Nowhere to go? Examining facility acceptance levels for serving individuals using medications for opioid used disorder.

Medications for opioid use disorder (OUD) are associated with better overall outcomes for individuals managing their OUD. While much attention has focused on expanding access to these medications, this study aimed to gain further clarity on how facility-level characteristics may be contributing to availability of complementary recovery-oriented and/or recovery support services for individuals diagnosed with OUD. We created a census of 410 facilities located within a Midwestern metropolitan area that provided services aligning with the substance use disorder (SUD) continuum of care between September 2017 and March 2018. Among facilities serving individuals with opioid-related needs (N = 360), we triangulated five sources of data to measure facility-reported acceptance for individuals who are using medications for OUD. We also obtained facility rationale for their acceptance level (N = 89). We used multinomial logistic regression to identify facility-level factors associated with acceptance for medication use, and we used content analysis to identify categories of common rationales. Compared to moderate acceptance facilities, zero and low acceptance facilities were more likely to provide recovery support services or less likely to provide more than one type of SUD service. In contrast, high acceptance facilities were more likely than moderate acceptance facilities to focus primarily on mental health needs or provide multiple types of SUD services. Qualitative feedback suggests that the factors contributing to these relationships are complex and varied, providing multiple points for intervention at a facility level to increase service availability for individuals using medications for OUD. We address implications for policy and practice, highlighting the need to build an infrastructure that promotes availability of complementary recovery-oriented and recovery support service for individuals once they are prescribed medications for OUD.