Development and implementation of recovery housing policies and practices to support people taking medications for...

While recovery housing may be a promising recovery support service to support people prescribed medications for opioid use disorder (MOUD), many recovery housing program operators and staff remain hesitant about accepting people taking MOUD into their programs. This is due to MOUD-related stigma, concerns about the risk of MOUD misuse or diversion, and lack of practice-based guidance on how to accommodate people taking MOUD.

We conducted 138 interviews with residents and staff from Level II and III MOUD-accepting recovery homes across Texas to understand how recovery housing stakeholders developed and implemented policies to support people prescribed MOUD. We also explored participants perceptions of and experiences with navigating these policies.

Stakeholders developed MOUD policies related to three categories (screening and intake; medication oversight; and storage and resident access) along a structured continuum, balancing flexibility with oversight. MOUD policies promoted accountability and feelings of safety among residents. Cultivating a MOUD-supportive culture was central, especially in mixed-residency homes where stigma persisted. Policies evolved through trial and error as residences encountered issues such as stigma, medication diversion, and continuity-of-care gaps. With the exception of added medication policies, stakeholders noted little differences between operating MOUD-accepting and non-MOUD-accepting homes and their residents.

Recovery residences can integrate MOUD effectively with tailored policies, staff training, and stigma-reduction strategies. Findings highlight the need for sustained funding, technical support, and research to identify best practices across housing models and ensure equitable access to recovery housing for people prescribed MOUD.