Influence of Attitudes on Recovery Residence Acceptance and Use of Medications for Opioid Use Disorder

Background: Few options exist for long-term, transitional treatment supports for substance use disorders. This is especially relevant for individuals using medications for opioid use disorder (MOUD), as recovery residences (RRs)—the primary transitional setting after acute care—have traditionally required residents to abstain from all psychoactive substances. Although RRs are an important support for individuals using MOUD, MOUD use in RRs has faced logistical and attitudinal barriers, and limited research has investigated the integration of MOUD within RRs. The purpose of this study is to investigate types of MOUD accepted and preferred in RRs as well as the relationship between MOUD attitudes and MOUD use in RRs. It was hypothesized that RR leaders would prefer long-acting injectable and antagonist types of MOUD. It was hypothesized that RR leaders with positive attitudes about MOUD would report more types of MOUD accepted in their RRs and greater MOUD use among their residents, compared to leaders with negative attitudes.

Method: Data for this study was collected through an online survey of RR owners, operators, and managers in 20 states in the United States (n=128). Respondents were asked about types of MOUD accepted and preferences. Independent variables for this study were MOUD attitudes, assessed with ideological (α = 0.90) and logistical (α = 0.77) attitudes scales, both showing good internal reliability. Dependent variables were (1) total number of MOUD types accepted and (2) extent of MOUD used amongst RR residents. Poisson and Ordinary Least Squares (OLS) regression were used to examine the association between MOUD attitudes and the number of medications accepted and used in RRs, holding constant participants’ time in role, RR level, proportion of non-white residents, bed number, state and whether the RR accepts women.

Results: Most participants reported that their RR accepted MOUD (92%), and a little under half preferred certain types of MOUD (46%). The most accepted type of MOUD among houses was Vivitrol (88%) followed by naltrexone (83%), Sublocade (77%), Suboxone (77%), and Subutex (71%). The least accepted medication was methadone (68%). Of houses that had MOUD preferences, methadone (0%) and Subutex (6%) were the least preferred types of MOUD. Sublocade (25%) and Vivitrol (36%) were the most preferred. The Poisson and OLS regression found that more positive ideology towards MOUD was significantly associated with increases in both the total number of medications accepted (IRR=1.282, p<.01) in the RR and in the extent of MOUD use scale (Coeff.=1.105, p<.05) among RR residents, while attitudes related to logistical challenges were not significantly associated with MOUD acceptance and use among residents.

Implications: Findings reveal more favorable attitudes towards MOUD are associated with MOUD practices among RRs, specifically increased number of medications accepted in RRs and greater extent of use among residents. Furthermore, despite most respondents accepting MOUD, preferences towards specific types of MOUD exist, potentially contributing to variability in extent of MOUD use. Understanding preferences and attitudes about MOUD among RRs is imperative in clarifying next steps for integration and in continuing to support social work clients using MOUD.