some facilities, staff are also present. The effectiveness of MOUDs (methadone, buprenorphine, and naltrexone) has been demonstrated by past studies, including lowered odds for mortality. The use of MOUDs at more RRs has potential to greatly reduce resumed drug use and premature death rates because RRs offer long-term on-site support that other settings cannot.        

    

Even with recognized benefits of MOUDs and RRs, authors cite the following barriers to greater implementation:

   

1. Lack of physician staff to dispense 

2. Cost of medications   

3. Adherence challenges including related to co-occurring mental health disorders,  

4. Negative perceptions of MOUDs    

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At RRs, stigma towards MOUDs may come from staff, but also other residents who favor an abstinence-based approach. Safety risks posed by diversion to drug sales and misuse also get in the way of further implementation, as well as increased risk for resumed drug use for residents. Difficulties monitoring MOUDs because of lack of staffing and secure storage also pose a barrier.     

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Based on these barriers, what are facilitators of MOUDs in RRs? Authors cite:

   

1. Staff development to promote “medication-assisted recovery” and reduce stigma at RRs including by inviting peers with successful MOUDs stories.    

2. Reducing diversion and overdose risk through low-cost techniques such as pill counts, medication logs, behavioral monitoring by employees and/or residents, and using injectable medications instead of pills.    

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To implement these strategies, authors call for well-funded policies and further inquiry into MOUDs and RRs, including through the type of research infrastructure building that stands at the center of IRIS’s mission. Chrysalis House and Power Recovery Center are IRIS partners active in providing MOUDs within RRs, and this is a priority area for IRIS’s next round of funded pilot research projects.