Concurrent Use of Extra-Medical Medication for Opioid Use Disorder Among Adults Prescribed Methadone or Buprenorphine: A Cohort Study of Urban Adults Who Have Injected Drugs

A cohort study examined the use of extra-medical medications for opioid use disorder (EM-MOUD) — meaning buprenorphine or methadone obtained outside of a formal prescription or dispensing program — among urban adults who inject drugs and are already receiving prescribed MOUD. Researchers found an 18% person-level prevalence of EM-MOUD use, with higher likelihood among those reporting polysubstance use, injection drug use, withdrawal sickness, recent incarceration or homelessness. Among methadone recipients, longer treatment duration (six or more months) was associated with lower EM-MOUD use, while dose was not a significant factor. For buprenorphine recipients, those prescribed higher doses were more likely to report EM-MOUD use, though treatment duration was not associated with a difference. The findings highlight the complexity of MOUD engagement among people with high social vulnerability and underscore the need for patient-centered approaches to treatment retention.

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Geographic Availability and Use of Medications for Opioid Use Disorder Among Medicaid Enrollees



A cross-sectional study of approximately 8 million Medicaid enrollees across 10 states examined whether racial and ethnic disparities in MOUD use are tied to geographic availability of treatment. Researchers found that greater availability of methadone and naltrexone was associated with increased use among non-Hispanic white enrollees but not among non-Hispanic Black or Hispanic enrollees — suggesting that proximity to treatment alone does not translate equally across populations. Buprenorphine availability was not associated with differential use by race or ethnicity. These conclusions indicate that expanding geographic access to MOUD is a necessary but insufficient strategy for closing treatment gaps, and that structural and systemic barriers must also be addressed to achieve equitable care.

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Policy and Payment Factors Influencing Adoption of Low-Barrier Buprenorphine Treatment

A qualitative study of 28 clinicians and staff from outpatient buprenorphine programs in Philadelphia explored how policy and payment structures influence OUD treatment practices. Participants identified insurance coverage, reimbursement rates, payer policies and licensure requirements as major drivers of clinical decision-making, often in ways that conflicted with low-barrier, harm reduction-aligned care. Many programs relied on supplemental funding to serve uninsured patients, and payer-imposed requirements such as prior authorizations and attendance-based reimbursement were cited as barriers to timely and individualized treatment. Reforming reimbursement structures, reducing administrative burdens and aligning regulatory frameworks with evidence-based care could meaningfully improve buprenorphine access and retention for patients with OUD.

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Collaborative Care Intervention for Risky Opioid Use Among Primary Care Patients: The STOP Randomized Clinical Trial



A cluster randomized clinical trial tested a collaborative care intervention for primary care patients engaging in risky opioid use who did not meet criteria for moderate or severe OUD. The intervention combined brief advice from primary care providers, nurse care manager interactions and remote health coaching. While the study did not find a statistically significant difference in mean days of risky opioid use between groups, participants in the intervention group had notably lower rates of moderate-to-severe OUD at both six and 12 months. High-risk prescription opioid use declined in both groups but was significantly lower in the intervention group at 12 months. These results suggest collaborative care models in primary care settings may help reduce opioid-related harm and prevent progression to OUD among high-risk patients.

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