Patient Characteristics of Medication Focused Recovery Residences for Young Adults with OUD

Introduction: Young adults (YAs) face extensive engagement barriers in opioid use disorder (OUD) treatment, leading to poor retention, adherence, and outcomes. Recovery residences (RRs) are widely utilized components of the care continuum, but are poorly understood. Young adults with OUD face unique barriers to recovery housing, for example, same-aged peers might be of developmental importance to youth, but most RR residents are typically older; acceptability of medications for OUD (MOUD) varies widely within RRs, limiting options for youth taking MOUD; and typical adult RR’s may not have developmentally appropriate supervision. This exploratory descriptive study examines an innovative, developmentally-specific model of RR for young adults with OUD that actively promotes MOUD (i.e., medication storage and administration, low barrier access to prescribers, variety of MOUD options), with the goal of identifying characteristics and pilot outcomes of YAs utilizing this RR model.

Methods: Residents were referred through local treatment programs and lived in one of two neighboring RRs in Baltimore, Maryland. All attended outpatient treatment at a nearby treatment facility. A standard battery of questionnaires was administered at admission, 12-week, and 24-week time points

Results: Data were collected from 46 unique YA residents with OUD between August 2019 and December 2020. Residents were M=24.5 years old (SD=2.7), mostly male (65%), most endorsed past injection use (54%), had M=4.8 prior inpatient treatment episodes (SD=6.9), and reported first opioid use at M=17.6 years (SD=3.8). Upon entry, residents endorsed moderate depression (PHQ-9 M=15, SD=7.3) and anxiety symptoms (GAD-7 M=12.6 SD=6.3). All were prescribed MOUD (22% XR-naltrexone, 28% XR-buprenorphine, 43% sublingual buprenorphine, 7% methadone; 20% switched type during their stay). Average length of stay was 14.4 weeks (range = 3 days to 50 weeks), with 62% retained at 12-weeks and 18% at 24-weeks. Most discharged against therapeutic advice (70%) or were admitted to a residential SUD program (21%). Weekly urine drug testing showed 7.5% of residents with at least one opioid positive urine at 12-weeks and 7.4% at 24-weeks.
Discussion and

Conclusions: These preliminary results contribute to emerging knowledge regarding models of care for a high-severity population of YAs with OUD, for whom there are limited developmentally-specific treatment options. It was notable that all residents were receiving MOUD, considering the barriers in many RRs. Residents who stayed in the house did well overall, with low rates of opioid positive urines and almost all retained on MOUD for the duration of their stay. However, only a minority were retained at 24-weeks with most having left against therapeutic advice and many presumed to have relapsed to opioid use. Future research should focus on examining patient- and program-level predictors of engagement, retention, and relapse outcomes, as well as distilling key program characteristics for refinement, to provide a reproducible model for future programs.

References: Miles, J., Howell, J., Sheridan, D., Braucht, G., Mericle, A. (2020). Supporting individuals using medications for opioid use disorder in recovery residences: challenges and opportunities for addressing the opioid epidemic. The American Journal of Drug and Alcohol Abuse, 46(3), 266-272. doi.org/10.1080/00952990.2020.1719410
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Learning Objective: Attendees should be able to explain why innovative recovery residences are a needed addition to after care treatment for young adults with opioid use disorder.