MOUD engagement patterns and their association with substance use severity at three years

Medications for opioid use disorder (MOUD) are among the most effective treatments for opioid use disorder (OUD), yet real-world patterns of use vary widely. This study examined whether stability or variability in MOUD engagement was associated with differences in substance use severity after three years of recovery. Participants (N = 88) were drawn from the Long-Term Recovery Project, a longitudinal study of individuals with OUD. MOUD use patterns were categorized as stable use, stable non-use, one MOUD change, or two or more changes. A one-way ANOVA revealed significant group differences in substance use severity at 36 months, F(3, 84) = 4.78, p = .004, η² = .15. Post-hoc tests indicated that participants with two or more MOUD changes had significantly higher severity scores than those with stable non-use. These findings suggest that greater instability in MOUD use may correspond to poorer long-term recovery outcomes.