The Implementation of Medications for Opioid Use Disorder in Recovery Residences: Assessing the Impact of the Consolidated Framework for Implementation Research Constructs

Background: Long-term and stable treatment options are needed to reduce the negative outcomes associated with opioid use, especially for those using medications for opioid use disorder (MOUD). Recovery residences (RRs)—the primary transitional setting after acute care in the United States—have begun to integrate the use of MOUD into houses. While literature has addressed whether RRs are implementing the use of MOUD, there is less understanding of the extent of MOUD implementation, such as number of medications accepted and extent of use among residents. Furthermore, the extant literature is missing a theoretical framework to inform a research agenda. Guided by the consolidated framework for implementation research (CFIR), the purpose of this study was to identify contextual factors impacting implementation of MOUD in RRs. It was hypothesized that RRs with more positive valence and strength of three CFIR domains, including intervention characteristics, outer setting and inner setting would increase the number of MOUD types accepted and extent of use among RR residents.

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). Independent variables for this study were (1) beliefs about MOUD as an intervention; three inner setting domain constructs including (2) organizational culture, (3) organizational climate, and (4) organizational readiness to change; and four outer setting factors including (5) reporting MOUD status to outside organization, (6) certification status, (7) external funding, and (8) connection to outside organization. Dependent variables were (1) total number of MOUD types accepted and (2) extent of MOUD used amongst RR residents. Poisson and OLS regression were used to examine the association between CFIR constructs 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 or not the RR accepts women.

Results: Regression models found that beliefs about MOUD as an intervention and certification (i.e., CFIR “intervention” and “outer setting” characteristics) were significantly associated with increases in the total number of medications accepted in RRs and the extent of MOUD use among residents. RR climate (i.e., CFIR “inner setting” characteristic) was associated with increases in the extent of MOUD use among RR residents. Conversely, organizational readiness (i.e., CFIR “inner setting” characteristic) was associated with decreases in extent of MOUD use among RR residents.

Implications: This study is the first to apply the CFIR to implementation of MOUD in RRs. Findings indicate beliefs about the intervention and certification were associated with increases in types of MOUD accepted and in extent of use, and the implementation climate was associated with increases in extent of MOUD use. Future social work research should further assess if other outer setting factors that coincide with RR certification, such as involvement with NARR and opportunities for funding also increase implementation efforts, as well as how to better support RR implementation climate and readiness. Continued research of RRs is needed to further support social work clients using medications seeking long-term recovery.