Medication Based Recovery in Opioid Use Disorder: A Clinical and Epistemic Imperative

Medication‑based recovery (MBR) is based on a recent proposal by leading addiction scientists, which rejects abstinence‑only definitions that drive unsafe practices such as forced tapering or discharge. Instead, it reframes opioid use disorder (OUD) treatment by recognizing that recovery can be achieved and sustained while patients remain on medication for OUD (MOUD). MBR is structured around a staged care pathway of protection, remission, and recovery, prioritizing immediate harm reduction, sustained clinical engagement, and measurable improvements in health and social functioning. It endorses ongoing MOUD combined with validated monitoring, behavioral interventions, and social supports to reduce overdose, infectious complications, and other harms. Effective implementation of MBR requires an aligned policy and payment reforms to support measurement‑based practice, coordinated services and integrated delivery, licensing and credentialing changes to protect clinicians who provide evidence‑based MOUD, and workforce development to expand prescribers and embed addiction expertise in primary care and telehealth. MBR also requires public and family education to reduce stigma and to reframe expectations about what constitutes meaningful recovery. Success should be measured by retention on MOUD and reductions in overdose risk during the protection phase, decreases in use and symptom severity during remission, and gains in housing, employment, and social functioning during recovery. Framed as both a clinical and an epistemic imperative, MBR affirms the legitimacy of evidence‑based care and counters epistemic exclusion that marginalizes patients and clinicians who rely on MOUD. Widespread adoption of MBR holds the promise of reducing mortality, improving health, and expanding equitable recovery opportunities for patients and families.