Recovery housing provides safe, stable, substance-free living environments that support people recovering from addiction. While these settings have shown promise for many individuals in recovery, research on their effectiveness for people with opioid use disorder (OUD), especially those taking medications to treat it, remains limited.
To address this gap, researchers working on the Infrastructure for Studying Treatment and Addiction Recovery Residences (I-STARR) project surveyed and consulted with 15 experts in recovery housing and addiction treatment. These experts, serving as an advisory board, helped identify the most important research questions to pursue and training topics needed to move this work forward.
What is Recovery Housing?
Recovery housing, also called recovery residences, includes various types of living arrangements that share common features: they are substance-free environments where residents support each other in recovery. These can range from self-governed homes where residents manage the household together (like Oxford Houses) to more structured settings with professional staff support. The key elements are peer support, safe housing, and shared responsibility among residents.
About 9% of people who have resolved alcohol or drug problems have used recovery housing at some point, making it a relatively common recovery support. For people with OUD, recovery housing could provide crucial benefits during early recovery, including a stable environment, protection from triggers that might lead to relapse, help with medication adherence, and connection to supportive peer communities.
Medications for Opioid Use Disorder (MOUD)
MOUD includes medications like methadone, buprenorphine, and naltrexone that significantly improve outcomes for people with OUD. These medications work by reducing cravings and withdrawal symptoms, making recovery more manageable. However, many recovery housing programs have been reluctant to accept residents taking these medications, creating barriers for people who could benefit from both treatments.
Research Priorities Identified
The advisory board identified several high-priority research topics. The three most important were:
First, understanding outcomes for people prescribed MOUD who live in recovery housing. Do these individuals reduce their substance use? Do they stay in treatment? What factors influence their success? This foundational research is essential but currently lacking.
Second, examining what helps residents taking MOUD stick with their medication regimen. Recovery housing could play a role in supporting medication adherence, but we need to understand what works.
Third, finding strategies to improve connections between healthcare providers who prescribe MOUD and recovery housing operators. Better communication and coordination between these two groups could help more people access both services.
Beyond these top priorities, the experts emphasized the need to understand barriers that prevent people prescribed MOUD from accessing recovery housing in the first place. These barriers include both practical challenges (like recovery housing operators lacking knowledge about safely managing medications) and attitudinal ones (such as negative beliefs about medication-assisted treatment).
The discussion also revealed the importance of examining whether certain groups face particular difficulties accessing recovery housing while taking MOUD, highlighting potential disparities that need attention.
Training Needs
The experts also identified critical training needs. For researchers studying this topic, the highest priority was understanding the challenges recovery housing operators face. Before researchers can effectively study or improve these settings, they need to understand the realities of running recovery housing.
For recovery housing operators, the top training priority was learning how to overcome potential tensions between medical providers who prescribe MOUD and the people managing recovery residences. These two groups often have different perspectives and concerns, and bridging this gap is essential for supporting residents.
Current Progress
Based on these priorities, the I-STARR project has already funded four pilot studies examining topics such as measuring barriers to supporting MOUD in recovery housing, understanding the needs of people in the criminal justice system who take MOUD and need recovery housing, and exploring innovative solutions like mobile pharmacies to improve medication access.
The project has also developed a 12-part webinar training series for both researchers and recovery housing operators, attracting between 30 and 100 live participants for each session. These trainings are now available online for anyone to complete at their own pace.
Why This Matters
The ongoing opioid crisis continues to devastate communities across the country. In 2022 alone, over 107,000 people died from drug overdoses, most involving opioids. Recovery housing represents a potentially valuable but underutilized resource for people prescribed MOUD. By identifying research priorities and addressing training needs, this work aims to build an evidence base that can guide effective practices and policies.
The roadmap developed through this process provides clear direction for researchers, recovery housing operators, and policymakers working to address the opioid crisis. As one advisory board member noted, research is urgently needed to establish whether and how recovery housing can effectively support people prescribed MOUD, ensuring that this potentially life-saving resource is available to all who could benefit from it.
Mericle, A. A., Masson, C. L., Zemore, S. E., Subbaraman, M. S., Khebzou, D., Schmidt, D., Kapiteni, K., & Jason, L. A. (2025). A roadmap for maximizing the use and effectiveness of recovery housing for individuals prescribed medications for opiate use disorders. Frontiers in Public Health, 13:1533082. doi: 10.3389/fpubh.2025.1533082
