"Now that we've opened the door": challenges recovery home directors face when housing residents receiving medication for opioid use disorder.

Medications for opioid use disorder (MOUDs) are a well-established treatment strategy. Supported by evidence of their effectiveness to reduce opioid misuse, they promote stabilization, prevent overdose deaths, and promote long-term recovery. Unfortunately, many individuals prescribed MOUDs face stigma inaccessing other recovery support resources. Recovery homes (RH), also known as recovery residences or sober living homes, are residential environments designed to support and provide structure to individuals working to achieve sobriety. However, some RHs have historically been unsupportive, with some explicitly denying entry to those prescribed MOUDs. The purpose of this study is to better understand obstacles hindering successful RH placement and support for those receiving MOUDs, as perceived by three groups participating in a housing navigation pilot: recovery home directors, individuals referred to a housing navigation helpline, and recovery coach navigators employed by a behavioral health organization that connects referred clients to recovery homes. Data from these three groups were collected as part of a larger evaluation of a housing linkage pilot. Semi-structured interviews were conducted with each group to ascertain barriers to supporting recovery home residents receiving MOUDs. Findings show the logistical barriers recovery homes face providing access and support for residents receiving MOUDs. Part of this challenge stems from the strict abstinence focus of RHs supported by many, but not all staff. While some directors employ strategies to support residents receiving MOUDs, they unintentionally employ stigma-driven practices that can undermine medication uptake and destabilize the recovery trajectory for residents living in recovery housing. To best support this population, RH staff need more education around evidence-based medication and support to address logistical challenges serving this population, such as providing timely and consistent medication access, especially for those arriving from carceral settings. Finally, to implement effective strategies to destigmatize medications and integrate residents receiving MOUDs, training is needed to help staff understand laws and policies that inform their work.