MAT Patients Finding a Fit in Recovery Housing

As the effects of the opioid crisis continue to grow, awareness of the need for recovery housing also has grown quickly. Among other treatment and recovery supports, access to high-quality recovery housing is essential for many people. Yet the demand for recovery housing far outpaces the need. Even when recovery housing is available, residences vary greatly in terms of the level of services and supports provided, the populations and regions served, and the culture. Acceptance of medication-assisted treatment (MAT) is one such factor that varies greatly—impacting access to recovery housing for people with opioid use disorder (OUD).

Common questions about MAT and recovery

For many people in or seeking recovery from OUD, medication is an important—and often life-saving—pathway. Medication can help individuals to focus on their recovery process by stabilizing brain functioning and relieving cravings and withdrawal symptoms. Currently, medication is one part of the “three-legged stool” of medication, psychosocial services and recovery supports that is recommended to address OUD. This approach has been proven to reduce drug use, risk of overdose, injection behaviors and criminal activity.

Across recovery communities, some questions remain about the role of medication in supporting a person’s commitment to recovery. Common questions include whether using agonist or partial agonist medications (methadone, buprenorphine) constitutes a legitimate pathway to abstinence-based recovery. Such medications are opiate-based and bind with receptors in the brain in place of heroin or other opioids. In the past, MAT has been referred to as “drug replacement therapy,” leading to disagreement about whether it is consistent with a substance-free life in recovery. However, MAT is consistent with abstinence-based approaches to recovery, especially when someone is taking medication as prescribed, is not engaging in other substance use, and is participating in recovery supports.

Myths and misinformation about MAT can lead to stigma and discrimination, and can limit access to life-saving services and supports.

Innovations in MAT recovery housing

Many recovery housing operators are innovating to meet the significant demand and unmet need for safe, supportive housing among people in recovery from OUD. A growing number of mission-driven recovery housing operators are adapting policies, procedures and programs to build proficiency in supporting residents who use MAT. Key considerations include how homes screen and support residents, prepare and train staff, ensure safety and prevent diversion of medications, coordinate with prescribing physicians, and foster a culture inclusive of MAT pathways.

Each of these considerations must be carefully addressed and clearly communicated to residents and staff. Often, operators are encouraged to consult attorneys to ensure they understand all applicable federal and state laws. For example, screening policies and procedures must be fair and consistent across all potential residents and must avoid categorical exclusions based on the use of medications. Such exclusions could violate the federal Fair Housing Act or the Americans with Disabilities Act.

Further, the screening process should help potential residents and operators alike determine if there is a mutual fit. Questions should explore a person’s recovery goals and plans; how they align with the services, supports and culture of the residence; and the person’s willingness and ability to abstain from alcohol and illicit drug use and to commit to the terms of a resident agreement.

Fostering a house culture that welcomes and supports MAT is essential to becoming an MAT-proficient recovery residence. This may require adaptations that are best developed through a process of open discussion, education and reflection with residents and staff. Often, residences reflect the culture of local recovery communities, which have historically defined recovery in ways that do not support the use of medications. Strategies to help build understanding and acceptance of MAT include educating residents about MAT, including those who are currently using medication and those who are not; sharing success stories and openly discussing concerns; and identifying, developing or providing connections to MAT-welcoming recovery support services.

Because this is an emerging area of innovation, there is little research on how best to integrate recovery residences and MAT. The National Alliance for Recovery Residences (NARR), in collaboration with the National Council for Behavioral Health and C4 Innovations, recently released a guide for recovery residence operators. NARR and its partners will continue to offer updated guidance and learning opportunities as best practices emerge.

Kristen Paquette, MPH, is CEO of C4 Innovations, a behavioral health training, technical assistance and consulting organization focusing on initiatives that help vulnerable populations.